What is Dual Diagnosis and How Does it Happen?

Substance use disorder and mental health issues often deliver a one-two punch—occurring at the same time for people who could really use a break.

Or, to borrow another cliche, these dual diagnoses kick folks while they’re already on the ground.

What’s up with that? Why do we see a prevalence of co-occurring mental health and substance use disorders? What causes these two problems to pair up? And what should we do if we find ourselves, or someone we love, fighting the uphill battle of a dual diagnosis?

Let’s talk about it.

Today we’ll cover the basics of co-occurring disorders, including a working definition and statistics. We’ll discuss which came first—mental health struggles or substance abuse—and the best treatment plan for overcoming both.

What is Dual Diagnosis?

Before we really dive in, let’s deal with the issue of semantics. After all, words matter. When it comes to discussing the struggles of dealing with both a mental health disorder and a substance abuse disorder, you might come across two different terms that apply: dual diagnosis or co-occurring disorder.

Dual diagnosis and co-occurring disorder represent the same medical situation and mean the same thing. Dual diagnosis is a more outdated term, while co-occurring disorder is what you’re likely to see more of in the future. To keep the theme going, we’ll continue using both for our conversation today.

Dual Diagnosis: A Working Definition

So what, exactly, constitutes a co-occurring disorder or dual diagnosis? A person who is struggling with both a mental illness and a substance use disorder at the same time.

Stub your toe the morning after a big leg day at the gym, and you’ve got a symbol for what dual diagnosis can do to a person. First, you hobbled because your thighs ached, and now you’re hobbling and hopping because you just about broke your toe.

A dangerous combination, no doubt.

Co-occurring disorders work much the same way, massively inhibiting a person’s ability to interact with the world around them in a healthy and productive manner.

And it’s not just the piling up of disorders that causes problems. In fact, Psychology Today reports that people with a dual diagnosis often endure more severe versions of each disorder compared with people who only struggle with one thing at a time.

What Studies and Statistics Tell Us About Co-Occurring Disorders

About half of all people with a mental illness will eventually develop a substance use disorder—and vice versa—according to the National Institute on Drug Abuse. The Substance Abuse and Mental Health Services Administration estimates that just under 9 million adults in the U.S. currently fit the description for a dual diagnosis.

Sadly, only about 630,000 of them are expected to get the help they need to treat both conditions.

Let’s add to that number with our growing knowledge, shall we?

What Causes a Dual Diagnosis?

What causes a person to struggle with both mental illness and a substance use disorder?

In this field, we’re careful to point out that people don’t choose addiction or psychiatric struggles, so you can rest assured that no one—and I mean no one—would willingly take on the brutal reality of co-occurring disorders.

So, where do they come from?

You might be wondering which comes first—mental illness or substance misuse—and the answer is that it all depends

After all, a person may drink to calm overwhelming anxiety. Or, he may become overwhelmingly anxious because of how much he drinks. Makes sense, right? Let’s take a look at the science behind how mental health issues and addiction are connected.

Both Sides of a Dual Diagnosis Take Place in the Brain

As VeryWell Mind explains, mental health disorders and substance use disorders are both, at their most basic level, chronic brain disorders. And they both wreak havoc on the same area of the brain.

It’s no wonder that a spot weakened by one disorder may be more susceptible to the other.

Of course, we must also consider each individual’s unique history, specifically as it relates to their genetics, development and environment.

3 Key Factors That Contribute to a Dual Diagnosis

Co-occurring disorders are more likely for people who experience the following contributing factors. As you might guess, a pile of contributing factors makes it that much more likely that a person may face a dual diagnosis at some point in their life. These factors include:

Genetic factors
Developmental factors
Environmental factors

Let’s consider a made-up gal named Allie as we walk through what a pile-up of contributing factors might look like:

Allie was born in the late 70s to a couple named Dave and Megan, who had three other children after Allie.

Dave and Megan experimented with drugs before Allie was born—and while Megan had no trouble quitting when she became pregnant, sobriety was another story for Dave. In her early childhood, he hid his addiction and eventually dropped the habit before she was old enough to really understand his struggles.

When Allie was a teenager, her parents relied on her to manage the younger kids and to help contribute to the family income. They didn’t talk about their financial or emotional woes, but the tension was palpable, and she carried it with her wherever she went.

As an adult, Allie chose a different path. She was serious, rarely impulsive, and managed her money well. She met a man who felt the same, and they married, having three children of their own.

It was after the birth of her third child that things began to change for Allie. She experienced postpartum depression for the first time, and the challenges of motherhood and a career began to weigh heavily upon her. The anxiety she barely acknowledged as a teen came rushing back to the surface, and she was surprised to find her controlled exterior cracking.

A year or two into her mental health struggles, a friend invited Allie over for an afternoon drink. A welcome respite during a busy week. That glass and the accompanying conversation soothed Allie’s mind, if only for a bit.

And it was only for a bit. So, the next week, when her friend invited her over again, Allie happily agreed. She curled her feet up under herself on the couch and downed two glasses this time—returning home a happier and listened-to mother.

It wasn’t until months later that Allie realized those weekly drinks now happened nightly, and two glasses often became a bottle, and she was mostly drinking alone. And when she wasn’t drinking, Allie’s mind raced. She worried about her growing children and her stalling career.

And so she lived in the tension—struggling to manage both addiction and anxiety.

And it’s no wonder, really. Life handed Allie a whole lot of contributing factors. Let’s take a look:

Genetics: We know her dad struggled with mild addiction, and we can guess that one or both of her parents may have dealt with severe anxiety due to financial worries.
Development: Her teenage years—a vital time for brain development—brought about a low-level anxiety that rested just under the surface of everything she did.
Environment: The perfectionist goals she set for herself in marriage, parenting and work created a toxic and unsustainable environment for the long haul.

And before we pass this information off as obvious, take a moment to consider why you might be thinking, “Yeah, yeah, we get it. People who have a tough life are more likely to suffer from mental health issues or substance misuse.”

Stories like Allie’s are a dime a dozen—and they come much worse than this too. We’re better off recognizing the miracle of not finding ourselves here than we are dismissing those who do.

And the research around the contributing factors of dual diagnosis reveals some pretty surprising details, including:

It’s not just Allie who’s susceptible. Anyone with genetic, developmental or environmental factors would benefit from learning more about co-occurring disorders and treatment options.

What’s The Best Treatment Plan for A Dual Diagnosis?

If co-occurring disorders deliver a one-two punch, people facing both mental health and substance use disorders need a treatment plan that really fights back.

The best approach is to ask for integrated treatment, where a team of medical professionals and certified counselors work together to understand and address each of an individual’s issues at the same time. In the long haul, this aggressive form of treatment usually costs less and proves more effective than two plans designed to address addiction and mental health separately.

To find an integrated treatment plan, search for programs like cognitive behavioral therapy or dialectical behavioral therapy. The approaches consider the whole person, focuses on the present over the past and helps patients develop practical and proactive ideas for living a more healthy life.

If you or someone you love struggles with mental health issues and a substance abuse disorder, we can help. Give us a call at 844.768.0169.

By Stephanie Thomas

Contributing Writer with Promises Behavioral Health