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Dual Diagnosis – Addiction & Mental Health Conditions

In some cases, individuals who suffer from drug addiction or alcoholism may also concurrently struggle with mental health issues.

If you think you are one of these individuals, it’s possible that you have a dual diagnosis. In order to increase your chances of a healthy and lasting recovery from addiction, it is ideal for both of your conditions – the substance use disorder and the mental health condition – to be treated simultaneously.

How Is a Dual Diagnosis Determined?

doctor with patientIn order to determine who suffers from both an addiction as well as a coexisting medical or mental health condition, a good treatment center will conduct a thorough psychological and medical intake examination.

The process for such an examination will include an in-depth, comprehensive history provided by the patient. In order for this process to be successful, it is imperative that the patient be completely honest with the staff of the treatment center.

Once You Discover You Have a Dual Diagnosis

If you discover that you have a dual diagnosis, it is nothing to be ashamed of.

It is quite possible that the co-existing condition has actually played a significant role in your addiction to drugs and alcohol.

Some individuals, for instance, suffer from mental health conditions that cause them to inflict self-injury. When these individuals engage in the act of cutting or otherwise mutilating themselves, it can bring about a sense of calm and control. Almost always, however, those reassuring feelings are soon replaced with shame, guilt, or self-loathing – feelings which can then motivate that individual to turn to drug abuse.

Behavioral Problems May Indicate a Mental Health Condition

One of the best ways to prevent drug or alcohol addiction in someone who suffers from a mental health condition is to discover the condition early. Signs and symptoms of mental health conditions, in general, may vary according to the condition.

Overt behavioral problems, however, can sometimes indicate certain kinds of underlying mental health conditions. Among children and young adults, some of these types of mental health conditions have historically been referred to as conduct or behavior disorders.

Common Symptoms of Behavior Disorders Among Youth

If you recognize any of the following behavioral problems in yourself or in a loved one, it’s possible that a behavior disorder may be present1:

  • Aggression and frequent arguments.
  • Lying.
  • Theft.
  • Poor grades in school or lack of motivation in school.
  • Sexual activity at an early age.
  • Uncooperativeness or deliberate disrespect towards authority figures.
  • Harming oneself or others.
  • Using drugs, alcohol, or cigarettes.

Do any of these symptoms sound familiar? The DSM-IV calls for at least 3 out of 4 specific conduct disorder symptoms to be present within the last 6 months.2

However, recognition of any of these symptoms may be a warning sign that professional psychiatric help may be warranted – whether or not a drug or alcohol addiction is also present.

Types of Behavior Disorders

Behavioral Problems

The severity of behavior disorders among youth can range from the mild to the severe – depending on the child and the circumstances. These problems can also extend into adulthood if they are not treated early on.

If a drug or alcohol addiction is also in the picture, then it will be vitally important to seek an addiction treatment center that is also capable of addressing dual diagnosis cases.

Some relatively common behavioral conditions that are often first diagnosed in a pediatric or adolescent population include:

  1. Conduct disorder.
  2. Oppositional defiant disorder (ODD).
  3. Self-injury or cutting.
  4. Obsessive-compulsive disorder (OCD).

1. Conduct Disorder

Conduct disorder usually appears in early childhood. However, many children and adolescents who suffer from a conduct disorder will be unable to adjust the societal norms and restrictions after they transition into adulthood.3

Later in life when these children become adults, they may tend to break the law, for example. And if these individuals also develop a drug or alcohol addiction, they may be unable to hold a job or focus on what is important for a successful life.

Many young individuals who suffer from conduct disorders have a high disregard for people in authority – which sometimes creates a barrier to treatment. When these young adults finally do make it into treatment, lengthy treatment is often required to develop new habits and attitudes.

Early intervention, however, can sometimes ease the process.

2. Oppositional Defiant Disorder (ODD)

When a child is persistently disruptive or resistant to rules and authority, he or she may suffer from oppositional defiant disorder (ODD). ODD is marked by characteristic behaviors that any healthy child can exhibit from time to time. However, the ODD patient is more consistent in their defiance.

Oppositional defiant disorder symptoms may include4:

  • Refusal to comply with rules and regulations on a persistent basis.
  • Deliberately annoying others.
  • Becoming easily annoyed by others.
  • Vindictiveness.
  • Inability to maintain friendships for long periods.
  • Temper tantrums.

It is easy to see how these types of behaviors can prolong the treatment process when drug or alcohol addiction are also present. Developing a specific treatment plan that includes addressing the ODD diagnosis alongside the drug or alcohol addiction is crucial for successful treatment of both conditions.

3. Self-Injury or Cutting

The practice of injuring oneself should never be confused with suicide ideation – although it is possible for these two conditions to co-exist.

