Dual diagnosis is a complicated intersection of mental health and substance use problems which presents exceptional challenges in diagnosis and management, as the two groups of disorders often influence each other’s development and progression.

People with co-occurring disorders in the UK face a combination of emotional, mental, physical, and social hardships. Recognizing and addressing the consistent nature of mental health and substance use is vital for offering comprehensive and effective care to people dealing with dual diagnosis.

The integrated approach for dual diagnosis treatment in the UK identifies the sophisticated relationship between substance use and mental health and aspires to promote holistic recovery and healing.


Dual diagnosis is a medical term that represents a condition where a mental health disorder and a substance use disorder occur concurrently. Another name for dual diagnosis is co-morbidity or co-occurring disorder. Management for both illnesses is undertaken at the same time. Treatment comprises medication, behavioural therapy, in-patient or outpatient care and support groups [1].

Common mental health conditions that are more often involved in dual diagnosis are anxiety and depression. A substance disorder may include problems with recreational or prescription drugs, alcohol, or another substance with addictive potential. When a combination of these disorders occurs, the consequences of each can be more damaging.

Unaddressed mental health problems serve as the basis of substance abuse. Substance abuse in turn makes you vulnerable to mental health problems and hence, this generates a vicious cycle.

How Is Mental Health Associated With Substance Use

There is a complex connection  between substance use and mental illness.

Individuals with mental health problems may use drugs and alcohol for the same purpose compared to other people – to feel good and relaxed.

Often, the mental health problem comes first and the substance abuse follows as a coping mechanism or a method to self-medicate.

On occasions, substance abuse and mental health problems start at the same time, originating from a common cause like genetics, stress or trauma.

Substance abuse can alter the neurochemical composition and stability of the brain, triggering mental health issues or making a prevailing mental disorder worse.

Examples Of Dual Diagnosis

The most prevalent mental health conditions that co-occur with substance abuse problems include depression, anxiety, behavioural disorders, schizophrenia, and bipolar disorder.

There are no limits to the blends of mental disorders and recreational or prescription substance abuse. Here we list some of the common examples of dual diagnosis [2].

  • Depression and Alcoholism
  • Anxiety and Prescription Drug Addiction
  • Schizophrenia and Marijuana Addiction
  • Anxiety and benzodiazepine dependence
  • PTSD (Post-Traumatic Stress Disorder) and Opioid Addiction
  • ADHD (Attention-Deficit Hyperactive Disorder) and Alcoholism
  • Psychosis and Meth Addiction

How Common Is Dual Diagnosis?

Researchers have estimated that around half of people with a substance use disorder will have some sort of mental health problems and vice versa.

An estimated 17 million adults in the United States had a comorbid substance abuse and mental health condition in 2020 [3].

At least one significant mental illness has been observed in 53 percent of drug abusers and 37 percent of alcoholics.

Among all individuals diagnosed with mental disorders, 29 percent abuse drugs or alcohol.

The Challenges Of Dual Diagnosis

While substance abuse and mental disorders have their objective complications, there can be added challenges when they co-occur, including:

  • Trouble in identifying whether particular problems came from mental illness, substance abuse, or both
  • Relapsing in a contagion manner; whether a setback in one’s treatment may trigger a return in symptoms of both disorders.
  • Harmful interactions with commonly recommended medication for a mental illness and drugs or alcohol being used
  • Trouble in coping with two disorders simultaneously. Some individuals may detach from people dear to them, dropping their support network without knowing
  • Dual diagnosis doubles the taboo and the stigma.

People's understanding and encounters of dual diagnosis differ.

It varies with the particular form of mental illness and its effects on the body, alcohol or the drugs used, and how a combination of these interact inside the body.

It is also influenced by the treatment methods or support network the person has. Certain treatments may be effective for some individuals but not others.

Studies conducted in the UK have reported the occurrence of dual diagnosis in 20–37% of individuals in all mental health centres [4]. There is supplementary evidence for these dramatic stats.

As per UK statistics, 86% of individuals receiving alcoholism treatment had a co-morbid mental health disorder, and about 44% of individuals with drug use problems also had a mental condition.

The prevalence of anxiety co-occurring with substance use disorder in the UK is 9%. Depression with substance use is more prevalent, with an estimated 1/3rd of adults suffering from substance use will suffer from major depression.

The prevalence of addiction increases further in people with ADHD or Autism Spectrum Disorder (ASD), with 36% of ADHD/ASD individuals suffering from addiction on average. Likewise, substance use co-occurs in 43% of total individuals with PTSD [4].

Common substances that are abused include prescribed medications (including ADHD meds, opioid pain relievers, and sleep aids), alcohol (wine, beer, liquor), and street drugs or recreational drugs (like cocaine, methamphetamines, marijuana).

Substance addiction or substance use disorder is not labelled by the form of alcohol you drink or the drug you use. More accurately, it relates to the effects on your quality of life of the alcoholic beverage or the drug you use. In other words, if the use of drugs or your drinking habits is causing difficulties in your everyday life, you are said to have a substance abuse issue.

To help you recognize the symptoms of a substance abuse issue, going through the following questions may help. The more “yes” responses you provide, is more probable that your drinking or drug abuse is a significant problem and interfering with your everyday life.

