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Dual Diagnosis

Substance abuse & mental illness

When living with the symptoms of depression, anxiety, or more severe mental disorders, it is not uncommon for sufferers to turn to alcohol, or some other substance, to ease the pain.  It often happens when a mental disorder is undiagnosed and untreated, or if long-term substance abuse has contributed to the development of a mental illness. This is why a substance abuse assessment can be an important tool when diagnosing and treating mental illness.

What is dual-diagnosis?

Dual diagnosis refers to the co-occurrence of substance abuse with a mental illness. Substance abuse is a common problem among people with mental illness and, if undiagnosed can interfere with treatment and recovery.

How common is it?

Mental illness and substance abuse often go hand-in-hand. They may occur at the same time, or one may develop before the other. It is important to recognize both conditions in order to affect the best possible treatment outcome.

People with serious mental illness are 4-5 times as likely to develop a substance abuse disorder as the general population, according to , according to the Substance Abuse and Mental Health Services Administration (SAMSA). Co-occurring substance use and mental disorders can occur at any age. Research suggests that as many as half of the adults who have a diagnosable mental disorder will also have a substance use disorder at some point during their lifetime, according to the President's New Freedom Commission on Mental Health

A National Association of Mental Health study shows the increased risk for substance abuse for the following psychiatric disorders:

  • Antisocial personality disorder, 15.5 percent increased risk of substance abuse
  • Manic episode, 14.5 percent increased risk of substance abuse
  • Schizophrenia, 10.1 percent increased risk of substance abuse
  • Panic disorder, 4.3 percent increased risk of substance abuse
  • Major depressive episode, 4.1 percent increased risk of substance abuse
  • Obsessive compulsive disorder, 3.4 percent increased risk of substance abuse
  • Phobias, 2.4 percent increased risk of substance abuse

Special populations

Older adults with depression are at a higher risk of alcohol abuse and dependence. Older depressed persons are three to four times more likely to have alcohol problems than older adults who are not depressed.  Although alcohol is the most common drug of abuse among all people with serious mental illness (18 percent), abuse of prescription drugs, street drugs or both (9.6%) is not unusual. Prescription drugs are more commonly abused among older adults; and younger adults are more likely to abuse street drugs.

Why is it so common?

When someone suffers from a mental illness, it is not uncommon for the sufferer to self-medicate with alcohol or other drugs to ease the symptoms. As use becomes more frequent, the person can become dependent upon the substance. Conversely, substance abuse can trigger symptoms of depression, anxiety, psychosis or suicidal thoughts. In addition, substance abuse that begins in adolescence and continues into adulthood may contribute to the development of emotional difficulties or psychiatric disorders, according to NAMI (National Alliance on Mental Illness).

How is it diagnosed?

Diagnosing a co-occurring substance abuse disorder can be a challenge. One of the most common symptoms of addiction is denial, so an accurate self-report of alcohol or drug use may be difficult to obtain. Also, some of the symptoms of addiction mimic those of certain mental illnesses, and vice-versa. The best way to determine if there is a co-occurring disorder is to find out as much as possible about the person, and to conduct a thorough mental and physical health assessment that includes a substance abuse screening.

How is it treated?

Both conditions can be treated at the same time. However, the predominant diagnosis should be addressed first. If an addiction is present, the first step is to detoxify the patient if possible. This is important because accurate assessment of the nature and severity of a psychiatric disorder is difficult in the presence of alcohol or drug dependency.

Drug and alcohol rehabilitation can occur on an inpatient or outpatient basis. The best option for treatment can be determined by the patient and his or her treatment team. Following detoxification, regular counseling and attendance at a 12-step or other recovery support group should be included in the overall treatment plan. Attention to exercise, nutrition, housing and other lifestyle issues will also enhance recovery.

Only 19 percent of people with a serious mental illness and drug or alcohol dependency are treated for both disorders, and 29 percent are not treated for either problem. For people with less serious mental illnesses and substance dependence problems, the pattern of under-treatment is even worse. Seventy-one percent receive no treatment, and only 4 percent receive treatment for both disorders, according to the President's New Freedom Commission on Mental Health.

Treatment outcomes are improved for both substance abuse and psychiatric disorders when the presence of both are detected and treated.

Assessments at Enloe Behavioral Health can be scheduled by calling 800.560.5900 or 530.332.5250, or one can simply walk in and request an assessment.

Contact Us

Enloe Medical Center
Behavioral Health
560 Cohasset Road
Chico, CA 95926

Open twenty-four hours a day, seven days a week.


Find a Doctor
Call: 1-877-Enloe-MD
(1-877-365-6363)
Visit: doctors.enloe.org