Dual diagnosis is defined by the presence of both mental health disorders and substance abuse disorders (alcohol and/or drug dependence or abuse) [1]. There are a variety of different mental health disorders that can be associated with substance use and labeled dual diagnosis. Some of these disorders include: schizophrenia, bipolar disorder, anti-social personality disorder, narcissistic personality, and depression. A big question among the experts is which comes first- the mental health problem or substance use? It’s a difficult question to answer because so many of the symptoms associated with mental health disorders resemble the by product of substance use and vice versa. This is also an important topic right now because of the overwhelming amount of substance use cases and mental health disorders that overlap.

In a recent study conducted by the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), it was estimated that 17.6 million American adults meet the criteria for an alcohol use disorder and approximately 4.2 million meet the criteria for a drug use disorder [2]. In addition to this, 19.2 million adults can be diagnosed for independent mood disorders (major depression, dysthmia, manic disorder, and hypomania) and 23 million meet the criteria for independent anxiety disorders (including panic disorder, generalized anxiety disorder and specific social phobias) [2]. The NESARC also reported that approximately 20% of those individuals reporting a mental health disorder also reported a substance abuse disorder. Conversely, 20% of those individuals with a substance abuse disorder also displayed mental health problems [2].

When alcohol use is observed along with mental health disorders, alcoholics usually report that they “self-medicate” in order to alleviate symptoms of their psychiatric condition, such as depression [3]. One of the problems with using drinking as an emotional balm are the negative effects of heavy drinking as well as withdrawal from drinking- both can worsen an already negative mood state [4]. Having said this, it is interesting to see how different mental health disorders manifest themselves when substance use enters into the equation. Depending on what the disorder is, substances use is reported to be used for different reasons and also to either alleviate or bring on certain symptoms. For instance, in the case of bipolar disorder, though drinking may occur in both the manic and depressive phases, drinking is more prevalent during the manic phase [4]. Similarly, drinking may also produce symptoms that are similar to the manic phase of bipolar disorder such as grandiosity, irritability or physical agitation. In regards to anxiety disorder for instance, alcoholics usually report intense symptoms such as palpitations, sweatiness, and fear of objects or social situations which usually disappear with the discontinuation of alcohol use. However, individuals with agoraphobia or social phobia might drink in order to reduce the amount of anxiety they feel [5].

All of these complications and overlapping symptoms makes it very difficult to properly diagnosis these disorders. Treating a dual diagnosis case also becomes an issue because from a traditional treatment background, mental health disorders and substance abuse are two separate issues and therefore require two separate sets of doctors. However, recent studies indicate that an integrated approach or combination therapy is a more effective means of helping dual diagnosis patients reduce substance abuse and eventually stop using [6]. Research shows that mental health clinicians usually emphasize the importance of support for the client and push medications. On the substance abuse side, there is usually an emphasis on harm reduction and abstaining from drug use, often staff will even tell clients to not take their medication- leading to worse results. It is almost guaranteed that patients in separate treatment programs will relapse if they have a serious substance abuse disorder and mental health problem [7]. Having said this, an integrated approach needs to be utilized in order to be more cost-effective and successful overall. Once healthcare professional recognize dual diagnosis as a new hybrid disorder, the sooner changes will be made.

1. Sciacca, K. "An Integrated Treatment Approach for Severely Mentally Ill Individuals with Substance Disorders" New Directions for Mental Health Services, Jossey Bass Publ. Summer 1991,#50.
2. Grant, B.F., Stinson, F.S., Dawson, D.A., Chou, S.P., Dufour, M.C., Compton, W., Pickering, R.P., Kaplan, K. (2004). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the national epidemiologic survey on alcohol and related conditions
Archives of General Psychiatry. 61: 807-816.
3. Modesto-Lowe, V. & Kranzler, H.R. (1999). Diagnosis and treatment of alcohol-dependent patients with comorbid psychiatric disorders. Alcohol Research & Health: 23(2): 144-149.
4. Kranzler, H.R., Mason, B. & Modesto-Lowe, V. (1998). Prevalence, diagnosis, and treatment of comorbid mood disorders and alcoholism, In: Kranzler, H.r>, and Rounsaville, B. eds. Dual Diagnosis and Treatment. New York: Marcel Dekker, Inc. 107-136.
5. Kranzler, H.R. (1996). Evaluation and treatment of anxiety symptoms and disorders in alcoholics. Journal of Clinical Psychiatry 57: 5-21.
6. Drake, R.E., Mercer-McFadden, C., Mueser, K.T., McHugo, G.J.,Bond G.R. (1998). Review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophrenia Bulletin: 24(4): 589-608.
7. Drake, R.E., Bartels, S.J., Teague, G.B., Noordsy, D.L., & Clark, R.E. (1993). Treatment of substance abuse in severely mentally ill patients. The Journal of Nervous and Mental Disease, 181 606-611.

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