Alcohol and Dual Diagnosis

It is estimated that 14.1 million adults in the U.S. suffer from alcohol use disorder (AUD), and 51.5 million suffer from a mental health condition. The co-occurrence of mental health issues and addiction is referred to as a dual diagnosis. Mental health disorders and addiction may interact and exacerbate each other. Co-occurring disorders affected 9.5 million people in the United States according to the National Survey on Drug Use, and Health conducted in 2019.1

Treating both the mental health condition and addiction simultaneously is essential for successful recovery. With simultaneous dual diagnosis treatment, a person can get to the root of their addiction and underlying mental health issues, develop better coping strategies, increase self-awareness, and reduce relapse risk. This type of treatment also helps people to understand how their substance use disorder and mental health disorder interact, how they affect their thoughts and behavior, and what can be done to manage them effectively.2

What Is Dual Diagnosis? 

Dual diagnosis is a condition in which an individual suffers from both a substance use disorder and at least one mental health disorder, such as depression, anxiety, or bipolar disorder.3 

One-third of those who suffer from mental illnesses and half of those who suffer from serious mental illnesses misuse drugs. A third of individuals who abuse alcohol also suffer from a mental illness, and more than half of those who abuse drugs do as well.4

This pattern of dual diagnosis occurrence is likely due to the fact that many people take drugs to self-medicate and cope with their mental health symptoms. However, this can lead to a cycle of addiction and further exacerbate their mental health disorder.3

The risk for dual diagnosis is increased in certain populations, including individuals who have experienced trauma, are homeless or have unstable housing, are involved with the criminal justice system, or have a family history of mental illness and substance abuse.3

What are the Signs and Symptoms of Dual Diagnosis

The signs and symptoms of dual diagnosis vary depending on the individual and can include emotional, physical, and behavioral changes.3

Some common signs and symptoms may include:3

  • Mood swings.
  • Extreme anxiety or depression.
  • Irritability.
  • Poor concentration/memory.
  • Increased risk-taking behaviors. 
  • Inability to control drug or alcohol use. 
  • Changes in sleeping patterns or appetite. 
  • Withdrawal from family and friends. 
  • Loss of interest in activities you once enjoyed.

What’s the Link Between Mental Health And Alcohol Abuse? 

The link between mental health and alcohol abuse is complex. Alcohol can be used as a way to self-medicate and cope with difficult emotions, or it can lead to the development of dual diagnosis and mental health conditions as a result of long-term abuse. People who misuse alcohol are more likely to suffer from depression, anxiety, personality disorders, and other mental health conditions.

Additionally, alcohol can worsen existing mental health disorders and make it more difficult for individuals with a dual diagnosis to recover from them. It is important for individuals who struggle with alcohol abuse to understand the potential risks associated with alcohol use, such as overdose, and to seek professional help if necessary.3

The following mental health disorders are the most common culprits in dual diagnosis cases:

Bipolar Disorder

Bipolar disorder is characterized by extreme mood swings, energy, and activity levels, as well as episodes of mania and depression. There is a very high rate of alcoholism and drug abuse among individuals with bipolar disorder. In fact, the prevalence of alcohol and drug addiction is at least 40% among adults suffering from bipolar I disorder.5


Drugs and alcohol are commonly used to boost low energy levels, activity levels, and moods associated with depression. Approximately 40% of people suffering from mood disorders have a dual diagnosis, and those with mood disorders have a greater likelihood of struggling with addiction.3


Individuals suffering from schizophrenia often turn to alcohol and drug abuse. Schizophrenia is a severe and complex mental illness characterized by distorted perceptions, feelings, and thoughts. Those suffering from schizophrenia, for example, smoke cigarettes at a rate three times greater than the average American.6


In many cases, PTSD and addiction are common cases of dual diagnosis, as individuals may self-medicate with alcohol or drugs following a trauma or life-threatening event. According to the US Department of Veterans Affairs (VA), one out of every three veterans seeking addiction treatment also suffers from PTSD, with 20% of them also struggling with drug addiction.7


As many as 20% of those battling anxiety (or mood) disorders also suffer from dual diagnosis and addiction, according to the Anxiety and Depression Association of America (ADAA). This is likely due to the fact that anxiety can drive a person to drink alcohol to alleviate the symptoms.8


ADHD is characterized by impulsiveness, difficulty focusing, disorganized thinking, and restlessness. It affects both children and adults. The prevalence of substance abuse and dependence on alcohol and drugs among ADHD adults is three times higher than that of the general community without any mental health disorders.9

What Are The Causes Of Dual Diagnosis? 

Dual diagnosis — also known as comorbidity or co-occurring disorders — is the presence of two mental health conditions, such as substance abuse and depression. It is an increasingly common issue in today’s society, affecting a large proportion of individuals with mental health issues. While there are many potential causes of dual diagnosis, some common triggers include genetics, age, environment, and trauma.10

Genetics can play a major role in dual diagnosis development, as certain mental health conditions are more likely to be inherited. For example, individuals with a family history of substance abuse are more likely to experience it themselves. Similarly, if a parent or other close relative has been diagnosed with depression or another mental health disorder, their children are also at a higher risk of developing similar conditions.3

Age is also an important factor when it comes to dual diagnosis. Younger people tend to be more prone to risky behavior and substance abuse, leading them to develop a mental health disorder in addition to alcoholism or drug addiction. On the other hand, older individuals may be more likely to develop dual diagnosis due to the accumulation of life stressors, such as bereavement and relationship issues.3

