Out of the estimated 16 million people suffering from alcohol use disorder (AUD), 7.9 million have an additional mental health disorder. This co-occurrence of disorders is often known in the medical community as dual diagnosis.

Though a dual diagnosis can be more complicated to treat than a singular occurring addiction disorder, it’s certainly possible. Read on to learn more about dual diagnosis, what it looks like, and how it can be treated.

Understanding Dual Diagnosis

Also known as co-occurring disorders, dual diagnosis is the term for a situation where a mental health illness and substance abuse addiction simultaneously occur.

This is common among individuals with alcohol use disorders, who may drink to numb the unpleasant symptoms and feelings that often come with mental health disorders. For example, a person with an anxiety disorder may turn to alcohol to lessen feelings of panic and dread. Research has shown that alcohol use may worsen symptoms of mental health conditions, though it does not cause them.

Individuals with a dual diagnosis are statistically significantly more likely to develop alcohol use disorder than those without. About a third of those dealing with an alcohol addiction have at least one co-occurring disorder.

A dual diagnosis is especially dangerous because the symptoms of each can exacerbate one other. That makes it easy for the abuse and the mental health disorder to both spiral out of control if left untreated.

It’s important for those dealing with a dual diagnosis involving substance abuse disorder to seek treatment from professionals with training and experience. Treating clients with a dial diagnosis typically requires clinical skills and licensing beyond basic substance abuse counseling.

Spending time in a rehab facility is often a good way for many individuals with co-occurring disorders to begin a new sober lifestyle while treating their mental health condition appropriately. This allows counselors and therapists to delve deeper into the individual’s circumstances and treat the person as a whole instead of focusing on just the AUD or mental health disorder.

Common Co-Occurring Disorders With AUD

There are several primary mental health disorders that often appear in conjunction with alcohol use disorder. Most individuals with dual diagnosis use drugs or alcohol to mask the symptoms they experience from their mental illness, which may often include any of following disorders.


Depression is a state of mood characterized by general feelings of emptiness and a lack of interest in life. Those suffering with depression may find their thoughts, feelings, and behaviors strongly affected by their disorder.

Some of the main symptoms of depression include:

  • Feelings of hopelessness and/or despair
  • Feelings of intense sadness
  • Irritability
  • Decreased ability to concentrate
  • Insomnia or sleeping too much
  • Weight gain or weight loss
  • Social isolation
  • Decreased energy
  • Lack of interest in activities and hobbies

Depression can greatly affect self-esteem, daily behavior, and may even lead to suicidal thoughts.


Anxiety is characterized by an overwhelming worry or dread that can greatly negatively affect everyday life. It often involves lasting feelings of crippling panic and can quickly spiral out of control for its sufferers.

Symptoms of anxiety disorders can include:

  • Restlessness
  • Shortness of breath
  • Panic attacks
  • Insomnia
  • Increased heart rate
  • Sweating
  • Inability to concentrate

People who suffer from anxiety disorders may find themselves frequently going to their doctor or the emergency room, as anxiety and panics can share symptoms with more serious ailments and heightened worry can exacerbate the feeling that something is wrong.

Bipolar Disorder

Formerly known as manic depression, bipolar disorder can cause extreme mood swings in the individual it affects. It’s typically characterized by periods of intense energy (or mania) alternating with periods of debilitating depression.

Bipolar disorder may cause the following symptoms:

  • Extreme irritability
  • Insomnia or lethargy
  • Increased risk taking
  • Episodes of aggression
  • Impulsivity
  • Anger or sadness
  • Euphoric or elevated mood
  • Increased or decreased sex drive

Treatment of bipolar disorder requires diagnosis and management by a healthcare professional. Medication is often prescribed, and counseling is highly recommended even in cases without a dual diagnosis.

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder is a condition in which an individual struggles to recover following a traumatic event.

Symptoms of PTSD can include:

  • Nightmares
  • Insomnia
  • Flashbacks
  • Irritability or hostility
  • Lack of interest in hobbies and activities
  • Anxiety
  • Paranoia

For those suffering from PTSD, alcohol can provide a much-desired respite from triggering thoughts and feelings.

PTSD inhibits the production of endorphins in the brain, making those who have it more likely to turn to alcohol or other substances in search of happiness. Veterans are especially likely to develop alcohol due to PTSD; according to the U.S. Department of Veteran Affairs, almost 75 percent of troops who experienced violence or trauma during combat later develop alcohol use disorder.

Obsessive Compulsive Disorder (OCD)

Obsessive compulsive disorder can manifest in a number of different ways but is typically rooted in overwhelming thoughts and fears leading to unhealthy compulsive behaviors. These can involve phobias about things like germs or public areas, or they can result in obsessive repetitive behaviors.

Symptoms of OCD may include:

  • Anxiety
  • Compulsive need to complete certain personal rituals or activities
  • Intense phobias that affect daily life
  • Depression

Alcohol is often used to alleviate the feelings and symptoms of OCD; an estimated 24 percent of those affected by OCD also suffer from alcohol use disorder.


It’s important to recognize the warning signs that you or a loved one may be suffering from co-occurring disorders. Asking the right questions can help you to identify whether further steps may need to be taken before it’s too late.

  • Can you remember the last time you felt satisfied without drugs or alcohol?

    If not, it may be a sign that a mental health disorder has always been present. Self-medication is a powerful motive that leads many people to turn to substances that can alleviate the symptoms of mental health issues.

  • Did you start using alcohol and/or drugs to cope with feelings of stress, depression, or anxiety?

    Consider the source of what brought you to drink. If you first turned to alcohol or drugs to better handle difficult feelings, it may have the potential to turn into a larger problem quickly.

  • Have you experienced a serious trauma in the past?

