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Dual Diagnosis

What is Dual Diagnosis?

A person with a dual diagnosis has both an alcohol or drug problem and a mental health disorder. These conditions happen together frequently. About half of people who have a mental illness will also have a substance use disorder at some point in their lives and vice versa. The interactions of the two conditions can worsen both.

According to the National Center for Biotechnology Information (NCBI) [1], the dual diagnosis was first identified in the 1980s among individuals with coexisting severe mental illness and substance abuse disorders. Today, the Substance Abuse and Mental Health Services Administration (SAMSHA) uses the term co-occurring disorders (COD) to refer to the aforementioned concurrent disorders.

Dual diagnosis or co-occurring disorders (COD) is defined as co-occurring substance-related and mental disorders. People said to have co-occurring disorders have one or more substance-related disorders as well as one or more mental disorders.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) [3], in the current Diagnostic and Statistical Manual of Mental Disorders (DSM), alcohol use disorder (AUD) and other substance use disorders are defined as psychiatric disorders. Many people who misuse alcohol also abuse other drugs, and vice-versa. Additionally, other psychiatric disorders often co-occur with substance use disorder. This is referred to as co-morbidity. Dual diagnosis, co-occurring disorder, and co-morbidity are interchangeably used today.

Dual Diagnosis
Unfortunately, resorting to substances as a way to escape a mental health condition can be a damaging decision.

People with a dual diagnosis require an integrated treatment plan that addresses both disorders as interconnected issues. According to the National Survey on Drug Use and Health (NSDUH), 45% of people with substance use disorder have a co-occurring mental health disorder. By seeking treatment for addiction and co-occurring behavioral and mental health disorders, you can work on successfully attaining the fulfilling and healthy life you deserve.

What are the Causes of Dual Diagnosis?

Although an alcohol or drug problem and a mental disorder often happen together, this does not mean that one caused the other, even if one appeared first. In fact, it can be challenging to distinguish which came first. According to the National Institute of Health (NIH) [2], researchers think that there are three possibilities as to why they happen together:

  • Common risk factors may contribute to both mental disorders and substance use disorders. These factors include genetics, stress, and trauma.
  • Mental disorders can contribute to drug use and substance use disorders. For example, people with mental disorders may use drugs or alcohol to try to feel better temporarily. This is known as self-medication. Also, mental disorders may change the brain to make it more likely you will become addicted.
  • Substance use and addiction can contribute to the development of a mental disorder. Substance use may change the brain to make you more likely to develop a mental illness.

What Causes Substance Use Disorder? 

Like many mental health disorders, several factors may contribute to the development of alcohol or drug addiction. The main factors are:


  • Environmental factors, including your family’s beliefs and attitudes and exposure to a peer group that encourages drug use, seem to play a role in initial drug use.


  • Once you’ve started using a drug, the development into addiction may be influenced by inherited (genetic) traits, which may delay or speed up the disease progression.

What Causes Mental Illness?

Most mental conditions don’t have a single cause. Instead, they have a variety of causes, called risk factors. The more risk factors someone has, the more likely they are to develop a mental illness. Sometimes, mental illness develops gradually. Other times, it doesn’t appear until a stressful event triggers it.

There are many risk factors and triggers, but here are a few examples:

Dual Diagnosis
People who are subject to some types of sexual or physical assault earlier in life, for instance, are more likely to experience a dual diagnosis disorder as well as drug and alcohol addiction


  • Mental illness often runs in the family.


  • Living in a stressful environment can make you more likely to develop a mental illness. Things like living in poverty or having an abusive family put a lot of stress on your brain and often trigger mental illness.

Childhood trauma

  • Even if you’re no longer in a stressful environment, things that happened to you as a child can have an impact later in life.

Stressful events

  • Like losing a loved one, or being in a car accident.

Negative thoughts

  • Constantly putting yourself down or expecting the worst can get you stuck in a cycle of depression or anxiety.

Unhealthy habits

  • Like not getting enough sleep, or not eating.

Drugs and alcohol

  • Abusing drugs and alcohol can trigger a mental illness. It can also make it harder to recover from mental illness.

Brain chemistry

  • Mental illness involves an imbalance of natural chemicals in your brain and your body.

These risk factors don’t just affect who will develop a mental illness in the first place. They also affect how severe their symptoms will be, and when they will experience those symptoms.

Signs of a Dual Diagnosis or Co-Occurring Disorder

The signs of a dual diagnosis vary greatly between people. Typically, symptoms will depend on the type of drugs or substance abuse as well as the severity of the co-occurring condition.

