Dual Diagnosis: Addiction And Mental Health
- What Are Co-Occurring Disorders?
- Disorders With Addiction
- How Common Is A Dual Diagnosis?
- Signs Of Co-Occurring Addiction
- Risks And Challenges
- Treatment Methods
- Where To Find Care
Many people with addictions also deal with a co-occurring mental health condition. Common conditions include anxiety, mood disorders, stress-related conditions, neurodevelopmental disorders, and personality disorders. There are several addiction care options that treat co-occurring disorders.
In recent years, society has gained a better understanding of addiction and substance use disorders.
While many people still erroneously believe that addiction is a simple lack of willpower, others now understand what experts have known for years: that addiction is a mental health condition.
As a mental health condition, addiction often occurs alongside other mental health conditions. When they appear alongside addiction, these conditions are called co-occurring disorders.
What Are Co-Occurring Disorders?
Co-occurring disorders, or dual diagnoses, are mental health conditions that occur at the same time.
The exact connection between mental health conditions and addiction is unclear, but it is not unusual for specific mental illnesses to occur in the same person.
For example, many people with depression also have anxiety, and vice versa. Likewise, autism and ADHD often appear together.
Part of the connection between mental health conditions and substance abuse may come from seeking symptom relief.
Some people with depression, for instance, may self-medicate with alcohol or drugs. These substances can, in turn, worsen the depression and create a vicious cycle.
Below, we will discuss disorders that frequently occur together, as well as ways you may identify the signs and symptoms of these conditions in yourself or someone you love.
Most Common Co-Occurring Disorders With Addiction
Any mental health condition may occur with a substance use disorder, but some conditions occur more often than others.
Addiction And Anxiety Disorders
Anxiety disorders are some of the most common mental health conditions in the United States. Many people who deal with anxiety also deal with substance abuse.
Learn more about anxiety disorders and addiction.
Addiction And Generalized Anxiety Disorder (GAD)
Generalized anxiety disorder (GAD) is sometimes simply called “anxiety.”
Some of the most common symptoms of GAD include:
- excessive worry
- unexplained feelings of dread
- insomnia and other sleep problems
- physical symptoms such as headaches or stomach aches
- chest tightness
- difficulty concentrating
Some people with GAD may use substances to experience symptom relief, especially if they do not have access to quality mental healthcare.
However, both types of drugs can cause rebound anxiety, which is worsening anxiety that arises after the substances wear off.
Find more information on the connection between generalized anxiety disorder and substance use.
Addiction And Social Anxiety Disorder
Social anxiety disorder is a form of anxiety that causes symptoms during social situations.
A person with social anxiety may experience excessive fear during parties, gatherings, and other events that involve several people.
They may go to great lengths to avoid social interactions, or they may find themself unable to relax during social gatherings.
Some people deal with social anxiety by drinking alcohol, which is often present at parties and events. Eventually, they may come to rely on alcohol to get through social situations.
Some may also use drugs that increase the desire to socialize. Stimulant drugs, for example, can increase a person’s social energy.
The hallucinogenic drug MDMA (molly) is also known for its use in social situations. People report feeling a sense of camaraderie when using it.
Read more about co-occurring social anxiety and substance use disorder.
Addiction And Panic Disorder
Panic disorder is characterized by short, intense bursts of anxiety called “panic attacks.”
Panic attacks may cause feelings of fear and dread, as well as physical symptoms such as a racing heart. Some have described panic attacks as a feeling that is similar to heart attacks.
Benzodiazepines are one type of drug commonly prescribed for panic attacks. Benzodiazepines work quickly to calm panic, but these drugs are also highly addictive.
It is possible for a person to become dependent on these drugs, especially if they misuse them.
Learn more about panic disorder and addiction.
Addiction And Obsessive-Compulsive Disorder (OCD)
Obsessive-compulsive disorder (OCD) is an often misunderstood anxiety disorder.
People with OCD experience obsessions (repetitive thoughts) that lead to compulsions (repetitive behaviors).
OCD is often associated with obsessive cleaning, but not every person with OCD has a cleaning compulsion.
Other common OCD obsessions include symmetry, safety, routine, counting, and patterns.
People with OCD may sometimes use drugs or alcohol to seek relief from these constant compulsory behaviors.
Furthermore, using drugs or alcohol can become an OCD compulsion. This compulsion can quickly become an addiction.
Keep reading about obsessive-compulsive disorder and substance abuse.
Addiction And Stress-Related Disorders
Stress disorders occur after a person has experienced a traumatic event or a series of traumatic events.
Similar to anxiety disorders, stress disorders can cause fear, dread, and avoidance. They can also cause insomnia, flashbacks, a heightened startle response, and other distressing symptoms.
Below are some of the most common stress disorders co-occurring with addiction.