    PTSD is one of the major co-occurring disorders for many patients with dual diagnoses. Particularly for those who experienced trauma as a child or teen, alcohol can become a coping mechanism to mask the lasting pain of the experience.

  • Do you have a family history of mental illness?

    ? If so, you could already be at risk to develop a co-occurring disorder. Having a family history of mental health problems greatly increases the risk of developing a mental disorder. This potential genetic predisposition should be considered when assessing whether or not you or a loved one may be suffering from co-occurring disorders.


The symptoms of a dual diagnosis may greatly vary depending on the co-occurring mental health disorder of the individual, as well as the severity of the AUD. However, there are some basic warning signs to watch out for; if you or a loved one are experiencing any combination of the following symptoms, it may be time to speak to a professional about treatment options.

Symptoms of dual diagnosis can include:

  • Withdrawal from family and friends
  • Sudden and unexpected changes in behavior
  • Loss of motivation
  • Lethargy and/or fatigue
  • Using drugs or alcohol under risky conditions
  • Changes in appetite
  • Changes in sex drive
  • Difficulty concentrating
  • Increased anger, irritability, and/or anxiety
  • Developing a high tolerance for alcohol and/or drugs
  • Difficulty functioning without alcohol and/or drugs
  • Interpersonal issues (relationships, friendships, etc.) due to use of drugs or alcohol

Since the symptoms of both disorders tend to exacerbate one another, it’s often difficult to discern whether symptoms are caused by one disorder or the other. Because of this, co-occurring disorders (and the individual suffering from them) are treated as a whole. Professional treatment addressing both disorders at the same time is advised for patients with dual diagnosis. This allows the individual to fully be able to deal with treating their disorder instead of turning to alcohol or drugs to mask the symptoms. This treatment of both disorders simultaneously is known as integrated intervention.


People suffering from co-occurring disorders have several options to choose from when it comes to their treatment. You and your counselor should work together to create the best recovery plan to aid both your sobriety and your mental health condition. This plan may include any of the following options:

  • Detoxification

    In this phase of treatment, individuals are provided with a safe space to fully detox from alcohol or drugs. This may include 24/7 supervision in an inpatient detox facility for up to a week, which tends to be much more effective than detoxing on an outpatient basis.

    Depending on the severity of your alcohol use, you may need to check into a detox facility for safety’s sake. It can be dangerous (and in some cases even deadly) to attempt a detox on your own if you’re likely to experience severe withdrawals. Discuss options with your doctor or therapist to figure out the best and safest way for you to proceed.

    After the detox stage is completed, patients will be able to move on to an inpatient or outpatient rehab to learn the skills required for a sober and healthy lifestyle.

  • Inpatient Rehab

    Inpatient rehab takes place in a residential rehab facility setting. Patients will receive care around the clock and will have limited access to the outside world during this time. Inpatient rehab facilities offer groups, therapy sessions, and therapeutic activities, as well as focusing on self-care and creating a healthy future.

    Inpatient rehabs are staffed with doctors, nurses, and counselors of varying levels and degrees. You’ll work with a team to create a detailed recovery plan that you can use to stay on the right track once you leave the facility.

    An inpatient treatment can be an especially good choice for those presenting with a co-occurring disorder. Mental illnesses often require medication to control symptoms. Being monitored in a 24-hour facility is the safest way to make sure you’re getting the right medication at the right dose.

  • Outpatient Rehab

    With outpatient rehab, patients are able to get treatment while only minimally disrupting their daily lives. Patients treating their addiction on an outpatient basis make frequent visits to a rehab facility or therapist for counseling sessions and groups multiple times per week.

    In outpatient rehab, you can expect to learn many of the same skills as you would in an inpatient setting, but in a more relaxed environment.

    Because outpatient rehab is less supervised and structured than its inpatient counterpart, it may not be the best option for those with severe AUD. Talk to your doctor or therapist to decide whether outpatient services are right for you.

  • Support Groups

    Best used as a supplement to traditional counseling, support groups and twelve-step programs like Alcoholics Anonymous or Smart Recovery can be helpful in maintaining sobriety for many people with a dual diagnosis.

    Group programs can help people working toward living a healthier lifestyle connect with individuals who have similar goals of sobriety. It’s a great way to turn a journey that can feel truly isolating at times into a community of support and encouragement.

    For those with co-occurring disorders, Double Trouble in Recovery is a twelve-step group designed specifically to help people struggling with both substance abuse and a mental health condition.

    When choosing which treatment option is right for you or your loved one, be sure to consider the following questions:

    • How long has drinking alcohol been an issue?
    • How often does the person drink?
    • How much do they drink?
    • Will they require a supervised detox?
    • How severe is the mental health disorder?
    • Is the person a danger to themselves or others?
    • Does the person have a strong support network?
    • Does the person have health insurance/are finances an issue?

    Asking the right questions can help guide treatment in the right direction and make sure the individual in need gets in touch with the right services.

Getting Help

If a rehab facility is going to be helpful in treating co-occurring disorders, it needs to be a good fit for the individual.

Don’t be afraid to ask questions and make calls to several facilities if necessary. Not sure what to ask? Try starting with these questions:

  • Does the facility offer medically supervised detox?
  • Is there a psychiatrist on your medical staff?
  • What kind of licensing does your clinical staff hold?
  • Is your facility equipped to appropriately treat co-occurring disorders?
  • What types of treatment is your staff trained to use?
  • What is the ratio of patients to staff members?
  • What kind of family support is available?
  • Do you handle aftercare arrangements?

A dual diagnosis can feel overwhelming to deal with, but it doesn’t have to be. Help is available. Take the next step and seek treatment. Your life is worth it.


  • https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Dual-Diagnosis

  • https://www.aa.org/pages/en_US/find-aa-resources

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