Dual Diagnosis

Roughly one-third of all U.S. adults with a non-substance-based mental health diagnosis are also engaged in a pattern of substance abuse, according to figures compiled by the National Alliance on Mental Illness. Among people affected by major depression, schizophrenia and other severe mental health issues, the rate of substance abuse increases to approximately 50 percent. The same findings hold true in reverse. At least a third of U.S. adults affected by alcohol abuse qualify for an independent mental health diagnosis, while over 50 percent of adults affected by drug abuse also qualify for such a diagnosis. Some people affected by mental illness eventually develop serious problems with drugs or alcohol; conversely, some people affected by serious problems with drugs or alcohol eventually develop an independently diagnosable mental illness.

Experts in mental health and addiction refer to dual diagnosis as a comorbid condition. This means that there is an additive effect between diagnosable substance problems and mental illness that worsens the impact on affected individuals. Specific issues found in cases of dual diagnosis include a reduced tendency to seek and receive proper medical care, a reduced tendency to participate actively in available treatment programs and a reduced level of responsiveness to some of the medications commonly used to help people dealing with serious mental illness.

Dual Diagnosis Recovery

Despite the comorbid nature of substance use disorder and other mental health problems, doctors have fairly effective ways of supporting a recovery from a dual diagnosis. Since substance use can significantly degrade the effectiveness of mental illness treatment, the recovery process frequently begins with substance detoxification and treatments aimed at promoting a stable state of drug or alcohol abstinence. Depending on the substance involved, the appropriate treatment may include medication, some form of behavioral therapy or psychotherapy, or a combination of medication and behavioral therapy/psychotherapy. Even when substance use is an ongoing problem, doctors can often find treatment approaches that provide at least some relief for their dual diagnosis patients.

Dual diagnosis treatment can take place in a range of settings, including inpatient programs or residential facilities, outpatient programs and mutual self-help groups. Factors that help determine the appropriate venue for treatment include the severity of the substance problems involved, the severity of the separate mental illness involved and the ability or willingness of the individual to participate actively in the recovery process.

What Helps and Hinders Dual-Diagnosis Recovery?

In the study published in Advances in Dual Diagnosis, researchers from Yale University and Norway’s Buskerud and Vestfold University College used information gathered from previous American and European research efforts to analyze the factors that can either facilitate recovery from a dual diagnosis or hinder such a recovery. These researchers undertook their review and analysis, in part, because much of the existing body of evidence focuses on either substance problems or separately diagnosable mental illnesses rather than addressing the unique issues of dual diagnosis. They also undertook their work out of a desire to improve the level of available knowledge regarding effective dual diagnosis treatment.


After completing their review and analysis, the researchers concluded that three main factors make successful dual diagnosis recovery more likely to occur: an emphasis on treatment goals that contribute to the establishment of a fulfilling daily routine, a treatment outlook that emphasizes recovering individuals’ strengths rather than their weaknesses and a treatment approach that stresses the importance of reconnecting socially with others and forming beneficial support networks. Conversely, two factors substantially decrease the likelihood of a successful dual diagnosis recovery: a treatment approach that fails to take individual patient differences into account and a larger system of treatment that addresses substance problems and other diagnosable mental health issues in an overly complicated, non-integrated manner.


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