Addiction And Post-Traumatic Stress Disorder (PTSD)
Addiction is a highly common issue among people with post-traumatic stress disorder (PTSD). PTSD is a long-term condition that may arise after a person has experienced trauma.
This disorder is commonly associated with veterans, but civilians may experience PTSD as well. Scenarios such as assaults, natural disasters, and accidents can all cause PTSD.
Find more about co-occurring PTSD and addiction.
Addiction And Acute Stress Disorder (ASD)
Acute stress disorder (ASD) is similar to PTSD. However, ASD refers to the short-term symptoms of trauma rather than the long-term symptoms. These symptoms occur immediately after the traumatic event.
ASD symptoms can include:
- mood swings
- breathing difficulties
- difficulty concentrating
Drugs and alcohol are sometimes used as a means of self-medication for this disorder.
Learn more about the link between acute stress disorder and addiction.
Addiction And Mood Disorders
Some disorders primarily affect mood, and these disorders often occur alongside addiction.
In fact, according to research on co-occurring conditions, mood disorders are some of the most common disorders that coincide with substance use disorders.
While many drugs create an immediate euphoric high, long-term drug use can lead to mental health struggles such as depression.
Likewise, depression and other mood disorders may cause people to seek relief through drugs and alcohol.
Learn more about mood disorders and addiction.
Addiction And Depression
Depression is a mood disorder that is commonly seen in people who also have anxiety. People with depression often deal with intense sadness, lethargy, hopelessness, and apathy.
While the exact link between depression and addiction is unclear, some experts believe that these two disorders reinforce one another.
Addiction And Bipolar Disorder
Bipolar disorder is a condition that includes alternating periods of depression and mania.
During depressive episodes, a person with bipolar disorder may experience all of the depressive symptoms listed above.
During manic episodes, the same person can experience high energy levels, euphoria, and hyperactivity. Some people experience psychosis during manic episodes.
Manic episodes often include poor impulse control and risk-taking behaviors, which may contribute to addiction in people who have bipolar disorder.
A person may impulsively use addictive drugs while in a manic state, which can then lead to long-term substance abuse.
Discover more about bipolar disorder and addiction.
Addiction And Neurodevelopmental Disorders
Neurodevelopmental disorders are conditions that originate from non-typical brain development. These conditions can impact thought patterns, behaviors, and communication.
Addiction And Attention Deficit Hyperactivity Disorder (ADHD)
People with attention deficit hyperactivity disorder (ADHD) are more vulnerable to addiction than the general population.
ADHD is a complex disorder with multifaceted symptoms. It is divided into three types.
The three types of ADHD are:
- inattentive type: a non-hyperactive form of ADHD that impacts focus, motivation, and task completion
- hyperactive type: a form of ADHD that includes attention difficulties, poor impulse control, and high energy levels
- combination type: a form of ADHD that combines elements of the inattentive type and the hyperactive type
ADHD is caused by low levels of dopamine in the brain. Dopamine plays an important role in maintaining focus and motivation.
Many types of drugs, particularly stimulants, increase the brain’s dopamine supply. As a result, some people with ADHD may self-medicate with illicit stimulants like meth or crack cocaine and become addicted.
Poor impulse control may also contribute to addiction, as somebody with ADHD may use drugs without considering the consequences of doing so.
However, illicit stimulant use should not be confused with legal, prescribed stimulant use for ADHD, which can relieve symptoms and help people avoid seeking symptom relief elsewhere.
Learn more about ADHD and addiction.
Addiction And Autism
Autism is a condition that impacts how people behave and communicate. Autistic people may struggle with social cues and have deep, specific interests.
Autism includes a broad collection of traits that impact each autistic person differently.
Researchers have seen mixed results when studying the connection between addiction and autism.
Addiction And Tourette Syndrome
Tourette syndrome causes sudden and involuntary movements, or tics. Tics may include motor movements and vocalizations.
The severity of Tourette syndrome varies between individuals. While some people experience mild tics, others have more severe tics that can include multiple muscle groups.
According to Tourette syndrome and addiction research, there is a genetic link between the two disorders.
The same genes that impact Tourette syndrome may also play a part in a person’s risk of addiction.
Learn more about risk factors for Tourette syndrome and addiction.
Addiction And Personality Disorders
Personality disorders are disorders that impact how people think, respond emotionally, and interact with other people.
Personality disorders result in thoughts, emotions, and behaviors that cause distress.
Research suggests that people with personality disorders have higher rates of substance abuse disorders than the general population.
Addiction And Schizophrenia
Schizophrenia is a rare disorder that impacts how people view reality. It causes hallucinations, delusions, and thought distortions that impair day-to-day functioning.
It also has a strong link to substance abuse. According to schizophrenia research, about 47% of people with schizophrenia also have a substance use disorder.
