Dual Diagnosis: Moving Toward Recovery

  1. Home
  2. /
  3. Mental Health
  4. /
  5. Dual Diagnosis: Moving Toward Recovery

Passed Out | Dual Diagnosis | The Hills

Struggling with drug addiction would be challenging enough for most people, but juggling an addiction and a mental illness takes things up a notch. If you, or a loved one, has received a ‘dual diagnosis,’ don’t panic. It’s true that the road to recovery can be rocky, but if you’re open to making a change, your prognosis can be quite positive. 

However, it’s important to understand how your drug use can impact your mental illness, and vice versa. In this post, we’ll explore the complexities of dual diagnosis and provide a breakdown of what a quality dual diagnosis rehab program looks like. Along the way,  we’ll give you a rundown of the types of therapy you’ll find on offer. We’ll also explore the potential physical effects of dual diagnosis so you can get out ahead of them. Let’s get started. 

What is Dual Diagnosis?

Put simply, dual diagnosis is a label applied to individuals suffering from substance abuse while at the same time experiencing a mental illness. 

Here are a few possible examples: 

  • Pain killer abuse while struggling with a schizophrenia diagnosis 
  • Cocaine addiction while in the throes of bipolar disorder 
  • Problematic alcohol abuse while suffering depression 

Dual diagnosis is so vexing because the drug abuse can exasperate the mental illness, or vice versa.  For instance, An individual struggling with bipolar disorder may experience more severe symptoms if they indulge in heroin use during periods of mania. The drug abuse provides a temporary ‘high,’ but there are long term consequences—consequences that the individual may not consider while in the throes of a manic episode. 

Either substance abuse or mental illness can manifest first. An individual experiencing a mental health crisis may turn to controlled substances as a form of self-medication. But the benefits gained from substance abuse are, as mentioned, temporary. However, dependence can develop. Once that happens, the individual can enter into a self-destructive downward spiral that may require the intervention of a qualified mental health professional. 

As you can see, dual diagnosis is a very broad category. Consequently, broad advice for individuals struggling with this condition may not be particularly helpful. We can, however, endeavor to outline several best practices with dealing with this trying diagnosis. See the following sections for advice on evaluating treatment programs. 

How Prevalent is Dual Diagnosis? 

Roughly one third of individuals experiencing mental illness develop dependence on a controlled substance. What’s more, roughly half of people experiencing severe mental illness experience substance abuse. In short, dual diagnosis is quite common. 

As you might expect, these statistics are found in the substance abuse community as well. Around a third of alcohol abusers suffer from a mental illness. In the same vein, around half of all drug abusers struggle with mental illness. Men are more likely than women to be diagnosed.  But, in general, individuals of a low socioeconomic status are at elevated risk, as are military veterans. 

What is the Cause? 

There is no one cause. However, what is known is that the more severe the underlying mental illness, the more at risk the individual is. That is to say, the more sever the mental illness, the more likely they are to experiment with—and become dependent on—controlled substances

Complicating matters further is the fact that some substances, such as nicotine, alcohol and heroin, are inherently addictive. These drugs affect the brain’s reward center, and abusing them often results in dependency. 

Overall, the most commonly abused drug is alcohol, followed by marijuana and cocaine. However, it’s possible that alcohol’s popularity is primarily due to its availability relative to other drugs. Males aged 18-44 are at the greatest risk of dual diagnosis. However, adolescents with severe behavioral problems are many times more likely than their peers to have abused alcohol or drugs. 

The bottom line: substance abuse complicates almost every aspect of care for a person with mental illness. 

What are the Symptoms of Dual Diagnosis? 

Dual diagnosis requires the patient to have been previously diagnosed with a mental illness. Therefore, symptoms of said mental illness are insufficient to apply the label of dual diagnosis to the individual. In general, dual diagnosis requires that the patient also struggle with a substance abuse disorder. Further, symptoms of the mental illness and substance abuse should occur simultaneously. 

To gain a better understanding of dual diagnosis, let’s separate common symptoms of mental illness from dual diagnosis itself. 

What are the Symptoms of Mental Illness? 

Mental illnesses are also referred to as mental health conditions. These are disorders that affect your mood, your ability to think clearly, and your behavior. Naturally, the symptoms of a mental health condition can vary widely. Examples of common mental illnesses include: 

  • Anxiety disorders 
  • Schizophrenia 
  • Depression 
  • Bipolar disorder 
  • Eating disorders 

Each of these mental illnesses can have their own symptoms. Note that most people have mental health issues from time to time. But when mental health issues become so frequent that they cause significant stress or hamper your ability to function, then you should seek the aid of a mental health professional. 

