A significant number of people who struggle with substance use disorders are also living with an underlying mental health disorder, whether diagnosed or not. This combination is known as dual diagnosis or co-occurring disorders, and it’s a far more common mental health issue than many realize.
Understanding the most prevalent comorbidity of co-occurring substance abuse and mental disorders is essential for developing effective treatment plans that address both drug use and health simultaneously.
Examples of Common Dual-Diagnosis Combinations
Substance use disorders (SUDs) rarely occur in isolation. Many of those struggling with addiction also face underlying common mental health disorders known as co-occurring disorders or dual diagnosis. Understanding the link between substance abuse and mental health is crucial for accurate diagnosis, treating co-occurring disorders, and long-term recovery.
Below are the five most common co-occurring disorders that intertwine with substance addiction:
Personality Disorders
These disorders are enduring patterns of inner experience and behavior that deviate markedly from the expectations of an individual’s culture. These symptoms of mental health conditions are typically inflexible and pervasive, and may lead to significant distress or impairment. According to a national survey on drug use, people diagnosed with a personality disorder have a lifetime risk of addiction approaching 75%, making this one of the highest-risk groups for substance abuse.
Types of personality disorders that commonly co-occur with addiction include:
- Antisocial Personality Disorder
- Borderline Personality Disorder
- Narcissistic Personality Disorder
- Avoidant Personality Disorder
- Dependent Personality Disorder
- Paranoid Personality Disorder
People with mental illness often use drugs or alcohol to cope with chronic feelings of emptiness, self-loathing, or emotional dysregulation. For instance, those with Antisocial Personality Disorder may engage in high-risk behaviors without regard for consequences, including heavy substance use. At the same time, those with Borderline Personality Disorder often struggle with emotional instability and impulsivity, both of which are linked to addiction.
Notably, people with these disorders try to resist or avoid seeking help, especially those with antisocial traits, complicating recovery efforts which may result in another mental health disorder.
Major Depressive Disorder (MDD or Depression)
Depression is a leading global cause of disability and a major contributor to the burden of disease, ranked third in the world in 2008. In the United States alone, approximately 8% of adults have experienced a major depressive episode, with higher rates among adolescents and young adults. Unfortunately, major depression often goes undiagnosed or untreated, especially when masked by common risk factors like substance use, chronic illness, and hormonal changes.
People struggling with depression may turn to substances to:
- Numb emotional or physical pain
- Induce feelings of pleasure or normalcy
- Improve energy and focus (via stimulants)
- Fall asleep or escape intrusive thoughts
This self-medication strategy can quickly evolve into dependency. Furthermore, co-occurring depression significantly increases the risk of suicidal ideation and attempts, making early intervention critical.
Bipolar Disorder
Bipolar disorder is a chronic mood disorder characterized by alternating periods of manic (or hypomanic) highs and depressive lows. It is one of the top ten causes of disability worldwide, affecting over 40 million people. Because bipolar disorder has overlapping symptoms with another mental disorder, schizophrenia, they are sometimes misdiagnosed as one another.
During manic phases, Individuals with bipolar disorder may feel invincible and engage in risky behaviors, including excessive alcohol or drug use. In depressive phases, they may use substances to escape intense sadness, fatigue, or hopelessness. Many use sedatives to “come down” from manic states or stimulants to counteract depression, inadvertently reinforcing the addiction cycle.
Misdiagnosis is common. Bipolar disorder is often confused with unipolar depression, ADHD, or borderline personality disorder, which further complicates treatment when addiction is involved.
Attention-Deficit/Hyperactivity Disorder
More commonly known as ADHD, attention-deficit hyperactivity disorder is a complex neurodevelopmental condition characterized by a persistent pattern of inattention, hyperactivity, and impulsivity that goes beyond what is considered developmentally appropriate for a person’s age. It should not be confused with hyperactivity disorder, as this lacks the conditions for ADHD.
In addition to the core symptoms, individuals with ADHD often struggle with co-occurring mental states like emotional dysregulation, including difficulty managing frustration, mood swings, low tolerance for stress, and heightened emotional reactivity. ADHD manifests in different ways depending on the individual. Some may display predominantly inattentive symptoms such as forgetfulness, disorganization, and difficulty sustaining focus while others may exhibit primarily hyperactive-impulsive behaviors, like restlessness, interrupting others, and acting without considering consequences. Many people experience a combination of both.
These symptoms are not just occasional or situational. They are excessive, pervasive, and significantly interfere with functioning in multiple settings, such as at home, school, work, and in social environments.
Anxiety Disorders
According to the National Institute of Mental Health, co-occurring mental health disorders are the most prevalent mental health conditions in the United States, affecting over 19% of adults annually. They include a range of diagnoses such as:
- Generalized Anxiety Disorder (GAD)
- Social Anxiety Disorder
- Panic Disorder
- Obsessive-Compulsive Disorder (OCD)
People with these disorders often seek out substances like alcohol, cannabis, or benzodiazepines to self-medicate and manage overwhelming symptoms such as nervousness, panic attacks, or obsessive thoughts. Eating disorders can also occur. Social uneasiness, in particular, frequently drives them to use alcohol or drugs as a coping mechanism in social situations. Over time, this pattern can spiral into substance dependence.
Roughly 20% of individuals with a substance use disorder also have a mental disorder, and many don’t realize the two are interconnected and seek mental health treatment.
Post-Traumatic Stress Disorder (PTSD)
One of the most common mental health disorders is PTSD. PTSD develops after exposure to a traumatic event such as military combat, physical or sexual assault, or a serious accident and is marked by symptoms like flashbacks, nightmares, emotional numbness, and hypervigilance. These symptoms can be intensely distressing and are often re-experienced over and over again, keeping the nervous system in a perpetual state of arousal.
To alleviate this unrelenting discomfort, people with mental disorders like PTSD may turn to increased drug and alcohol use to numb emotional pain, block out traumatic memories, induce sleep, and regain a sense of control over their day-to-day activities.
It’s estimated that up to 50% of people in addiction treatment have co-occurring PTSD. Trauma-informed care is essential in addressing both the root causes of PTSD and the addictive behaviors like alcohol or drug abuse that it fuels.
Diagnosis and Treatment
A comprehensive evaluation by licensed mental health care providers is essential for an accurate dual diagnosis. The individual’s symptoms, medical history, and substance use patterns are assessed, and a course of treatment is laid out to address both disorders simultaneously.
The dual diagnosis treatment may include a combination of medication, addiction therapy (like cognitive behavioral therapy or dialectical behavior therapy), support groups, and lifestyle changes.
Medication is prescribed to help manage withdrawal symptoms and serious mental illnesses or conditions such as psychosis, while therapy helps the individual develop coping skills and address underlying issues. Treatment for mental and substance use disorders is often provided in inpatient or outpatient settings, depending on the severity of the condition.
Why Dual Diagnosis is Important to Understand
Understanding dual diagnosis is essential for delivering effective treatment to individuals facing both substance use and mental health disorders. Outcomes significantly improve when these conditions are addressed together through integrated care.
This leads to better recovery rates, enhanced emotional stability, and better overall functioning, resulting in a higher quality of life. A comprehensive approach to dual diagnosis not only supports symptom management but also helps individuals build healthier relationships, maintain employment, and sustain long-term recovery.
Final Thoughts from Mile High Recovery Center
You’re far from alone if you struggle with addiction and mental health issues simultaneously. An effective dual diagnosis treatment program like the one we provide at Mile High Recovery addresses both conditions, giving you the best chance at recovery. Our team is committed to helping individuals with dual diagnosis issues heal both body and mind through evidence-based care tailored to their experience.
