Linda Lewis Griffith

Quick guide to dual diagnosis of mental illness and substance abuse

The death of Robin Williams brought the term dual diagnosis to the public’s awareness.

The term refers to the presence of both a psychiatric disorder and substance abuse in the same patient. It is often referred to as co-morbidity or co-occurring disorders.

According to the National Institute on Drug Abuse, a person who is addicted to drugs or alcohol is twice as likely to suffer from a mood and anxiety disorder as someone who is not addicted. The reverse is also true.

The Foundation Recovery Network estimates that 8.9 million people are impacted by dual diagnosis each year. Yet only 7.4 percent receive appropriate treatment.

The relationship between substance abuse and mental illness is complex. The National Alliance on Mental Illness explains that drugs and alcohol can be a form of self-medication. Patients who are depressed or anxious feel less distressed when they are high.

Yet the immediate feel-good effect almost always makes the mental illness worse. For instance, a student may become suicidal when he drinks too much alcohol. Or a woman feels increased panic when she tries to withdraw from heroin.

Dual diagnosis also can be the result of shared risk factors. Predisposing genetic factors make a person susceptible to both substance abuse and mental illness. Environmental triggers, such as stress, trauma and early exposure to drugs pave the way for both to occur.

A dual diagnosis always predicts a poorer outcome for a patient with mental illness. People who are actively abusing substances are less likely to be invested in their treatment programs. They miss appointments with their therapists and doctors. They forget to take their medication. They require more psychiatric hospitalizations.

Still, recovery is possible. With the right combination of professional care, social support and determination, those with dual diagnosis can begin their journey toward recovery.


Address the substance abuse. Acute drug and alcohol dependencies require supervised detoxification. Drug and alcohol facilities provide a wide array of services, including medical care, medication evaluation, individual and family therapy and relapse prevention.

Take medication. Various medications are available to treat both the symptoms of mental illness and drug and nicotine addictions. Some medications treat several problems at once. Zeroing in on the correct medication and dosage can require several attempts. Be patient while your medical provider discovers the best combination for you.

Get into psychotherapy. Behavioral treatment (alone or combined with medication) is the cornerstone of successful treatment, according to the National Institute on Drug Abuse. One form of treatment, cognitive-behavioral therapy, helps patients identify and change harmful belief systems. It is shown to be successful for children, teens and adults.

Join a support group. Many people find ongoing support to be essential for their sobriety. Such groups as Alcoholics Anonymous and Narcotics Anonymous provide day-to-day assistance from others who have been in the trenches.

Get emotional support. Healthy relationships with friends and family let patients know they are loved and give them a safe haven in which to recover. Sometimes friends and family are cited as the cause of the problems. It’s important to select them with care and awareness.