  • Do you feel you should lower the frequency of your drug use or drinking?
  • Have you felt the need to use additional doses of alcohol or drugs to achieve the same effects on your outlook or mood?
  • Do you regret saying things while high on drugs or drunk?
  • Do you fail to cut down on drug use or alcohol, but you can't?
  • Have you found yourself lying about how often or how much you use drugs or drink alcohol?
  • Are you finishing your prescription meds at a faster rate than expected?
  • Have your family members or friends expressed unease about your drug or alcohol use?
  • Have you ever felt guilty, bad or ashamed about your drug use or drinking?
  • Has your drug use problems or alcoholism affected your work and school performance or created issues in your relationships?
  • Has your drug abuse or alcoholism caused trouble with law enforcement?

The mental disorders that most frequently co-occur with substance use disorders are anxiety, depression and bipolar disorder.

Prevalent Signs Of Anxiety

Unwanted worry and tension

Sense of restlessness

Feeling always “on edge” or excessive touchiness

Headaches and stiff muscles

Difficulty in concentrating

Sudden breathing difficulty or Racing heart

Trembling, sickness or light-headedness

Difficulty sleeping

Telltale Signs Of Depression

Sense of hopelessness and helplessness

Lack of interest and loss of purpose in everyday activities

Lack of vigour and energy

Pervasive feelings of insignificance or responsibility

Inability to feel pleasure

Changes in body weight or appetite

Changes in sleep habits

Trouble in focusing on specific tasks

Physical discomfort, anger, and reckless attitude

Frequent Symptoms Of Mania In Bipolar Disorder

Feelings of extreme irritability or euphoria

Impractical, grandiose views

Compromised decision-making and impulsivity

Rage or anger

Reduced sleep requirement

Added energy

Fast speech and sprinting thoughts


Other mental conditions that generally co-occur with addiction or substance abuse include Borderline Personality Disorder, Schizophrenia and Post Traumatic Stress Disorder.

Dual diagnosis doesn’t imply a singular diagnosis — it is rather a mixture of two or more diagnoses occurring simultaneously.

Sometimes, it can be tough for your health professionals to make a precise diagnosis because the signs of these conditions often overlap. For instance, self-neglect can be a sign of substance abuse as well as major depression.

However, your health professionals will use a variety of screening assessments to assess you for both disorders. It is essential to be honest and sincere when speaking with your doctor or other health professional. Based on your responses, they can decide your conditions and ascertain appropriate management [1].

Here we will list a few of the screening and diagnostic methods for identifying dual-diagnosis disorders:

Clinical Interviews: Includes demographic background, medical history, family history, drug history, and socioeconomic status.

Self-Assessment Questionnaires: Includes detailed questions on signs and symptoms of mental health conditions and substance use disorder to identify the disorders and quantify the severity of both conditions.

Blood Tests: In some cases, certain blood tests might be advised to ascertain the effect of long-term drug use or identify co-occurring physical health issues.

Imaging Scans: Rarely, imaging scans would be required if you have a history of trauma or other relevant signs of physical/neurological illness that might have contributed to your mental health condition.

Managing dual diagnosis includes treating your primary mental health condition along with the substance abuse problem. It is a long-term therapeutic journey that comprises working with a healthcare provider to recognise how each condition affects the other. This will help you decide which management options will be most successful.

To achieve a complete recovery from your dual diagnosis disorders, you must take a break from the addictive substances. For most people, this begins with a process of detox or detoxification. For the period of inpatient detoxification, health professionals monitor your health status 24/7 for at least a week. They will help you dissuade off the substance and offer ways to decrease the impact of withdrawal.

Depending on certain factors, your action plan for dual diagnosis will comprise medication, behavioural therapy, in-patient care support groups or any combination of these. For instance, CBT can be undertaken for alcoholism treatment as well as for dealing with mood disorders [1].


The authorized health professionals may recommend medication for one or both of your dual diagnosis conditions.

Selected drugs can aid in the alleviation of the symptoms of both dual-diagnosis conditions.

For example, the FDA has approved bupropion for nicotine dependence and for the treatment of depression.

Behavioural Therapy

Certain behavioural therapies have shown promise in treating co-occurring disorders. These include:

Cognitive behavioural therapy (CBT): This type of therapy teaches you how to change ineffective thinking patterns or cope with them.

Dialectical behavioural therapy (DBT): This therapy reduces behaviours that can induce self-harm. These can include suicidal thoughts, drug use or other actions that involve self-harm of any sort [2].

Support Groups

A healthy support group can be very useful by giving you the social and emotional support you want to sustain your sobriety.

The individuals in these groups have been through the same situation before. Your mates will disclose their experiences and practices and answer your queries.

They can also provide tips on how to manage everyday life and routine encounters.

In-Patient Care

If you are feeling dependent on substances for day-to-day functioning along with dealing with symptoms of a mental health condition that affects your quality of life, you will benefit from enrolling in an inpatient treatment centre that specializes in dual diagnosis treatment.

Once enrolled, you will get the benefits of 24/7 monitoring along with round-the-clock mental health care that can include therapy, medication and support.

The clients can choose to enrol in an outpatient treatment centre if their work-life commitments don’t allow for continuous inpatient care. These centres will set up a flexible schedule for your therapy sessions and appointments suited to your routine, though 24/7 monitoring wouldn’t be possible.

1. Cleveland Clinic. Dual Diagnosis. https://my.clevelandclinic.org/health/diseases/24426-dual-diagnosis

2. Medline Plus. Dual Diagnosis. https://medlineplus.gov/dualdiagnosis.html

3. National Alliance On Mental Illness. Substance Use Disorders. https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Substance-Use-Disorders

4. Dualdiagnosis.org. Dual Diagnosis Statistics https://www.dualdiagnosis.org.uk/dual-diagnosis-statistics/