Understanding Dual Diagnosis: When Mental Illness and Substance Abuse Collide

When you struggle with both mental health and substance abuse issues, the path to recovery can be extra challenging. Even if you make the courageous move to seek help, you might not know where to begin. Experiencing both mental health issues and substance addictions can make it difficult to make the right decisions for your well-being. Mental health and substance issues can also play off and aggravate each other, making both conditions more severe.

If you’re thinking of making the leap and asking for help, you’re already a step ahead of the game. Acknowledging your struggles is essential for getting appropriate treatment and care for your symptoms. You may have a long road ahead of you, but chances are you’re more resilient than you think. Here are some things to know about getting a dual diagnosis and setting off on the path to wellness.

Finding Integrated Treatment

One of the biggest hurdles in handling co-occurring addictions and mental health issues is finding professionals who can handle both simultaneously. Many practices and facilities simply aren’t equipped or trained to take on the challenges of a dual diagnosis. The treatment protocols for mental health issues and substance abuse can require very different types of training and specialization.

Many people with addictions also don’t recognize that their substance abuse is a symptom of a mental health issue (or, sometimes, vice versa). These individuals may find themselves at either a drug rehab center or a mental health facility. Their singularly focused treatment won’t be as effective because the two problems are so deeply intertwined. A better option would be a mental health rehab program with a dedicated dual diagnosis approach.

Getting the Right Diagnosis

Figuring out the exact relationship between your mental health and substance abuse issues can be a major undertaking. It can be difficult to pinpoint whether your addiction stems from your mental health issues or the reverse. It can also be challenging to isolate and treat the cause of symptoms from each condition. For instance, are you irritable because of a mood disorder or because you’re in withdrawal?

Another complication is figuring out what mental health diagnoses to assign, which can be tricky even without addiction in the picture. Mood and personality disorder symptoms often look very similar across different conditions. For instance, borderline personality disorder and bipolar disorder often get mistaken for one another. You could also have multiple co-occurring mental health disorders in addition to an addiction.

Understanding Self-Medication

Substance abuse is often not the root of the problem — it’s a form of self-medication to manage a preexisting mental health condition. For instance, a person with undiagnosed depression may turn to alcohol or drugs in an attempt to dull the pain. Or someone with anxiety may find themselves over-consuming marijuana or other drugs to help calm down. 

Trying to treat the addiction without first treating mental health symptoms can often lead to more problems. Your symptoms could become more severe without the numbing or soothing effects of your addiction. But continuing to use substances can actually worsen your symptoms both acutely and over the long run. Effective treatment involves making sure you understand both diagnoses, treating them concurrently, and managing triggers for both conditions.

Managing the Risk of Self-Harm

People with dual diagnoses are more likely to engage in self-harm or commit suicide. Alcohol abuse, for instance, significantly increases the risk of suicide in people with bipolar disorder. Self-harm and suicide can also come in the form of accidental drug or alcohol overdose while self-medicating. Substance abuse may increase self-injury behaviors like intentional self-cutting or -bruising as well.

People with dual diagnoses should get comprehensive treatment to reduce the risk of suicidal and self-harming behaviors. This includes learning healthy coping mechanisms to replace both substance abuse behaviors and any self-injury habits. Many patients will need clinical therapy that specifically addresses suicidal ideation. Extra care and attention should also be taken in creating a safety plan for these individuals, in case of emergency.

Handling Financial and Legal Fallout

Sometimes, people with dual mental health and substance abuse issues face significant legal and financial issues. Some have run into trouble with the law while trying to acquire drugs or gotten into car accidents or violent incidents. Many have spent significant amounts of money on their addictions and/or on paying for the legal fallout of their actions.

As these people begin to heal, managing these consequences can cause them to experience increased shame or feel overwhelmed. Financial or other stress can lead to exacerbated mental health symptoms and a strong tendency to relapse. Effective treatment programs can provide advice or preparation for dealing with such setbacks.

Developing a Support Network

People with dual diagnoses may need extra support to manage systems and avoid relapse, in addition to therapists, friends, and family. If you’re struggling, a shared community is a strong way to stay on track. A group program for people struggling with both mental health and substance issues is an excellent option for making connections while undergoing treatment.

Building community through team sports, hobby groups, religious or community centers, and other group activities can also be helpful. Having the support of many friends and loved ones can help motivate you to stay on track. It can likewise lift your overall sense of well-being, reducing symptoms and decreasing the impulse to self-medicate.

The Road Ahead

Managing dual diagnoses can be a long and difficult road, especially as some mental health conditions never really go away. But with the right attitude, treatment, and support network, it is more than possible to improve and thrive. When in doubt, don’t be afraid to seek help from your treatment team and support network — they’re there because they want you to succeed.