Symptoms of a dual diagnosis include:

  • Sudden changes in general behavior
  • Difficulty managing daily tasks and responsibilities
  • Avoiding events or social activities that were once enjoyed
  • Neglecting health and hygiene
  • Delusional thinking or cognitive impairments
  • Refusal to seek or comply with treatment
  • Mentions of thoughts of suicide or suicidal behaviors
  • Erratic and impulsive behaviors
  • Issues managing finances
  • Poor performance at school or work
Dual Diagnosis
People with attention-deficit hyperactivity disorder (ADHD) may be more inclined to abuse substances as a way to cope with their symptoms. Many people are prescribed stimulants to treat their ADHD, which can be habit-forming and lead to a toxic pattern of substance abuse.

Statistics on Dual Diagnosis

Who is affected?

  • According to the National Institute on Drug Abuse [4], 7.7 million adults have co-occurring mental and substance use disorders. This doesn’t mean that one caused the other and it can be difficult to determine which came first.
  • Of the 20.3 million adults with substance use disorders, 37.9% also had mental illnesses.
  • Among the 42.1 million adults with mental illness, 18.2% also had substance use disorders.

Who gets treatment?

There are many effective treatments for both mental and substance use disorders. A comprehensive treatment approach will address both disorders at the same time.

Not everyone with co-occurring conditions gets the treatment they need:

  • 52.5% of those with dual diagnosis conditions received neither mental health care not substance use treatment.
  • 34.5% of those with dual diagnosis conditions received mental health care only.
  • 09.1% of those with dual diagnosis conditions received both mental health care and substance use treatment.
  • 3.9% of those with dual diagnosis conditions received substance use treatment only.

Individuals who struggle with mental health disorders either seek clinical medication or self-medicate with drugs and alcohol. People that get prescriptions for their condition are less likely to develop abuse disorders, but often the medications that they get access to have high abuse potential, creating more risk.

People that self-medicate for their mental illnesses often start early, and the use of drugs or alcohol as a way to escape becomes a natural part of life.

The reverse order can also be true, in which a mental disorder is caused or worsened by the use of drugs or alcohol. For example, some common pairings:

Why is Self-Medication Dangerous?

When a person has a problem with mental illness and substance use, they need to seek out the best dual diagnosis treatment program. Often, individuals use drugs and alcohol to self-medicate for their mental illness. These drugs only make them feel better temporarily. Because the effects wear off, the person has to use repeatedly to relieve the symptoms of their mental conditions.

Self-medication is dangerous because it can lead to addiction or even an overdose. It also makes treatment harder because the person has to treat addiction and a mental illness. If they do not treat both problems at a dual diagnosis treatment center, they are more likely to have a relapse.

According to the Substance Abuse and Mental Health Service Administration (SAMHSA) [5], no specific combinations of mental and substance use disorders are defined uniquely as co-occurring disorders. Some of the most common mental disorders include:

People being treated for mental disorders also often misuse the following types of substances:

  • Alcohol
  • Tobacco
  • Opioids
  • Stimulants
  • Marijuana
  • Hallucinogens
  • Prescription drugs

Dual Diagnosis Treatment Center

Treating dual diagnosis clients is a critical aspect of our inpatient treatment experience because co-occurring disorders are strongly connected with instances of substance abuse. Creating a treatment plan that addresses the physical aspects of withdrawal, the psychological connection with drug use, and addressing underlying mental health disorders is all a part of setting clients up for success. 

A thorough mental health analysis identifies opportunities for treatment. Meeting with mental health counselors and medical care providers means access to behavioral therapy and medication treatment. Proper treatment leads to change for better, healthier living. 

The dual diagnosis treatment center may use different therapies like cognitive behavioral therapy or trauma therapy to help the individual to change their lifestyle. Group meetings help provide feedback, advice, and support during recovery. Meanwhile, family therapy allows clients to get the support they need to stay sober after their rehab stay is complete.

Dual Diagnosis Treatment Centers NJ

We Level Up NJ believe that if the client can identify the underlying issue and treat it simultaneously with their treatment for addiction, the client’s chances of a successful, relapse-free recovery are much improved. In fact, once we can identify and properly begin treatment on the underlying issue that’s driving or co-occurring with the dependency on alcohol or other drugs, clients will have reached a major milestone and will be that much closer to long-term sobriety.

Dual Diagnosis
You aren’t alone. You deserve to get help.

We Level Up NJ do not believe that long-term recovery comes in a one-size-fits-all program. For this reason, each client, upon arrival at our drug treatment center, will undergo extensive and comprehensive dual diagnosis exams which include physical and psychological tests with our team of physicians, mental health specialists, spiritual advisers, and nutritionists. 

Together, we will determine what the client’s underlying issues are so we can then customize an individualized approach and, when appropriate, provide integrated dual diagnosis treatment. The symptoms of the multiple disorders that can occur alongside addiction can present complex and similar symptoms. Proper diagnosis requires a highly trained professional staff with years of experience.


[1] NCBI –

[2] NIH –

[3] NIAAA –

[4] NIDA –

[5] SAMHSA –

[6] We Level UpDual Diagnosis Treatment