Self-injury is generally practiced on an impulse basis, and it may be associated with other impulse control disorders.5 In this regard, self-injury and cutting behavior often indicate the presence of mental illness. However, the explicit act of self-injury is a behavioral issue that can be addressed alongside addiction in dual diagnosis treatment.

Many times, the act of cutting or other forms of self-injury are performed while under the influence. This is not always the case, though – and use of drugs or alcohol may be coincidental to the behavior issue of self-injury.

Risk Factors for Self-Injury or Cutting

There are a few risk factors for self-injury, including:

  1. Age. Individuals who injure themselves generally begin this practice during adolescence.
  2. Abuse. People who’ve suffered from sexual, physical, or emotional abuse at some time in their life are more likely to self-injure.
  3. Associations and friends. Being exposed to the concept of self-injury through friends or family can lead an individual to experiment with this destructive behavior. Even exposure through acquaintances or television can lead to the condition.

Other Forms of Self-Injury

Self-injury is not limited to cutting. It may also include:

  • Burning.
  • Piercing (other than ornamental).
  • Hitting or punching objects.
  • Breaking bones.
  • Pulling out hair.
  • Not allowing previous wounds to heal.

Treatment for Self-Injury

The treatment for self-injury is different for everyone.

The factors surrounding self-injury are unique to each person – and treatment is tailored to include any and all underlying mental health issues, including depression and anxiety. In most cases, successful treatment of self-injury involves ongoing therapy with a psychologist who has experience in treating this particular condition.

4. Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is a condition identified by the repetition of specific thoughts, activities, or speech in order to alleviate morbid or “bad” thoughts. Some individuals believe that if they do not perform certain rituals, something bad will happen to them, their family or even to complete strangers.

What Causes OCD?

Little is known about how the condition of OCD develops. However, several physical factors have been identified as possibly contributing to the development of OCD. These physical factors include6:

  • Infections.
  • Abnormal brain function.
  • Family history (genes).
  • Injuries to the head.

The Connection Between OCD and Substance Abuse

In one study conducted by the National Institute of Health, results showed that7:

  • 70% of substance abusing participants had manifested symptoms of OCD at least one year prior to the onset of their substance abuse habits.
  • The average number of years that OCD preceded substance addiction issues was 8 years.
  • About 25% of participants indicated that they had developed OCD after they had started to abuse drugs or alcohol.

Treatment Programs

man arriving homeOne key to managing a dual diagnosis is recognizing it early and incorporating treatment into a comprehensive plan for recovery.

There are several types of treatment programs available for drug and alcohol addiction. The two main structures of treatment are:

  1. Inpatient care. Inpatient care provides 24/7 residential addiction treatment. This type of treatment structure is generally recommended for those with severe addictions and for those with a dual diagnosis.
  2. Outpatient care. Outpatient care lets individuals regularly attend treatment while still returning to home at night.

If you or someone you love has a dual diagnosis, you will want to think through with your healthcare provider which type of treatment structure will work best for your particular situation. Factors you will want to consider include:

  • The severity of the addiction.
  • The severity of the dual-diagnosis mental or behavioral issue.
  • Responsibilities you have towards your family or career.
  • The cost of treatment.

Inpatient Treatment: An Escape from Everyday Stresses

No promises are made that your time in treatment will be stress-free – as recovery from addiction and learning to manage a behavioral problem can bring new forms of stress. However, at residential inpatient treatment, you are removed from the everyday environmental stressors and potential cues that may trigger the negative feelings that tempt you to engage in substance abuse.

Upscale Treatment

Certain upscale residential treatment centers are specially designed to bring peace and relaxation into the treatment model, which can help counteract the stresses of recovery and withdrawal. 

Depending on the specific center you choose, experienced staff members at both luxury and executive rehab facilities can teach alternative means of coping with stress – including martial arts, yoga, and meditation. Executive facilities offer special resources for keeping you engaged at work throughout recovery, however, for those with pressing career obligations.

Outpatient Treatment: Rehabilitation from Home

An outpatient treatment program will offer many of the same treatment approaches at those found at an inpatient facility – only the patient at the outpatient facility goes home at night after treatment. The main difference in treatment lies in the level and intensity of patient involvement and  professional monitoring.

A patient who chooses an outpatient program may be subjected to random or daily drug screenings – as he or she will remain living at home, in a relatively uncontrolled environment with continued access to the drugs of choice. Patients who are determined to be good candidates for outpatient therapy can continue to work or fulfill family obligations during rehabilitation.

Duration of Treatment for Dual Diagnosis Patients

A dual diagnosis does not automatically mean that an individual will need to be admitted to a treatment center for a set period of time. It does, however, generally require a more focused (and sometimes lengthier) duration of treatment – regardless of whether treatment is on an inpatient or an outpatient basis.

