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Dual Diagnosis

Mental illness is one of the largest health problems in the United States. As many as one in five Americans live with a mental health disorder such as depression, anxiety, or trauma-related illnesses. In addition to these illnesses, people also live with alcohol or substance use disorders. Some live with both.

Mental health and substance use disorders often occur together, diagnosed as a dual diagnosis or co-occurring disorders. While it may sound overwhelming, dual diagnosis conditions are frequently diagnosed in people with alcohol or substance use disorders. In fact, research shows that in 2019, 9.5 million adults had both a mental illness and a substance use disorder.

If you suspect you may have a co-occurring disorder, you should immediately contact your primary care physician or a mental health professional who can guide you towards diagnosis and treatment.

What does it mean to have a co-occurring disorder & dual diagnosis?

Being diagnosed with a dual diagnosis means you have a substance use disorder and a mental health disorder(s) that need to be clinically treated simultaneously. Examples of diagnoses include:

  • Substance Use Disorder and Bipolar Disorder I
  • Alcohol Use Disorder and Panic Disorder
  • Borderline personality disorder, major depressive disorder, and polysubstance use disorder

If you’ve been diagnosed with a substance use disorder and a co-occurring disorder, you are not alone. These are strikingly prevalent in the population. Another way that may help you understand is to think of being diagnosed with two physical medical conditions, such as a heart condition and diabetes. Both should be treated at the same time because treating one will benefit the other. That is precisely what we do at Crystal Lake Healing as we work with you and treat your substance use and mental health disorders.

What are mental health disorders?

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Mental health disorders can be grouped into categories, followed by a specific diagnosis.

Anxiety disorders

An anxiety disorder can cause intense feelings of panic and fear that seem to have no cause. The emotions, frequency, and intensity can vary and often impact your day to day living.

Specific diagnoses include:

Generalized anxiety disorder is a condition where you experience chronic and unrealistic anxiety about at least two areas of your life, such as family, relationships, finances, etc. Some symptoms include:

  • Feeling nervous
  • Irritability or feeling on edge
  • Trouble concentrating
  • Difficulty sleeping

Social anxiety disorder 
causes intense anxiety and fear about social situations. If you struggle with speaking in public for fear of being judged or are visibly uncomfortable in social situations, you may be experiencing symptoms of a social anxiety disorder. Other symptoms include:

  • Feeling afraid, especially around new people, even though you want to get to know them.
  • Extreme fear of being judged by others
  • Avoiding places where people will be

Panic disorder 
symptoms include:

  • Feeling terror despite no real danger which leads to panic attacks.
  • When having a panic attack, you may have:
  • Difficulty breathing
  • Excessive sweating
  • Chest pain
  • Rapid heartbeat

Mood disorders

Mood disorders are disruptive, distorted emotional states or moods that seem unrelated to your life circumstances. If you’ve experienced depression, you may notice that you had little energy, persistent sadness, and necessary self-care (showering, brushing teeth) took a lot of effort. On the other hand, mania can result in going days without sleeping, excessive happiness to the exclusion of different feelings, and a sense of invincibility, impacting your daily life. Some mood disorders include:

Major depressive disorder

Characterized by symptoms such as:

  • Mild to severe sadness
  • Little pleasure in activities you usually enjoy
  • Weight loss or gain because your appetite increases or decreases
  • Sleeping too little or sleeping too much
  • Poor self-care
  • Trouble concentrating
  • Suicidal thinking


Bipolar Disorder – This disorder is includes cycling between two states: mania and depression.


  • Extreme sadness
  • Trouble making decisions or concentrating
  • Inconsistent sleep patterns


  • Racing thoughts
  • Inability to make decisions
  • Impulsivity with no thought to consequences
  • Overly confident, inflated sense of self
  • Decreased sleep

Persistent depressive disorder this chronic depression is usually diagnosed if you’ve experienced early-onset depression (in your teens or young adulthood) and your depression has persisted for at least two years. While depressed, you may experience:

  • Low energy and chronic fatigue
  • Poor self-esteem
  • Constant feelings of hopelessness
  • Anhedonia, means you are unable to experience pleasure.

Personality disorders

Personality disorders are characterized by very rigid and distorted ways of thinking, impacting your behavior and interpersonal relationships. In one study, 14.3% of people diagnosed with an alcohol use disorder also met the diagnostic criteria for Borderline Personality Disorder.

