What is Dual Diagnosis? When Addiction and Mental Illness Co-Occur

Table of Contents

  1. What is Mental Illness?
  2. What is Addiction?
  3. The Prevalence of Dual Diagnosis and How it Occurs
  4. Mental Illnesses that Commonly Occur with Addiction
  5. How Co-Occurring Disorders Are Diagnosed
  6. Integrated Treatment Offers Better Outcomes for Dual Diagnosis
Addiction and mental illnesses commonly occur together. When they do, it’s known as a dual diagnosis, or co-occurring disorders. Dual diagnosis requires specialized treatment that addresses both disorders. Since dual diagnosis is common, it’s not difficult to find a program that treats both addiction and mental illness.

If you or someone you love has been diagnosed with co-occurring disorders or you suspect a dual diagnosis, it’s important to understand both addiction and mental illness, including how they occur, how they’re diagnosed and how they’re best treated.

What is Mental Illness?

According to the American Psychiatric Association, around one in five adults–20 percent of the population–has some form of mental illness. 1 Mental illnesses cause changes in thought patterns, emotions, or behaviors– or all three. It can interfere with healthy social functioning and reduce feelings of good health and wellbeing. The most common mental illnesses are anxiety and depression. In any given year, around 40 million Americans are living with an anxiety disorder, and nearly 15 million suffer from depression.

Mental illness is highly treatable, but many people who have a mental illness don’t seek help because it is still a misunderstood and vilified diagnosis. Stigma against mental illness is still prevalent in modern society, even though mental illnesses are medical conditions that just happen to affect the brain instead of another organ like the heart or liver.

The best treatment for mental illness is a combination of medication and counseling. Medication properly balances brain chemicals, while counseling helps teach skills and strategies for coping with and reducing symptoms.

What is Addiction?

Addiction is widely considered to be a brain disease because it changes the physical structures and chemical functions of the brain. These changes lead to compulsive drug abuse despite the negative consequences it causes. Someone struggling with addiction will be unable to quit using drugs or alcohol despite wanting to quit or trying to stop. The National Institute on Drug Abuse stresses that once an addiction develops, good intentions and willpower are not enough to end it for the long-term. 2 It almost always requires professional help.

Addiction is highly complex. It almost always has underlying issues, which often include a history of trauma, chronic stress, family dysfunction or mental illness. These issues must be addressed in order to effectively treat an addiction. Additionally, addiction does serious damage to many areas of life. It causes dysfunction in relationships and can lead to financial and legal troubles. It does a number on health and wellbeing. Successfully treating an addiction requires repairing the damage it has done. Finally, addiction changes thought and behavior patterns and leads to dysfunctional ways of thinking and behaving. Central to successful recovery is identifying these harmful patterns and learning to think and behave in healthier ways.

Dependence vs. Addiction

Dependence often occurs with addiction, but it’s not the same thing as addiction. Dependence is a physical reliance on drugs or alcohol characterized by withdrawal symptoms that set in when using stops. Dependence occurs as the result of the brain changing its chemical function in order to compensate for heavy substance abuse. This causes tolerance, which means that it takes increasingly larger doses to get the same effects. But as more is used, the brain continues to compensate, and at some point, brain function may shift so that it now operates more comfortably when the substance is present. Then, when use suddenly stops, normal brain function rebounds, and this sudden change in neurotransmitter activity produces physical withdrawal symptoms.

Addiction and dependence are diagnosed under the umbrella of “substance use disorder.”

The Prevalence of Dual Diagnosis and How it Occurs

According to the National Alliance on Mental Illness, around one-third of people who have any type of mental illness, and half of those with a serious mental illness, also have a substance use disorder. 3 Conversely, around one-third of people who abuse alcohol and over half of people who abuse drugs also have a mental illness.

How they Interact

The link between mental illness and substance abuse is well-established. Three scenarios help scientists understand the link:

  1. Abusing drugs or alcohol almost always makes a mental illness worse, and it can cause a new mental illness to occur.
  2. People who have a mental illness often use drugs or alcohol to self-medicate symptoms, such as using drugs or alcohol to reduce social anxiety or feelings of depression.
  3. Some people are at a higher risk of developing both addiction and mental illness due to overlapping factors.