An undiagnosed mental illness can sap your zest for life and can even lead to thoughts of suicide. If you suspect that you have a mental illness, please do not hesitate to seek help. 

Below are general symptoms of mental illness. A given mental illness may have additional symptoms. 

  • Often feeling sad, down, or depressed
  • Feeling sad, down or depressed and being unable to articulate why you feel that way 
  • Reduced ability to concentrate 
  • Fragmented thoughts 
  • Confused thinking 
  • Involuntary or compulsive thoughts 
  • Racing thoughts 
  • Experiencing an ‘adrenaline rush’ with no clear cause 
  • Excessive fear, anxiety or worries 
  • Compulsive or risky behaviors 
  • Extreme mood swings 
  • Withdrawal from friends and family that lasts for more than a few days or that occurs often 
  • Significant fatigue that isn’t alleviated by sleep or that returns shortly after waking 
  • Delusions, or detachment from reality 
  • Frequent paranoia 
  • Hearing voices 
  • Trouble relating to other people 
  • Inability to cope with daily, ordinary stresses 
  • Significant changes in eating habits 
  • Major changes in sex drive 
  • Excessive or irrational anger 
  • Inability to moderate the use of alcohol or other substances 
  • Suicidal thoughts 

As you peruse the next list, you’ll notice that some of these overlap. This is because mental illness and drug abuse can intertwine and feed off of one another. 

Symptoms of Concurrent Mental Illness and Substance Abuse 

Symptoms can vary widely. But, in general, you may see: 

  • Withdrawal from friends and family 
  • An intense, lingering feeling of shame, guilt or worthlessness that may lead to self-destructive behavior
  • Increased tolerance of risky, potentially dangerous behavior—engaging in behaviors you would usually find unsavory
  • Sudden changes in behavior 
  • Willingness to use substances even in dangerous or unsanitary conditions 
  • Loss of control over consumption 
  • Increased willingness to harm others in order to secure the substance—lessening of empathy 
  • Developing tolerance of the substance so that more is required to achieve the same high 
  • Feeling like you need the drug in order to function 
  • Suicidal thoughts 

Now, let’s turn our attention to the impacts of dual diagnosis on physical health. 

Physical Health & Dual Diagnosis 

The physical health of individuals struggling with dual diagnosis may be neglected for a variety of reasons. Consequently, these folks may suffer from several physical conditions. For instance, individuals struggling with schizophrenia or bipolar disorder as well as substance abuse may suffer from: 

  • Poor hygiene, which can lead to various other health issues 
  • Unexplained bruising, small cuts and other wounds 
  • Weight gain 
  • Abdominal obesity 
  • Diabetes 
  • Metabolic syndrome 
  • Cardiovascular disease 

According to the National Institute for Health and Clinical Excellence, individuals suffering from a major mental illness should receive routine physical health checks. If you also struggle with substance abuse, these physical checks are doubly important. Different types of drugs affect the body in different ways, and these effects can vary from person to person. It’s possible, therefore, that one person may show physical deterioration while another does not. Don’t rely on others as a barometer of a drug’s effect on the body. 

Additionally, illegal drugs are not manufactured to the exacting specifications that actual medications are. Consequently, the quality and strength of these substances may vary from dose to dose and from source to source. When an individual finds that they’re no longer able to get high from a dose they’re accustomed to, it’s common for them to seek a new source. But if that source is significantly stronger than they expect, overdose can occur. 

What’s more, drug abuse can have a wide range of short, mid and long term effects. Any of these effects can in turn affect your mental illness. Regarding physical effects of drug abuse, a few possible short-term effects are: 

  • Changes in appetite resulting in weight loss or gain 
  • Wakefulness that may interfere with ability to get adequate rest 
  • Adrenal stress 
  • Increased heart rate 
  • Elevated blood pressure 
  • Stroke 
  • Heart attack 
  • Overdose and death 

It’s also worth noting that narcotics like cocaine or amphetamine can cause psychosis. 

