What is a Dual Diagnosis?

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Dual diagnosis is a term doctors use when a person struggles with a substance abuse addiction and a mental illness. Sometimes, doctors also call this condition a co-occurring disorder.

An estimated 9.2 million people in the United States have a dual diagnosis, according to the National Alliance on Mental Illness (NAMI).

The conditions that occur with dual diagnosis can range in severity from mild to severe. Some of the symptoms that a person could suffer from a dual diagnosis include:

  • Avoiding social activities with family and friends
  • Experiencing withdrawal symptoms when they aren’t using, such as in the morning or early afternoon
  • Losing control over how much and how often a person uses a particular substance
  • Problems thinking/problems concentrating
  • Sudden, unexplained changes in behavior
  • Withdrawing from family and friends

One of the reasons why a person with a dual diagnosis needs to recognize symptoms of both conditions is that one can contribute to the other. If a person doesn’t address both their addiction and the mental health concerns they are dealing with, they are less likely to beat their addiction and also improve their quality of life.


Dual Diagnosis by the Numbers

Nearly one-third of all people who struggle with addiction also have a mental illness, according to NAMI.

An estimated 21 million Americans struggle with addiction and substance abuse. Of those, an estimated 8 million also have a dual diagnosis with a mental illness.

These statistics mean that a person with a mental illness is twice as likely to struggle with substance abuse than a person who does not. According to NAMI, a person with a mental illness in the United States: 

  • Consumes 38% of all alcohol
  • Uses 44% of all cocaine
  • Uses more than half the opioid prescriptions

As a general rule, the more severe a person’s mental illness is (such as having a condition like bipolar disorder or schizophrenia), the more likely a person is to have a substance abuse addiction. 

Having a doctor know about a person’s dual diagnosis matters on many levels. First, doctors know that a dual diagnosis can make both conditions harder (but not impossible to treat). Second, those who struggle with a dual diagnosis may need more intense care, such as staying at an inpatient treatment facility, due to their complicated medical diagnoses. In some instances, doing so may help to keep the person safer because they are monitored for hallucinations, suicidal thoughts, and thoughts of self-harm. See this for more info about Holistic Addiction and Mental Health Treatment

Treating a Dual Diagnosis


Cognitive-behavioral therapy or CBT is a therapy approach that involves educating a person on different aspects of addictive thinking and mental health issues. A therapist works with a person to help them realize how their ways of thinking are affecting their lifestyle choices and overall sense of well-being. Then a therapist helps the person identify behaviors that can help them live a healthier and sober lifestyle.


Dialectical behavior therapy is a form of cognitive behavior therapy that doctors commonly use to treat medical conditions like borderline personality disorder. However, people with PTSD, eating disorders, and more can also benefit from the therapy approach. The approach involves that of “validation.” This means that a therapist helps a person discuss the way they think and feel. A therapist “validates” or helps a person identify why the way they think does or doesn’t make sense.


Rational emotive behavior therapy (REBT) is a therapy form that helps a person identify thoughts and behaviors that are negative — such as feelings of anger, depression, or guilt. A person then works to turn negative emotions into positive ones. The therapy involves making life changes, such as healthy eating, planning ahead, and relieving stress, that can help a person feel mentally and physically better.

Experiential Therapy

Experiential therapy is commonly used for those with PTSD. It involves allowing a person to engage in role-playing, art, music, or other forms of expression where a person can express what has happened to them in the past. Working through these thoughts and emotions can be very therapeutic.


Eye movement desensitization and reprocessing (EMDR) is a technique doctors commonly use on patients who have gone through trauma and experience PTSD. To perform this exercise, a therapist asks a person to re-live all or a portion of a traumatic experience. They then direct the person’s eye movements during that time.

Motivational Interviewing

Motivational interviewing is a counseling technique where a therapist helps a person find their personal motivations for making changes, such as staying sober. This therapy is based on the belief that unless a person wants to make changes, they can rarely move forward.


Dual diagnosis is a common occurrence. Both conditions can worsen the other and may require more intensive treatment or additional therapy approaches to help a person live better and experience more positive results. A person should never feel ashamed of their dual diagnosis — it is part of their experience, and they can live a better, healthier life with time and treatment.

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