Are Treatment Programs Successful?

Like any other chronic condition, relapse is always a possibility for the recovering individual. And this process of becoming and staying sober can be further complicated by a dual diagnosis condition.

However – like any other chronic condition – both diagnoses can be managed successfully with the right supportive environment, professional resources, medication, and determination.

Addiction Needs to Be Treated Like a Chronic Disease

Whether or not you agree that addiction is a chronic, recurring brain disease – one effective treatment approach for addiction and dual diagnosis is similar to that for other chronic conditions.

When chronic conditions or diseases such as high blood pressure or diabetes are managed properly, the symptoms lessen and the patient may go on to live a full life. When symptoms return, treatment plans are modified – medications are adjusted, and former treatment protocols may sometimes be repeated.

This same approach may also be effective for treating addiction – and especially in cases of dual diagnosis.

Relapse Is a Common Along the Road to Recovery

Occasionally, an individual may complete treatment for drug or alcohol addiction and may never face an occurrence of relapse. However, these cases are rare.

Many individuals will stumble along the road to recovery at one time or another. This does not mean that the treatment has been unsuccessful. It simply means that the treatment plan needs to be adjusted – just like medication sometimes needs to be adjusted for other chronic conditions or diseases.

Treat Your Dual Diagnosis to Overcome Relapse

If  you are a recovering individual and are starting to recognize your possible symptoms of a dual diagnosis for the first time, it’s important for you to immediately seek treatment for these co-occurring conditions. If your treatment plan can be refreshed and tailored to address dual diagnosis, you will be in a stronger position to overcome relapse and continue a sober lifestyle for longer periods of time.

How Behavioral Problems Affect Addiction

The difficult question of whether you are more likely to suffer from an addiction if you have also suffered from a behavior disorder at some point is an important one. While there have been some studies reflecting possible correlations between behavior disorders and addiction to illicit substances – there is currently little evidence indicating that behavior disorders directly cause the development of addictions.

Most behavioral problems that would qualify for a dual diagnosis begin in early childhood or adolescence. And out of the many behavior problems that could potentially plague a young person, a compulsive need to thwart rules, regulations, laws, and societal norms is common.

Social Influence

These tendencies can lead a young person to commit violent and non-violent crimes – alienating these individuals even further from law-abiding social groups and society, as a whole.

As a result, these young people often form closer friendships with those who exhibit similar behavior to their own. Such social bonds can potentially strengthen one’s tendencies towards illegal and self-destructive behavior – including abuse of illegal substances.

Substance Abuse & Mental Illness among Juvenile Arrests

One report by the National Center on Addiction and Substance Abuse at Columbia University looked at juvenile justice systems in the United States.8 Among other measures, the study examined the prevalence of drug and alcohol use as well as the prevalence of mental illness.

Researchers found that:

  • About 80% of offenses could be linked with substance abuse.
  • About 75% of 10-to-17-year-olds who were incarcerated also had a mental health disorder.

While this study did not directly measure cases of dual diagnosis, the high percentages of both substance abuse and mental health conditions make the possibility of coexisting conditions appear high.

Without proper dual diagnosis treatment, these adolescents may continue to use drugs and alcohol – as well as manifest their behavioral disorders through crime and violence.

Learn More and Find Dual Diagnosis Treatment

If you’d like to learn more about dual diagnosis or find an addiction rehab program that treats dual diagnoses, please give us a call at 1-888-744-0789 Who Answers?. We would love to help answer any questions you might have and put you on the recovery path for your particular needs and circumstances.


  1. Child behavior disorders. (2016). National Institute of Health, U.S. National Library of Medicine.
  2. Searight, H. R., Rottnek, F., Abby, S. L. (2001). Conduct disorder: diagnosis and treatment in primary care. Am Fam Physician, 63(8), 1579-89.
  3. INSERM Collective Expertise Centre. (2005). Conduct: disorder in children and adolescents. Paris: Institut National de la Sante et de la Recherche Medicale.
  4. Mayo Clinic Staff. (2015). Diseases and conditions: oppositional defiant disorder (ODD). Mayo Clinic.
  5. Nock, M. K., Cha, C. B., Dour, H. J. (2012). Disorders of impulse control and self-harm. The Oxford Handbook of Clinical Psychology, Oxford Handbooks Online.
  6. Obsessive-compulsive disorder. (2014). National Institute of Health, U.S. National Library of Medicine.
  7. Mancebo, M. C., Grant, J. E., Pinto, A., Eisen, J. L., Rasmussen, S. A. (2009). Substance use disorders in an obsessive compulsive disorder clinical sample. J Anxiety Disord, 23(4), 429-35.
  8. Criminal neglect: substance abuse, juvenile justice and the children left behind. (2004). The National Center on Addiction and Substance Abuse.
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