Overlapping Factors

Overlapping factors for dual diagnosis include:

  • Genetic risks. Several regions of the human genome are associated with both mental illness and substance abuse.
  • Involvement in similar brain regions. Some brain regions are involved in both addiction and mental illness, such as the dopamine system, which is a factor in the development of both addiction and depression.
  • Environment. Environmental factors, such as chronic stress, can influence the development of both addiction and mental illness.

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Mental Illnesses that Commonly Occur with Addiction

While any mental illness can co-occur with a substance use disorder, some are more commonly associated with addiction than others.

Anxiety

Anxiety disorders include social anxiety disorder, generalized anxiety disorder and panic disorder. People with anxiety disorders often use drugs or alcohol to produce feelings of calm.

Depression and Bipolar Disorder

Depressive disorders include major depression and bipolar disorder, which are associated with a higher risk of substance abuse as a form of self-medication. A study published in the journal Psychiatric Clinics of North America found that nearly half of all people with bipolar disorder have a lifetime history of addiction. 4

Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder causes uncontrollable and repetitive thoughts and behaviors. People with OCD often use drugs or alcohol to reduce intrusive thoughts and compulsive behaviors.

Eating disorders

Anorexia, bulimia and binge eating disorder are the three most common eating disorders, and they often co-occur with addiction. People who have an eating disorder may abuse drugs or alcohol to control their appetite, cope with low self-esteem or reduce feelings of depression. According to an article in the journal Social Work, around half of all people with an eating disorder abuse drugs or alcohol, compared with just nine percent of the general population. 5

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) often occurs after a trauma and is characterized by symptoms like insomnia, nightmares, flashbacks and fear. PTSD is closely associated with substance abuse as a way to reduce the severity of symptoms and block troubling memories.

How Co-Occurring Disorders Are Diagnosed

Diagnosing co-occurring disorders can be challenging since symptoms of mental illness and addiction may overlap. Several assessments are used in a treatment or mental health setting to help care providers determine whether a mental illness is present and if so, whether the mental illness led to the addiction or vice-versa.

Intake assessments typically include an evaluation of current symptoms, a medical history and a mental illness history. The assessment helps care providers determine the severity of each disorder and develop a comprehensive, individualized, dual diagnosis treatment plan.

Because dual diagnosis is so common, both mental health and substance abuse treatment settings use integrated screening to help make the diagnosis. The simple screening helps providers determine whether a more comprehensive assessment is needed.

Integrated Treatment Offers Better Outcomes

Treating just a mental illness will do little to end an addiction, and treating just an addiction will do little to heal the mental illness. Successful recovery from a dual diagnosis requires integrated treatment that treats both disorders at the same time, taking into account both conditions.

Integrated treatment is a collaboration among treatment teams and provides a holistic approach to treatment. According to the Substance Abuse and Mental Health Services Administration, integrated treatment:

  • Reduces substance abuse
  • Improves symptoms of mental illness
  • Increases mental functioning
  • Reduces hospitalization
  • Increases stability in the client’s life
  • Results in fewer legal troubles
  • Improves clients’ overall quality of life

Holistic Treatment

A holistic treatment approach offers the best treatment outcomes. This approach involves a variety of traditional and complementary therapies and other interventions. These approaches address a wide range of issues of body, mind and spirit for whole-person healing.

Traditional Therapies

Traditional therapies include cognitive-behavioral therapy, dialectical behavioral therapy, acceptance and commitment therapy and pharmacotherapy, or the use of medications to treat symptoms of mental illness. Traditional therapies focus on helping people learn to better manage their thoughts, emotions and behaviors.

Complementary Therapies

Complementary therapies include art or music therapy, mindfulness meditation and restorative yoga. Complementary therapies improve self-awareness, self-esteem and self-confidence and provide clients with new ways to look at old issues.

Other Interventions

Other interventions and services in a holistic program are used as needed to ensure all needs are addressed. These interventions include psychoeducational classes that help people better understand dual diagnosis; vocational or educational assistance; legal help; and assistance with finding safe housing.

Goals of Treatment

Through a variety of therapies, individuals in dual diagnosis treatment:

  • Address underlying issues behind the addiction and mental illness
  • Develop coping skills for dealing with mental illness symptoms, cravings, stress and other relapse triggers
  • Identify troublesome thought and behavior patterns and develop new, healthier ways of thinking and behaving
  • Learn to relax and have fun without drugs or alcohol
  • Find purpose and meaning in a life of sobriety
  • Develop crucial life skills for successful independent living
  • Repair damaged relationships and restore function to other areas of life
  • Learn about addiction and mental illness, including how they develop, how they’re treated and how people enjoy long-term recovery from their diagnoses

Staying in treatment for an adequate period of time is essential for successful recovery. The National Institute on Drug Abuse stresses that anything less than 90 days is of limited effectiveness. This is especially true for people with a dual diagnosis.