Possible long-term effects of drug abuse include: 

  • Heart disease 
  • Lung disease 
  • Liver failure and/or hepatitis 
  • Cancer 
  • HIV/AIDs

Not everyone who uses a drug will become dependent. But for some individuals, drug use can change how the brain works. This can compound any existing mental illness. These changes to the brain can make it harder to stop taking a drug, even when it’s apparent that the drug is making a mental illness worse. This, in turn, can lead to poorer physical health. 

Dual Diagnosis Rehab Programs 

Therapy | Dual Diagnosis | The Hills

Treating only the mental illness is often ineffective. The reverse is also true. Treating only the addiction often leads to relapse. The best treatment for dual diagnosis is comprehensive rehabilitation that takes a holistic approach. Both the mental illness and the addiction must be treated at the same time by a team of qualified mental health professionals. These integrated programs arose in the 1980s and have been shown to be quite effective. 

Dual diagnosis rehab programs are designed to help individuals cope with concurrent mental illness and drug addiction. These programs tend to focus more on freeing individuals from the grip of addiction as doing so can often lessen symptoms of mental illness. After all, removing addiction from the equation and all the complications it introduces can help an individual better cope with mental illness. 

Dual diagnosis rehab programs typically treat individuals with major mental illnesses such as schizophrenia, bipolar disorder, anxiety disorder and depression. As you might expect, treatment differs from standard drug addiction treatment. For one thing, in order to overcome addiction, patients must gain insight into how their mental illness feeds on, and is in turn fed by, the addiction. Treating only the addiction is often not enough and may result in relapse, particularly if the mental illness involves periods of psychosis, paranoia or self-destructive impulses. 

Therefore, an important aspect of dual diagnosis recovery is finding a program that treats the patient as an individual. In a good program, counselors come to understand how the patient’s particular mental illness influences their dependence. Counselors and doctors can then work with the patient to provide a structured, individualized treatment plan. A quality program will involve: 

  • Initial assessment. Identifying the mental illness and the substances being abused. Analysis of how the drug influences the mental illness and how the mental illness in turn influences the drug abuse. 
  • Temporary hospitalization if necessary. For instance, IV therapy may be required to treat underlying nutritional differences. Micro-nutrient deficiency can exasperate withdrawal symptoms and can make symptoms of mental illness worse. 
  • Detox. Removal of the substance from the body through monitored abstinence. Symptoms of the mental illness will be monitored during this period as well. 
  • Therapy. The patient is introduced to various therapy models, such as cognitive behavioral therapy. These models can help them cope with cravings and/or mental illness symptoms. 
  • Aftercare. The patient is provided with a support network and other resources aimed at preventing relapse. 

In the therapy phase, individuals are often introduced to: 

  • CBT. Cognitive behavioral therapy is a type of therapeutic treatment that gives patients insights into how their habitual thoughts can impact, or even direct, their behavior. Learning to recognize cognitive distortions can reduce the urge to use or abuse drugs. 
  • DBT. Dialectical behavior therapy is a special type of CBT that focuses on teaching patients to recognize habitual thoughts that may lead to suicidal impulses or self-destructive behaviors. DBT can, over time, help patients recognize thought patterns that trigger drug abuse. 
  • SI. Sensory integration therapy helps patients better interpret sensations. Over time, structured SI practice will help patients react more productively to stimuli. Certain mental illnesses, such as schizophrenia, cause patients to misinterpret environmental stimuli. As you might expect, drug abuse makes this worse. 

Of particular importance to lasting recovery is aftercare. Social support provides a buffering, or insulating, effect for those with dual diagnosis. Attending support meetings, for instance, can help affected individuals avoid relapse. When suffering mental illness, it is common for individuals to feel as if there’s no one who understands their struggles. It can be extremely beneficial, therefore, to realize that there are others out there who do understand. Sharing dreams, goals, aspirations and inspirations with others can act as a sort of armor against relapse. 

In addition, many individuals have benefited from becoming a mentor to someone else. This sort of social contract can provide tremendous motivation to avoid problem substances. 


In this post, we explored the complex and interdependent relationship between mental illness and drug abuse. We covered the symptoms of both, and we made a foray into the potential physical effects of dual diagnosis. You should now have a clearer understanding of what dual diagnosis rehab programs have to offer, and why such specialized programs are preferred over standard rehab programs. 

If you or someone you know needs help with their dual diagnosis or launching forward on the complex path to recovery, consider reaching out to The Hills today. Find out what our facility can do to help you!

Related posts