Mental Health Conditions and Substance Use

Understanding Dual Diagnosis

A dual diagnosis consists of the presence of a simultaneous mental health and a substance use condition. Because substance use and mental health conditions are commonly present together, dual diagnoses affect about half of the amount of people that are affected by mental illness. Without proper evaluation, diagnosis and treatment, both conditions may worsen the other.

Dual diagnosis is a broad term used to describe any two psychiatric disorders existing as comorbidities. This commonly includes depression, anxiety, mood disorders and addictive disorders.

Some examples of circumstances that may cause the presence of two different mental health conditions are:

  • Childhood trauma or neglect
  • Substance use (drug and alcohol addiction)
  • Stressful life events or change
  • Personality traits
  • Emotional physical and sexual abuse
  • Physical health problems

Types of Dual Diagnoses

The following mental health conditions may be present in a dual diagnosis:


Used as a broad term for several specific mood disorders, depression can be described as persistent low mood and difficulty concentrating in everyday life. Major depressive disorder, persistent depressive disorder, perinatal depression (or postpartum depression) and seasonal affective disorder all fall under the same category of depressive disorders. Anxiety and depression may both be present at the same time.

Anxiety Disorders

While occasional anxiety can be normal, persistent anxious feelings and behaviors can be a sign of an actual disorder. Anxious conditions consist of generalized anxiety disorder (GAD), panic disorder, phobias (specific fears), separation anxiety disorder, social anxiety disorder and selective mutism. Most of these conditions consist of symptoms like nervousness, restlessness, fatigue, difficulty concentrating, hypervigilance, irritability and racing thoughts.

Mood Disorders

Mood disorders is an umbrella term used to describe the following conditions: bipolar disorder, major depressive disorder, disruptive mood regulation disorder, persistent depressive disorder, premenstrual dysphoric disorder, dysthymic disorder and hypomania. For a psychiatrist to diagnose mood disorders, screenings and testing are necessary to ensure a proper evaluation. Symptoms of mood disorders may include depressive or manic episodes, mood swings, restlessness, high or low energy, difficulty concentrating, changes in sleep patterns, delusions and impulsive behavior.

Different mood disorders and types of bipolar disorder (manic, depressive, etc.) will play a role in what symptoms or behaviors are present, including the presence of substance use.

Obsessive Compulsive Disorder (OCD)

Obsessive compulsive disorder is a relatively common condition that causes a person to have recurrent, uncontrollable or intrusive thoughts that results in repetitive behavior. A person with OCD may have different triggers than another person with the same condition, meaning it varies case by case. Common symptoms of obsessive-compulsive disorder are hypervigilance, anxiety, panic attacks, repetitive speech or movements, impulsivity and intense fear.

Eating Disorders

There are many kinds of eating disorders, all of which are dangerous and may become fatal if left untreated. They’re described as having a preoccupation with eating patterns, food, body image, weight and shape. Common eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder. Each type of eating disorder varies in symptoms, but they commonly present as an obsession with what a person eats, restrictive dieting, binge/purge eating, emaciation, fear of gaining weight, distorted body image and other health issues like anemia.

Substance Use Disorders

Substance use disorders also exist in many different forms but are commonly presented as alcoholism or drug addiction. A person with a substance use disorder may display irritable behavior, anxiety, changes in sleep patterns, changes in weight, paranoia and impulsive decision making.


Schizophrenia is a mental illness that affects a person’s senses, including how they behave and think. They may experience psychotic symptoms like hallucinations, delusions, intrusive or illogical thoughts and abnormal body movements. They may also experience difficulties participating in everyday activities, hobbies, social relationships, including withdrawal from social relationship, a lack of motivation and difficulty concentrating.

Attention Deficit Hyperactivity Disorder (ADHD)

A person with attention deficit hyperactivity disorder may present different symptoms depending on personal factors. The most common symptoms of ADHD include aggression, excitability, irritability, difficulty concentrating, short attention span, anxiety and mood swings.

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder develops after experiencing an intense, shocking or dangerous event. Symptoms may include irritability, impulsive behavior, reliving the experience, anxiety, insomnia or nightmares.

While not exhaustive, these are some of the most common issues that people with dual diagnoses may experience. The signs and symptoms of dual diagnoses often overlap with one another. However, a mental health professional can help navigate the steps of screening and investigating to ensure a proper diagnosis.

Dual Diagnosis Treatment

Treatment plans will vary depending on the diagnoses and personal factors of the individual experiencing mental health issues. Options like therapy, lifestyle changes and medication are often considered for their effectiveness and accessibility in dual diagnosis treatment.


Therapy can be a helpful tool in diagnosing and treating many mental health conditions. Not all therapeutic approaches are the same. Depending on a person’s diagnosis and personal needs, the following may be used:

  • Cognitive behavioral therapy (CBT) – Talk therapy focused on changing negative thoughts and behaviors caused by psychological distress
  • Dialectical behavior therapy (DBT) – Encourages changing negative thoughts and behaviors and focusing on self-acceptance
  • Psychotherapy – General talk therapy for mental or behavioral disorders
  • Exposure therapy or systematic desensitization – Talk therapy that gradually exposes a person to their triggers in a safe environment, which helps to desensitize them and reduce their anxiety or fears.

Lifestyle Changes

Implementing healthy habits can be the first step in the right direction for anyone. Although it may require discipline, there are easy, risk-free ways to lessen mental stress and emotional reactivity. Try creating and sticking to a daily routine, staying organized, minimizing excess stimuli when you need to focus and keeping your body active when possible.

Eating nutritious foods, practicing deep breathing techniques, exercising and learning your triggers and reactions can tremendously help cope with mental health struggles.


For some, a proper treatment plan may require taking medication. Side effects of medication may vary, and finding the right one may take some trial and error.

Support Groups For Dual Diagnosis

There are many different kinds of support groups and joining one can have many benefits. Support groups can be a comforting space for those who feel alone in their struggles with mental illness.

Being able to connect with others over a shared behavior or issue can help to lessen the burden and shame. In support group meetings, a person will learn healthy coping skills and techniques to alleviate the intensity or frequency of their symptoms.