Dual diagnosis treatment works for most people who engage fully with their treatment plan and stay in treatment for the duration of the program. Treatment helps people improve their thought and behavior patterns and develop the skills and strategies they need to recover from both a mental illness and a substance use disorder. Treatment can help you find peace and clarity in your life, improve quality of life and provide a greater sense of happiness and wellbeing.

Resources

  1. American Psychiatric Association
  2. National Institute on Drug Abuse
  3. National Alliance on Mental Illness
  4. The Psychiatric clinics of North America
  5. Social Work Today

Dr. Venice Sanchez

Ph.D., LMFT

Clinical Outreach Specialist, Europe Division

Dr. Sanchez works closely with Truvida Recovery patients regarding substance abuse and related mental illnesses and creates a supportive, cooperative and informed therapeutic environment. Her areas of expertise include Substance Dependence, Dual Diagnosis, Depression, Bipolar Disorder, Schizophrenia, Generalized anxiety disorder, Panic Disorder, Bereavement, Acute stress disorder, and more. Ms Sanchez has extensive training with experts in the field of Substance Abuse, and mood and thought disorders underlying the substance use. She received a Bachelor’s degree from University of California, Los Angeles and Medical Degree from Michigan State University College of Human Medicine. She continues training at the UC Irvine Psychiatry Residency Program and has been recognized with the Outstanding Resident of the Year Award.

Jaime Askew

LMFT, LPCC

Clinical Director

Ms. Askew is a Licensed Marriage and Family Therapist and Licensed Professional Clinical Counselor who has been working in the field treating substance abuse and mental health issues for over twenty years.  She obtained a Master’s degree in Clinical Psychology, with an emphasis in Marriage, Family, & Child Counseling from Pepperdine University and was among the first to obtain the LPCC license in the state of California.  She has been providing clinical supervision and training to interns, conducting workshops, and is a certified Trauma therapy trainer.  Her areas of expertise include working with legal issues, court ordered treatment, family preservation, trauma therapy, cognitive behavior therapy, family systems, social skills training, play therapy, and career/ vocational counseling.  Her passion is in advocating for at risk populations, holistic healing, and treating the underlying, core issues to help individuals achieve their maximum potential and happiness.  Jaime’s extensive experience and passionate leadership is of extreme importance to the overall TruVida clinical program, and her hands-on guidance of our clinical team insures that each patient is receiving optimal therapeutic treatment and care.

John Biroc

Consulting Psychologist

Dr. Biroc has a broad base of mental health and addiction recovery training and experience. He has supervised and taught therapists in various methodologies of effectively working with groups and individuals during therapy. He created and set up new group structures and trained staff in understanding the challenges of addiction recovery. He also helped develop curricula in Sociodrama and Psychodrama. Dr. Biroc is devoted to breaking paradigms that prevent progress in the path to lasting recovery. He is a member of the Nat’l Association of Marriage and Family therapists, and has a Ph.D. degree in Psychology, and a M.S. degree in Counseling from USC.

Dr. Nader Siahdohoni

Consulting Psychologist

Ph.D.

Dr. Nader is one our esteemed consulting Psychologists who provides our Clients with various breakthrough therapy’s that focus the functional systems including neurons, neurotransmitters, and certain brain waves that enable the way we think, behave, move, feel, and maintain homeostasis. Such therapy’s include NeuroMax neurofeedback, the state of art integrated technology in Neurofeedback, combinations of wireless Electroencephalogram (EEG), real time brain mapping and a unique and exceptional neuropathway therapy called “Visual Concentration Attention Therapy (VCAT)”. Dr Nader graduated from Walden University.

