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Dual Diagnosis: What’s the Connection? 

Dual Diagnosis, or co-occurring disorders, is when a person simultaneously experiences a mental illness and a substance abuse disorder. Symptoms of one disorder trigger the other.


While either can develop first, by far the most common issue is the person begins using to self-medicate, thereby eliminating the discomfort brought on by their mental illness. For a time, the person may feel less anxious or have fewer depressive episodes. But, it does not last. In fact, the substance abuse will only facilitate the mental illness returning even stronger.

Undiagnosed mental illness can lead to substance abuse as the person tries to treat the symptoms of the mental condition, self-medicating. A person who has received a mental illness diagnosis is often prescribed medication that has unpleasant side effects. The person may begin to abuse other drugs to mitigate those effects.

Chronic drug abuse alters the chemicals in the brain that control mood and other behaviors. These alterations can lead to mental health issues that the addict then treats with other drugs. For those who are already at risk for mental illness due to genetics and/or traumatic experiences drug abuse increases that risk.

Drugs and alcohol do nothing to address the underlying mental health symptoms. The reality is they create a whole new batch of problems for the person who is struggling and will increase the severity of the original mental health symptom(s).

Substance abuse often creates problems that trigger mental health symptoms. In some cases, substances can create mental health symptoms while the person is under the influence. When these symptoms last after the drugs wear off, then it can indicate a co-occurring mental health disorder.

Here are a few examples of triggered events:

  • Substance abuse increases the chances of becoming a victim of assault or rape. These traumatic events can create serious mental health issues like PTSD, depression, eating disorders and more.
  • Poor decision-making is common under the influence, and patients may make choices that cause them to struggle with mental health issues, such as anxiety, in addition to drug addiction.
  • Depression is a common effect of certain drugs like crystal meth and alcohol as they begin to wear off, and, over time, it will worsen and become a mental health disorder.
  • People who abuse drugs or alcohol often have unprotected sex or share needles with people infected with HIV or hepatitis C. This can lead to the contraction of the disease, which in turn can result in a struggle with depression and grief over the life damaging consequences.

Mental illness is common among those suffering from substance abuse and addiction. The relationship is so strong that many people believe the drugs play a formative role in the development of the mental illness. In most instances, this is not the case.

In the United States, approximately 8.9 million people have BOTH a mental health and a substance abuse issue.

The National Bureau of Economic Research (NBER) reports: “There is a definite connection between mental illness and the use of addictive substances. Individuals with an existing mental illness consume roughly 38 percent of all alcohol, 44 percent of all cocaine, and 40 percent of all cigarettes. Furthermore, the people who have ever experienced mental illness consume about 69 percent of all the alcohol, 84 percent of all the cocaine, and 68 percent of all cigarettes.”

There’s clearly a connection between substance abuse and mental health disorders, and any number of combinations can develop. Each combination has its own set of unique causes and symptoms, knowing these will help a person get the treatment that is appropriate for their separate, yet connected, diagnoses.