Environmental factors can also contribute to dual diagnosis development. People who live in areas of social deprivation or crime are more likely to suffer from mental health conditions, poverty or financial concerns, or homelessness — all of which can trigger substance abuse problems as a means of self-medicating. Trauma is another common cause, with individuals who have experienced traumatic events such as sexual or physical abuse being more likely to develop mental health issues, which can then lead to addiction.11

Dual diagnosis can be a difficult issue to manage, but understanding the causes is a crucial step toward successful treatment. Knowing the potential triggers of dual diagnosis can help individuals to take preventative measures, such as seeking early intervention if they recognize any of the risk factors in themselves or their loved ones. With proper support and the help of dual diagnosis treatment centers, the condition can be effectively treated and managed over time.3

How Does Dual Diagnosis Impact People?

People living with a dual diagnosis face unique risks and challenges. This can include negative health outcomes, social isolation, low self-esteem, and difficulty managing daily tasks. It is important to recognize the impact that a dual diagnosis has on an individual’s life in order to best support them in achieving their goals and improving their quality of life.3  

People living with a dual diagnosis are at an increased risk for suicide. This is due to the nature of their condition – as depression and other mental health disorders can make it difficult for them to cope with life’s stressors, leading to suicidal thoughts or actions. Additionally, substance abuse may further increase this risk by impairing one’s ability to think logically and make sound decisions.3

Those living with a dual diagnosis are also at an increased risk for social isolation due to the stigma associated with both mental illness and substance abuse. This can further impair one’s ability to create and maintain meaningful relationships, further isolating them from their peers and family members. Fortunately, there are a variety of support groups designed to help people living with a dual diagnosis overcome this isolation by providing an environment in which they can openly discuss their feelings and be supported by their peers.10

In addition to the behavioral impacts of a dual diagnosis, it can also lead to serious physical health issues. For example, those with a dual diagnosis may be at an increased risk for heart disease and stroke due to being more likely to use tobacco products or engage in risky behaviors such as drug abuse or unprotected sex. Additionally, those living with a dual diagnosis may have impaired cognitive abilities due to the depression and anxiety associated with their condition. This can lead to an inability to think clearly, make sound decisions, or remember important information.10

Finally, it is important to recognize the unique characteristics of individuals living with a dual diagnosis in order to best support them. People living with a dual diagnosis often have difficulty managing daily tasks or understanding the consequences of their actions. Additionally, they may not be able to recognize when they need help and may be reluctant to ask for it. It is important to remain patient and supportive in order to provide individuals living with a dual diagnosis the help they need in managing their condition.10

What Are The Challenges of Dual Diagnosis Treatment

When it comes to dual diagnosis, the challenge is often in accurately diagnosing and treating both disorders simultaneously. One of the biggest obstacles with DD is that, depending on the degree of severity for each disorder, one could overshadow the other when treatment begins. As a result, there can be difficult to determine which symptoms are being caused by which disorder.10

Another challenge is that, depending upon the resources available in a particular treatment setting, both disorders may not be addressed at the same time, which could make it difficult to provide an effective recovery plan. Additionally, many people with a dual diagnosis find it difficult to maintain sobriety and comply with prescribed medications due to their mental health issues.10

Furthermore, there is often a stigma attached to dual diagnosis treatment, leading people not to seek the help they need. This is especially true for individuals who are already facing other obstacles, such as homelessness or financial struggles.10

The good news is that with the right tools and resources, it is possible to successfully diagnose and treat both disorders at the same time. It is also important to note that dual diagnosis treatment is often more effective when it includes individual, group, and family therapy in addition to medication management. Treatment should be tailored to each individual’s needs so they can make sustainable lifestyle changes that may prevent future relapse.10

How Is Dual Diagnosis Treated? 

Dual diagnosis treatment plans are typically tailored to each person’s individual needs and may include a combination of clinical, behavioral, and pharmacological approaches. Treatment for dual diagnosis typically begins with an evaluation by a mental health professional. During this evaluation, the clinician will assess both the psychological and substance abuse issues in order to develop the most effective treatment plan.10

Medication-assisted treatment (MAT) typically includes drugs such as Naltrexone, Disulfiram, Acamprosate, and others to reduce or manage withdrawal symptoms while also addressing underlying mental health issues.10

Behavioral therapies can help individuals identify triggers that cause cravings and teach them healthier, more positive ways of responding to stressors. Dual diagnosis treatment may include a combination of Cognitive-Behavioral Therapy, Dialectical Behavior Therapy, Therapeutic Communities, Contingency Management, and more.10

Inpatient or residential treatment offers the highest level of care for those with dual diagnosis, providing a safe and structured environment in which to address both the substance abuse disorder and any underlying mental health issues. The duration of treatment can vary depending on the individual’s needs but typically lasts a few weeks to several months following the initial detox.10

No matter the treatment approach, it is important for individuals with dual diagnosis to take a holistic approach that focuses on long-term recovery. This includes regular monitoring and follow-up appointments to ensure that any symptoms have been alleviated and new coping strategies are in place.10

It is also important to find a treatment provider who is familiar with dual diagnosis and can create an individualized treatment plan that addresses the unique needs of each patient. Overall, addressing both substance use disorder and any underlying mental illness through proper treatment can help individuals lead healthier, more productive lives.10

Frequently Asked Questions