Key Takeaways
- Approximately 50 percent of individuals with a substance use disorder also have a diagnosable mental health condition.
- Treating addiction without addressing co-occurring mental health disorders results in significantly higher relapse rates.
- Integrated dual diagnosis treatment addresses both conditions simultaneously with a coordinated clinical team.
- Common co-occurring disorders include depression, anxiety, PTSD, bipolar disorder, and ADHD.
- Proper psychiatric assessment during treatment intake is critical for identifying co-occurring conditions that may have been masked by substance use.
What Is Dual Diagnosis?
Dual diagnosis, also known as co-occurring disorders, refers to the simultaneous presence of a substance use disorder and at least one mental health condition. This is not a rare phenomenon; the Substance Abuse and Mental Health Services Administration estimates that approximately 9.2 million adults in the United States have co-occurring disorders. The relationship between mental health and addiction is bidirectional: mental health conditions increase vulnerability to substance use, and substance use can trigger or worsen mental health symptoms.
Common co-occurring combinations include alcohol use disorder with depression, opioid use disorder with anxiety, stimulant use disorder with ADHD, and polysubstance use with PTSD or bipolar disorder. Each combination presents unique clinical challenges and requires a tailored treatment approach. A person self-medicating social anxiety with alcohol, for example, needs a fundamentally different treatment plan than someone using methamphetamine to manage untreated ADHD.
At Trust SoCal in Fountain Valley, every client receives a comprehensive psychiatric evaluation during the intake process. This assessment is designed to identify co-occurring mental health conditions that may have been masked by active substance use. Because many psychiatric symptoms mimic the effects of substances or withdrawal, accurate diagnosis often requires a period of sobriety and clinical observation before a definitive diagnosis can be made.
Why Treating Only the Addiction Is Not Enough
Historically, addiction treatment and mental health treatment operated as separate systems. Clients were often told they needed to get sober before they could address their mental health, or conversely, that they needed to stabilize their psychiatric symptoms before they could focus on addiction. This sequential approach consistently produced poor outcomes because it left one condition untreated while attempting to manage the other.
When a person with depression completes addiction treatment but does not receive treatment for their depression, the persistent feelings of hopelessness, fatigue, and emotional pain that characterized their depressive episodes remain. Without substances to numb these symptoms, the individual is left with raw emotional distress and no effective coping mechanism. Relapse becomes not just likely but almost predictable, because the underlying driver of their substance use was never addressed.
The same principle applies to anxiety disorders, PTSD, bipolar disorder, and other mental health conditions. Each of these conditions produces symptoms that substances temporarily alleviate, creating a powerful psychological incentive for continued use. Until the co-occurring condition is treated with appropriate psychiatric medication, therapy, or both, the motivation to self-medicate will persist even through periods of enforced abstinence.
Untreated co-occurring mental health disorders are one of the leading causes of relapse. If you have been through treatment before without a psychiatric evaluation, this may be a critical gap in your recovery plan.
How Integrated Dual Diagnosis Treatment Works
Integrated dual diagnosis treatment addresses both the substance use disorder and the mental health condition simultaneously within the same treatment program, by the same clinical team. This approach ensures that all providers are aware of both diagnoses and can coordinate interventions accordingly. When a therapist adjusts the addiction treatment plan, they consider the impact on the client's mental health, and vice versa.
A typical integrated treatment plan at Trust SoCal includes individual therapy that addresses both conditions, group therapy for addiction recovery, psychiatric medication management for the mental health condition, psychoeducation about the relationship between mental health and substance use, and holistic interventions that support overall wellness. The treatment team meets regularly to review each client's progress across both dimensions and adjust the plan as needed.
Evidence-based therapies that are effective for dual diagnosis include cognitive-behavioral therapy, which addresses both depressive thinking patterns and substance use triggers; dialectical behavior therapy, which builds distress tolerance and emotional regulation skills critical for both conditions; and EMDR, which processes traumatic memories that may be driving both PTSD symptoms and substance use. These modalities are selected based on the specific co-occurring conditions present.
The Role of Psychiatric Medication in Dual Diagnosis
Psychiatric medication is often an essential component of dual diagnosis treatment, but it must be prescribed and monitored carefully in the context of active addiction or early recovery. Some psychiatric medications, such as benzodiazepines for anxiety or stimulants for ADHD, carry their own risk of abuse and are generally avoided in individuals with substance use disorders. Alternative medications with lower abuse potential are used instead.