Some experts believe that the same structural brain changes that contribute to schizophrenia may also contribute to addiction.
For example, brains with schizophrenia generally have less control over the amygdala, which is the part of the brain that processes fear. A similar issue has been associated with addiction.
Discover more about people with co-occurring schizophrenia and substance use disorder.
Addiction And Antisocial Personality Disorder (APD)
Antisocial personality disorder (APD) causes a disregard for other people. It is sometimes called “sociopathy.”
Signs of APD can include:
- not caring about right or wrong
- lack of empathy or remorse
- disregard for the rights, needs, and feelings of others
- aggression toward others, including animals
- manipulating others
- persistent law-breaking
- inability to learn from consequences
- inability to fulfill obligations
Substance abuse is very common among people with APD. APD research says that 90% of people diagnosed with APD also have a substance use disorder.
However, these numbers can be difficult to quantify, as people with APD are highly unlikely to seek mental health treatment on their own.
APD may result in substance use for several reasons.
For instance, because people with APD cannot fully understand the consequences of their actions, they may not grasp why substance use can lead to addiction.
Likewise, the persistent disregard for others might make a person with APD ignore social rules about drinking, drugs, and moderation.
Learn more about antisocial personality disorder and substance abuse.
Addiction And Borderline Personality Disorder (BPD)
Borderline personality disorder (BPD) is a condition that results in unstable moods and behaviors.
People with BPD struggle to regulate their emotions, and that struggle can impact how they interact with others and maintain relationships.
This disorder causes intense mood swings, which can influence how people with BPD view themselves and other people.
BPD causes people to make impulsive decisions based on their moods, and those decisions often involve reckless behavior.
When that reckless behavior includes substance abuse, it can lead to addiction.
Find more information on the link between borderline personality disorder and addiction.
Addiction And Narcissistic Personality Disorder (NPD)
Narcissistic personality disorder is characterized by an extremely heightened sense of self.
People with NPD believe that they are highly important people, and they cannot tolerate anything that may challenge that belief.
Some signs of narcissistic personality disorder include:
- an excessive need for attention, admiration, and praise
- excessive feelings of entitlement
- perceiving other people as inferior
- surrounding oneself with people who serve their ego
- bragging about achievements and skills
- extreme exaggerations
- taking advantage of others or seeing other people as a means to an end
- a lack of empathy
- intense mood swings and rage over perceived slights
This disorder, like APD, often causes a disregard for social rules and the rights of others.
For someone with NPD, this disregard comes from the belief that they are too important to adhere to these rules.
As a result, NPD may cause a person to take unnecessary risks, some of which may include using drugs and alcohol.
Keep reading about narcissistic personality disorder and addiction.
Addiction And Eating Disorders
Eating disorders are mental health conditions that impact people’s relationship with food. Two of the most common are anorexia and bulimia, both of which stem from a negative self-image.
Anorexia causes highly restrictive eating patterns. People with anorexia may avoid food entirely or severely limit their food intake.
Bulimia causes people to eat large amounts of food and then purge the food shortly afterward, either by inducing vomiting or taking laxatives.
There are several connections between substance abuse and eating disorders.
Some common links between these disorders include:
- effects of alcohol: Some people avoid food so they can drink alcohol on an empty stomach, thus heightening the effects.
- self-medication: Many people with eating disorders also deal with intense anxiety over their appearance or body dysmorphia. Some may use drugs and alcohol as a way of self-medicating that anxiety.
- appetite suppressants: Stimulant drugs such as methamphetamine and cocaine can cause weight loss by suppressing appetite. People with eating disorders may use these drugs as a way to further restrict calories.
How Common Is A Dual Diagnosis?
According to research from the National Alliance on Mental Illness (NAMI), more than half of people with an addiction also have another mental health condition.
Likewise, mental health disorders may increase a person’s risk of developing an addiction.
According to the research above, roughly one-third of people with a mental health condition also deal with addiction.
Signs Of Co-Occurring Addiction And Mental Health Disorders
Signs of addiction often overlap with signs of other mental health conditions.
For example, insomnia and lethargy are both common symptoms of depression and substance abuse, even when these conditions do not overlap.
However, when a person deals with both substance abuse and another condition, the two conditions may reinforce one another and cause more pronounced symptoms.
Some signs of addiction and co-occurring disorders may include:
- sleep disturbances (insomnia, hypersomnia, or nightmares)
- personality changes
- social changes (isolation or switching friend groups)
- using drugs or alcohol as a coping mechanism
- loss of interest in previously enjoyed activities
- poor hygiene
- weight changes (extreme loss or gain)
- risky, erratic, or aggressive behavior
- energy changes (lethargy or hyperactivity)
- worsening symptoms of previously diagnosed mental health conditions
- poor cognition
Risks And Challenges Of Co-Occurring Disorders
The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends that healthcare providers screen for other mental health conditions while treating substance use disorders.
