Woman crying because her dual diagnosis treatment is challenging

Challenges of Dual Diagnosis

What is Dual Diagnosis?

An estimated 21 million people suffer from substance abuse disorder, while another 8 million suffer from a mental health disorder. A dual condition (or a co-occurring disorder) is when a person suffers from both types of disorders. 

A person with a substance use disorder may not even realize that they have a co-existing mental health disorder, making how to treat dual diagnosis patients challenging.

Pathways to a Dual Diagnosis

Dual diagnosis isn’t a diagnosis in or of itself. It’s the umbrella term for two or more co-occurring diagnoses in someone with a substance use disorder and a mental health disorder.  Many people with drug and alcohol addiction may also struggle with mental illness or a mental health disorder. 

Dual diagnoses aren’t just comorbid or simultaneously present conditions. A person may initially begin with either an addiction or a mental health issue and develop an associated co-occurring disorder. One doesn’t necessarily cause the other directly, but medical professionals agree that there is an association between addiction and mental health that cannot be ignored.

Alcohol and drug use and abuse can worsen underlying mental health disorders and can be considered a pathway to a dual diagnosis. Risk factors like stress, family history, or genetics can precipitate either condition.

Mental health disorders can also lead to self-medication which can precede substance use disorders. For instance, someone taking depression medication may evolve into taking more of the medication than needed or may decide to add alcohol to the mix. Alcohol abuse alters brain function, which can lead to mental health disorders.

It can be difficult for doctors to screen for either diagnosis or dual diagnosis since many of the symptoms overlap.

Screening for a Dual Diagnosis

Many physicians and mental health professionals routinely screen for mental health disorders, and that can lead to dual diagnosis. Screening includes three key avenues of assessment:

  • Biological assessment includes a patient’s family history and any underlying medical conditions.
  • Psychological assessment includes how someone copes with life and its stresses. It also assesses any previous health conditions.
  • Social assessment includes not only a patient’s relationships but also what kind of social support the patient has. If a patient doesn’t have access to basic needs like employment, shelter, or health care can be a driver for anxiety and depression.

Medical professionals understand that a patient’s culture, or the holistic makeup of someone’s life, influences patient care and the outcome of co-occurring disorders. This is one reason screening is so involved, and questions are personal and qualitative.

Examples of Dual Diagnoses

 A dual diagnosis could be any combination of disorders, such as:

An addiction diagnosis coupled with an emotional health disorder like depression or post-traumatic stress disorder, for instance, falls under dual diagnosis. Depression is the most commonly occurring psychiatric disorder with alcohol use disorder. Attention-deficit disorder, obsessive-compulsive disorder, and panic disorder are widely associated disorders with substance use disorder.

Is A Dual Diagnosis More Dangerous?

Patients diagnosed with a dual diagnosis are more at risk for self-harm, including suicide. This can make treating a patient’s dual diagnosis complicated and more complex. If treatment is ignored, a patient can relapse into substance abuse. This is a dangerous scenario and why dual diagnosis must be treated simultaneously.

Is A Dual Diagnosis Difficult to Treat?

Battling more than one diagnosis at a time can make treating co-occurring disorders challenging for both physicians and patients. Integrative care utilizing an interdisciplinary team of physicians and mental health professionals creates patient care plans that treat the entire scope of a patient’s dual diagnosis.

The first step is detox. The substance use must stop so both disorders may be treated. It may take a combination of in-house and outpatient support to clean all substances out of a patient’s body. The interdisciplinary team will use a variety of treatment options:

  • Medication
  • Behavioral therapy
  • Support groups

All these treatment options can be included with in-house detox, rehab, or outpatient care.


Dual diagnoses may elicit treatment in tandem or alone. Serotonin is often used for depression, and the norepinephrine and dopamine reuptake inhibitor (NDRI) Bupropion. The latter drug helps regulate mood by increasing the brain’s hormones, norepinephrine, and dopamine. 

Behavioral Therapy

Cognitive and dialectical behavioral therapies have been shown to help co-occurring disorders of dual diagnosis. 

Cognitive Behavioral Therapy

Cognitive behavioral therapy, also known as CBT, is a talk therapy that teaches patients in a structured way how to cope with disordered patterns of thinking. CBT is goal-oriented in that it helps patients identify and understand their thoughts and behaviors.

Dialectical Behavioral Therapy

Dialectical behavioral therapy, or DBT, reduces self-harm behaviors like cutting, drug use, and suicidal thoughts or actions. It is based on CBT but is talk therapy for persons who struggle with intense feelings that lead to self-harm.

Support Groups

Support groups provide venues for people who listen and talk with others with dual diagnoses. Alcoholics Anonymous (AA) is a well-known 12-step support system. Other 12-step programs include Narcotics Anonymous (NA) and Dual Recovery Anonymous. Most 12-step programs are peer-run and support their members by sharing experiences and hope.

What Makes a Dual Diagnosis Difficult to Treat?

Patients with a dual diagnosis may also have social and physical issues. A person suffering from an addiction may have suffered past traumatic experiences such as neglect or abuse. They may have brain neurology disrupted, or be genetically predisposed to addiction or depression. These disorders can worsen and intensify addiction, making them more challenging to treat.

Dual Diagnosis Treatment With Inland Detox

Unfortunately, only some treatment centers can deal with a dual diagnosis. Inland Detox is trained to treat both disorders simultaneously so that recovery enables sobriety. Inland Detox meets the challenges of dual diagnosis by ensuring that each patient receives personal care. 

Reach out to us today to begin the road to recovery.