Dear Rae: What’s a Dual Diagnosis? Is That What I Have?

ask sign dual diagnosis

Dear Rae: I am researching rehabs for my depression, and I also have a drinking problem. I keep reading about dual diagnosis and co-occurring disorders. Is that what I have?  N.K.


Dear N.K.

“Dual diagnosis” and “co-occurring disorders” are both terms that refer to someone who experiences a mental illness and a substance use disorder (SUD) simultaneously. Either disorder, SUD or mental illness, can develop initially and even cause the other disorder to develop or worsen.


Dual Diagnosis and Co-Occurring Disorders …

You are not alone. Some of the most common co-occurring mental health disorders found in those with SUDs are  mood and anxiety disorders. These include depression and bi-polar disorders (mood related), and post-traumatic stress disorder (PTSD) and trauma (anxiety related). In fact, about 20 percent of Americans with an anxiety or mood disorder also have a substance use disorder. And about 20 percent of those with a substance use problem also have a mood disorder, depression or other mental health challenges.


When high anxiety strikes, you might self-medicate with alcohol to ease the pain. Self-medication is common and defined by the use of drugs or other substances to treat self-recognized or self-diagnosed mental health issues.The substance may feel like it’s helping at first, but it’s a vicious cycle, not an end solution.


What’s more, those who have experienced PTSD and trauma can have a lower than normal baseline of dopamine. This makes them more susceptible to substance use, misuse and dependence because the substance creates a feeling of “normalcy.”


Treatment for Dual Diagnosis

Now, to answer your question: Is that what I have? A more thorough assessment would have to be performed. An assessment is used to diagnose and develop specific treatment recommendations. And a co-occurring disorder can be difficult to diagnose, because symptoms of substance dependence can mask symptoms of mental illness.


But, the best treatment for dual diagnosis is an “integrated intervention”. This means you would receive care for both your diagnosed mental illness and SUD at the same time. Treatment is not the same for everyone. Individualized treatment includes detoxification; residential or intensive outpatient treatment; recovery support; psychotherapy; and medication can also be used as a tool.


You would be advised to seek guidance from a reputable therapist or addiction treatment center specializing in working with co-occurring disorders. At Sanford, we treat the whole person in a comprehensive approach to wellness and recovery – addressing co-occurring conditions in one location (this is still an exception in most treatment settings). Research by the National Institute on Health states that an integrated approach will improve patient outcomes. Better outcomes include reduced substance use; decrease in legal and medical costs; improved mental health symptoms; job and relationship stability; and improved quality of life.


Think of this as a time for learning skills and receiving education rather than “fixing” something. We live in an idealized society and there can be a sense of shame for not feeling emotionally healthy. But seeking help in the form of therapy or treatment is not a sign of weakness. Rather a proactive indicator of strength to come.

Rae Green, JD, LPC, CAADC


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Rae Allyson Green, JD, MA, LPC, CAADC, is the Founder & President of Sanford Behavioral Health. After extensive experience working in residential treatment centers, Rae sought a new treatment approach for addiction and co-occurring disorders. Together with husband, David Green, she established Sanford Addiction Treatment Centers in 2015. Their mission was to elevate the effectiveness and availability of treatment for individuals diagnosed with substance use disorders (SUDs). Today, Sanford is an addiction, eating disorder, and co-occurring mental health treatment facility, serving the state of Michigan and beyond.