SAMHSA notes that people with co-occurring conditions are more likely to be hospitalized than people with just one condition.
Co-occurring conditions present risks and complications during the treatment process, but understanding these disorders can help treatment providers offer the most effective care.
One notable complication is the risk of drug or alcohol relapse due to unaddressed underlying causes.
For example, if a person has anxiety and an opioid use disorder, that person may be using opioids as a way to cope with the anxiety.
If that person’s addiction treatment never addresses the anxiety, that person may experience a relapse if they don’t learn tangible ways to manage their condition.
Treatment Methods For Dual Diagnosis Recovery
People with co-occurring conditions have several treatment options to help with substance abuse recovery.
The best treatment options depend on the individual, their diagnoses, and their circumstances.
Some of the most effective behavioral techniques for co-occurring addiction and mental illness include:
- cognitive behavioral therapy (CBT): a type of therapy that teaches how to recognize and address distorted thought patterns
- dialectical behavioral therapy (DBT): a skills-based therapy with an emphasis on distress tolerance skills
- motivational interviewing (MI): a therapy technique that begins with identifying goals
- eye movement desensitization and reprocessing (EMDR): a type of therapy that uses mechanical movement to help participants process trauma
Where To Find Dual Diagnosis Care
Rehab centers throughout the United States provide dual diagnosis care.
For example, many New England rehab centers have earned high ratings due to their understanding of co-occurring conditions.
Some available levels of care that typically offer dual diagnosis treatment include:
- inpatient rehab: residential drug abuse treatment
- outpatient rehab: programs that provide therapy in a non-residential setting
- aftercare: long-term maintenance treatment after intensive rehab ends
- detox: medical care and support during the phase of recovery when drugs leave the body
Dual Diagnosis FAQs
All mental health conditions, including addictions, are complex. When these conditions overlap, they can cause additional complications.
Many people have questions about dual diagnoses and what to do about them. Here you’ll find answers to some of the most common questions.
What Is The Best Treatment For Dual Diagnosis?
The best treatment varies from person to person, as each person has different needs, diagnoses, and circumstances.
However, the best dual diagnosis care will address both the addiction and the co-occurring disorder in an individualized setting.
What Is The Difference Between Co-Occurring Disorders And Dual Diagnosis?
Often, the terms “co-occurring disorder” and “dual diagnosis” are used interchangeably in addiction care.
A dual diagnosis refers to any two conditions that exist within the same person. A co-occurring disorder almost always refers to addiction and another mental health condition.
Which Mental Disorder Most Commonly Co-Occurs With Alcoholism?
Many people with an alcohol use disorder also have another mental health condition.
The exact numbers are difficult to quantify, but some of the most common co-occurring conditions include depression, anxiety, and bipolar disorder.
Is Gambling A Concurrent Disorder?
Gambling can become a behavioral addiction, or an addiction to a specific action rather than a substance.
Many experts view gambling as a concurrent disorder when it occurs alongside substance abuse.
Substance abuse therapy may also help with gambling addictions, as people can use the same coping skills when dealing with both types of addiction.
What Are The 5 Most Common Co-Occurring Mental Disorders?
Sources are divided on the exact numbers, but some experts say that the five most common co-occurring mental disorders are:
- generalized anxiety disorder
- bipolar disorder
However, rates of addiction vary depending on the drug.
Why Is It Important To Treat Co-Occurring Disorders?
Addiction can worsen other mental health conditions and vice versa.
If addiction is caused by another condition, addressing that condition can help the person increase their chance of a successful recovery.
Is Dual Diagnosis Treatment Available In Massachusetts?
Dual diagnosis treatment is available in Massachusetts. Several rehab centers in Massachusetts are equipped to address both addiction and other mental health issues.
Dual Diagnosis Treatment At Spring Hill Recovery Center
Addiction is a difficult disorder on its own, but a co-occurring disorder can make recovery even more complex.
Fortunately, the right addiction care treatment can help people deal with both and regain control of their mental health.
Spring Hill Recovery Center is a Massachusetts rehab facility that offers several levels of substance abuse treatment.
If you or a loved one may need help to overcome an addiction, contact our helpline today and begin the healing journey.
Written by Spring Hill Editorial Team
©2022 Spring Hill Recovery Center | All Rights Reserved
This page does not provide medical advice.
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- Mayo Clinic — Narcissistic Personality Disorder https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/symptoms-causes/syc-20366662
- Mayo Clinic — Obsessive-Compulsive Disorder (OCD) https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432
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- National Institute Of Mental Health — Borderline Personality Disorder https://www.nimh.nih.gov/health/topics/borderline-personality-disorder
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