Tiffany Agra

Therapist

LMFT #103693

Ms. Agra is a Cognitive Behavioral Therapist, who has been working with individuals, couples, families, and groups for the past seven years. Her other therapeutic approaches include Narrative Therapy, Family Systems Theory, Psychodynamic dream interpretation, and Gestalt Psychology. She has also been a Guest Speaker at other organizations. This unique background has made her effective at helping clients overcome the grip of substance addiction. Tiffany obtained two Bachelor’s degrees from the University of California, Davis, and her Master’s degree from the California State University, Long Beach. She has worked for both the county of Orange and Riverside, helping those who struggle with addiction and mental illness. In addition to providing evidenced-based approaches to the clinical program at Truvida Recovery, she brings her compassion as a fellow addict in recovery; living proof that we do get better!

Deborah Wieland

Therapist

MS, LMFT #96864

Ms. Wieland is an Eclectic EMDR Therapist, using R-TEP and G-TEP, and specializes in several modalities in treating Substance Use issues, Dual Diagnosis, Complex Trauma, and Severe Mental illness. Deborah also provides several types of therapy such as Psychodynamic, Rogerian, CBT, DBT, IFS, PICT, MI, Grief Recovery, Sand Tray, and Attachment Theory to help her patients achieve mental wellness and a sober lifestyle.

She has worked with Psychiatric Hospitals providing crisis interventions and psychotherapy to those struggling with substance abuse issues, mental health issues, and domestic violence. She completed her undergraduate and graduate studies at Vanguard University of Southern California. She has a Bachelor of Arts in Psychology, Summa Cum Laude and a Master of Science in Clinical Psychology. She is currently completing her Doctoral studies in Clinical Psychology at Cal Southern University. Deborah is an active member of EMDRIA, California Association Marriage Family Therapist (CAMFT), American Association of Christian Counselors (AACC), and Psi Chi International Honors Society of Psychology.

Ashley McLaughlin

Therapist

LMFT

Ms. McLaughlin is a Licensed Marriage and Family Therapist specializing in EMDR therapy. She brings over ten years of experience working in the field of addiction to the Truvida Team. She obtained a Master’s degree in Clinical Psychology, with an emphasis in Marriage and Family Therapy from Pepperdine University and has two Bachelor’s degrees in Psychology and Economics from University of California, San Diego. Ms. McLaughlin was trained in EMDR in 2013 and since has been helping individuals process through past traumatic experiences that have contributed to current struggles with substance abuse and mental health symptoms. Her extensive experience and passion for this field has helped guide individuals through the process of recovery in order to experience freedom from their past and a hope for their future.

Travis Taylor

Therapist

LMFT

Mr. Taylor is a Licensed Marriage and Family Therapist specializing in  Drug Abuse & Addiction,  PTSD, Anxiety, Bipolar Disorder, Borderline Personality, Codependency, Coping Skills, Depression, Dual Diagnosis. Taylor uses an integrative approach geared towards understanding self, specifically what drives one’s thoughts and behaviors. He excels in helping patients identify automatic thoughts that lead to specific feelings and undesired actions. Another useful approach stems from understanding how thoughts and behaviors are fueled by former messages that have been consistently reinforced. Travis has over 6 years of therapeutic practice and obtained a Master’s degree at Vanguard University.

Kat Johnson

AOD Counselor, Group Facilitator

With almost 10 years experience working at treatment centers, Kat Johnson shares her wisdom and passion for balanced living, creative writing, and meditation and how each plays a role in early recovery and beyond. Certified as a CADC II, and supported by a bachelors in psychology, Kat’s infectious energy brings her groups to life. She is grateful for every opportunity to spread health and wellness.

Paige A. Chastain

AOD Counselor, Case Manager

Ms. Chastain has dedicated her life to helping the suffering addict/alcoholic, bringing personal experience to both individual substance abuse and group counseling settings. She has worked in the field of addiction for several years, currently working as an addiction counselor and case manager.  Paige too, is a collaborative member of the multi-disciplinary team providing excellence in addiction services, working with clients from detox to intensive outpatient levels of care. She holds a strong skill-set in Psychoeducation, Motivational Interviewing and Dialectical Behavior Therapy.  She also has extensive experience with 12-step recovery programs. Paige is passionate about treating the client with empathy, compassion and respect throughout the client’s journey.  Paige holds an AA from Saddleback College, a BA from the University of California of Irvine and is a certified CADC-I holding memberships with CCAPP and NAADAC.