Antidepressants such as SSRIs and SNRIs, mood stabilizers like lithium and lamotrigine, and non-addictive anti-anxiety medications like buspirone or hydroxyzine are commonly prescribed in dual diagnosis treatment. The prescribing psychiatrist at Trust SoCal coordinates closely with the addiction medicine team to ensure that all medications are safe, effective, and consistent with the client's recovery goals.
Common Co-Occurring Disorders in Addiction
Depression is the most commonly co-occurring condition with substance use disorders. Chronic substance use depletes neurotransmitters like serotonin and dopamine, which are directly involved in mood regulation. When a person stops using substances, the depleted neurochemistry can produce a severe depressive episode that feels worse than the depression that preceded their addiction. Proper antidepressant therapy can bridge this gap while the brain heals.
Anxiety disorders, including generalized anxiety, social anxiety, and panic disorder, are also highly prevalent among individuals with addiction. Many people discover their substance use began as a way to manage anxiety symptoms, and removing the substance without addressing the anxiety creates an intolerable level of distress. Evidence-based anxiety treatment, including CBT, exposure therapy, and medication, provides sustainable relief without the risks of self-medication.
PTSD and addiction frequently co-occur, particularly among veterans, survivors of abuse, and first responders. The relationship is cyclical: traumatic experiences increase vulnerability to substance use, and substance use interferes with the brain's ability to process and heal from trauma. Integrated treatment that addresses both conditions simultaneously, as discussed in our article on trauma-informed care, produces the best outcomes for this population.
- Depression: Present in approximately 30-40% of individuals with substance use disorders
- Anxiety disorders: Affect roughly 20-30% of people seeking addiction treatment
- PTSD: Found in up to 50% of individuals with co-occurring substance use disorders
- Bipolar disorder: Individuals with bipolar are 7 times more likely to develop addiction
- ADHD: Adults with untreated ADHD are twice as likely to develop substance use disorders
- Personality disorders: Borderline personality disorder co-occurs with addiction at high rates
Identifying Co-Occurring Disorders During Treatment
Accurate diagnosis of co-occurring disorders is challenging because the symptoms of substance use, withdrawal, and mental health conditions often overlap significantly. A person in early withdrawal from alcohol may present with symptoms identical to a major depressive episode: insomnia, loss of appetite, irritability, hopelessness, and fatigue. Similarly, stimulant withdrawal can mimic the symptoms of ADHD, and opioid withdrawal can look like generalized anxiety disorder.
For this reason, the most reliable psychiatric assessment occurs after the acute phase of withdrawal has resolved, typically one to two weeks into treatment. During this period, the clinical team observes the client's symptoms, notes which symptoms persist as the substance clears the body, and uses standardized diagnostic tools to differentiate between substance-induced symptoms and independent psychiatric conditions. This careful, longitudinal approach to assessment prevents misdiagnosis and ensures that treatment is targeting the right conditions.
Trust SoCal employs board-certified psychiatrists who specialize in addiction psychiatry, a subspecialty that requires expertise in both mental health diagnosis and substance use disorders. This specialized training allows for more accurate diagnosis and more effective medication management in the complex clinical context of co-occurring disorders. To learn more about dual diagnosis assessment and treatment, contact Trust SoCal in Orange County at (949) 280-8360.
Long-Term Management of Co-Occurring Disorders
Recovery from co-occurring disorders is a long-term process that extends well beyond the initial treatment episode. Unlike a broken bone that heals and requires no further treatment, both addiction and mental health conditions require ongoing management to maintain stability. This typically includes continued psychiatric medication, regular therapy sessions, participation in support groups, and the consistent application of coping skills learned during treatment.
Aftercare planning for dual diagnosis clients at Trust SoCal includes referrals to outpatient psychiatrists who can continue medication management, connections with therapists who specialize in co-occurring disorders, and recommendations for support groups that address both addiction and mental health. The goal is to create a robust support network that sustains recovery long after primary treatment ends.
When choosing an aftercare therapist, look for someone with experience in both addiction and mental health treatment. A therapist who specializes in only one area may inadvertently neglect the other.
Rachel Handa, Clinical Director
Clinical Director & Therapist