Lesley Richards

AOD Counselor, Interventionist

Ms. Richards began in this field of healthcare as a volunteer for substance abuse treatment centers and worked her way up from there. Lesley has dedicated her life to helping the suffering addict. it is here strong belief that everyone deserves to have the opportunity to have a safe and sober life.  She is very compassionate about her work as an addiction counselor, and has a strong commitment in helping patients struggling with addiction in developing healthy coping mechanisms, and developing new positive behavioral habits.  Her Group counseling sessions are highly sought after within the TruVida program.  Lesley is a Certified Alcohol and Drug Counselor (CADC), National Certified Intervention Professional (NCIP), Nationally Certified Recovery Coach (NCRC), and is a member of the California Consortium of Addiction programs (CCAP), as well as the International Association of Addiction Professionals.

Christine Green

Treatment Facilitator

Christine Green is a certified personal trainer, and yoga instructor. Ms. Green is dedicated to helping patients struggling with substance abuse transform their lives through a consciousness-based approach to body-in-motion fitness.

Christine passionately shares her 18 years experience with our clients by sharing her specialized Yoga & Energy Healing Program, which she has developed over the past 8 years of working directly with addicts and alcoholics. Her Yoga program facilitates integration of all the layers of life – environmental, physical, emotional, psychological, and spiritual with the primary initial goal of overcoming withdrawal symptoms and cravings from drug and alcohol dependency. TruVida is fortunate to have her as part of the team.

Allison Goode

Art in Recovery Counselor

Allison Goode is a lifelong resident of Laguna Beach and professional artist for over 15 years, and has developed a very successful and trans-formative Art in Recovery program in treatment facilities through out California. Her passion for the fine arts and helping others recover from substance abuse addiction is contagious. Allison has a unique ability to connect with clients through the creative process helping clients set positive goals for their recovery. Ms. Goode has studied Fine Art and Graphic Design at Laguna College of Art and Design, is a certified RADT1 technician, and is currently completing her CCAPP certification program.

Thomas Mladinich

Admissions Manager

Mr. Mladinich hard work ethic and dedication make him a key part of the TruVida team. Tom’s ability to connect and relate with others have allowed him to excel as admissions manager. His personal experience has allowed him to proudly serve those in need of recovery from addiction. Tom is eager to work with our clients and provide the experience, strength and hope that they need to find success in recovery.

Willie Sanchez

Operations Manager

Mr. Sanchez is a self-motivated professional with a positive attitude. He is actively involved in a 12 step fellowship. He effectively contributes to each Patient with their struggles with addiction. Willie is RADT1 certified counselor and has been educated at Long Beach City College.

Jose Flores

Program Manager

Mr. Flores is a highly motivated and hardworking team member with TruVida. He has several years of experience working in treatment helping individuals get back on track, achieving a lot of great results. He brings problem solving skills and experience to use everyday, and is proud and passionate about his profession as a RADT-I program manager.

Dr. Joseph DeSanto

MD, Addiction Medicine, Internal Medicine

Medical Director

Dr. Joseph DeSanto is a Board Certified MD with over 12 years of addiction treatment experience, and over 26 years of medical experience. He has dedicated his life to the pursuit of treating those who suffer from the disease of Addiction. He provides comprehensive medical treatments and uses genetic, metabolic, and hormonal testing to get to the true causes of medical issues.

Dr DeSanto graduated from Lafayette College and attended the State University of New York medical school. He completed his internship and residency training at Cedars Sinai Medical Center in Los Angeles. His early career centered around emergency and urgent care, and later developed a passion as an Addiction Physician. As the medical director for TruVida, he oversees the medical care and detox care for all clients.

Dr. Andrew Morrow

MD, Psychiatrist

Psychiatrist

Dr Morrow is a member of the American Board of Psychiatry and Neurology Psychiatry, who specializes in the treatment of depression, anxiety, bipolar disorder, thought disorders, other mental health issues, and substance abuse addictions. Having undergone extensive training in medical school, psychiatric residency and over 15 years of psychiatric practice, he is well trained in both psychotherapy and medication management of mental problems. Dr Morrow integrates psychological, and social characteristics with biological therapy to treat the whole person; mind, body, and soul, and it is with great humility that he pursues the goal of freedom from substance abuse addictions.

Dr DeSanto conducted his undergraduate education at St. Louis University with a B.S. in Chemistry graduating summa cum laude. He then attended medical school at St. Louis University School of Medicine, and completed his residency training and served as chief resident at University of California, Irvine Medical Center.