Borderline Personality Disorder (BPD) usually begins in early adulthood, affecting how you think and feel about yourself and others. Symptoms include:

    • Intense fear of abandonment
    • Impulsivity, such as reckless spending, sexual behavior, and substance use, suddenly quitting a job you enjoy
    • A pattern of pushing people away, while wanting them to stay around you
    • Unstable and intense relationships
    • Suicidality and/or self-harm
    • Feeling empty
    • Rapid mood swings occurring within hours or over several days. An example is waking up happy and suddenly feeling rageful with no apparent cause.


Trauma can happen when you see or experience a deeply disturbing event or events and your ability to cope effectively is overwhelmed. Some examples of traumatic events include:

  • Childhood neglect or abuse
  • War or other violent events
  • Witnessing violence
  • Experiencing violence against yourself
  • Physical, emotional, sexual abuse
  • Grief
  • Natural disasters and other events or accidents.

While you may think of trauma related to veterans, the National Council for Behavioral Health reports that 70% of adults in the U.S. have experienced some kind of trauma. There are three kinds of trauma:

  1. Acute trauma is the result of a single event, such as a physical attack or witnessing an auto accident.
  2. Chronic trauma occurs when you are repeatedly exposed to a highly stressful situation. Some examples are prolonged childhood neglect and/or abuse or being bullied and/or harassed.
  3. Complex trauma occurs when you’ve been exposed to multiple, separate traumatic events.

Post Traumatic Stress Disorder (PTSD)
 can develop following a traumatic event, and it is a cluster of symptoms that interrupt your daily functioning that is grouped into four categories:

  1. Intrusion – Experiencing intrusive thoughts, memories, flashbacks of the event, or disturbing dreams. Flashbacks may be so intense you feel emotionally and physically as though you are reliving the event.
  2. Avoidance – You may avoid people, places, and events that remind you of the event to avoid triggering memories.
  3. Altered memory and moods – You may struggle to remember details of the traumatic event, and you may experience chronic shame and self-blame surrounding the situation. You may be unable to feel any positive emotions.
  4. Arousal and Reactions – These symptoms may mean you behave dangerously, you are hypervigilant of your surroundings, and you have unpredictable bursts of anger. It may also be difficult to sleep or concentrate.

Complex Post Traumatic Stress Disorder (C-PTSD)
is caused by prolonged exposure to a traumatic event. While sharing the above symptoms with PTSD, the following additional symptoms differentiate the two conditions. If you have C-PTSD you may also experience:

  • Difficulty maintaining relationships
  • Avoidance of other people
  • Lack of connection

In all of the above cases, substance use disorders feed into mental illness, with each problem compounding the other and making it vital to treat both simultaneously. As with any mental health diagnosis, you should speak to a qualified professional who will accurately diagnose and guide treatment for you.

If you are feeling suicidal, seek help immediately. Call 911 or local emergency number Contact the National Suicide Prevention Lifeline at 1-800-273-TALK.

What causes a co-occurring disorder?

It’s difficult to say exactly what causes a mental health disorder. Research has shown that much like a substance use disorder, genetics, environment, trauma, and early childhood exposure can influence whether you are diagnosed with a psychiatric disorder.


Research shows your genetic makeup can be an essential factor influencing developing a specific mental health diagnosis. In 2013, researchers at the University of North Carolina definitively linked genetics to five major psychiatric disorders, schizophrenia, bipolar disorder, major depressive disorder, autism spectrum disorders, and attention-deficit/hyperactivity disorder.

Environmental concerns

Being raised in a stressful environment or having an abusive home life are significant risk factors. If you’ve witnessed someone in your family struggle with depression, you may be more likely to develop depression. This holds true for witnessing or being a victim of violence either in the home or in other situations. Other environmental influences include financial stress, chronic medical conditions, death of a loved one, or divorce, which can occur at any time in your life.

Traumatic experiences

Trauma is a significant factor in developing a mood disorder or substance use disorder. For example, it’s estimated that 80% of individuals who have Post-Traumatic Stress Disorder usually have at least one other diagnosis. You don’t need to experience a direct trauma to be traumatized; often, witnessing an event can create trauma.

Early exposure and brain development

Evidence suggests that exposure to environmental concerns at an early age can influence if you are likely to develop a co-occurring disorder. This exposure can even occur before birth if you were exposed to substances such as drugs or alcohol.

None of these causes exist in isolation, and all likely influence each other. If you have a dual diagnosis, it’s difficult to say it’s because of genetics or because of your environment. It is highly likely that all of the above factors ultimately influence how developed a co-occurring disorder. What’s most important is to contact your health professional or a mental health clinician to start recovering from both.

Symptoms of a co-occurring disorder

The symptoms of a co-occurring disorder are hard to quantify because there are many ways in which co-occurring disorders can manifest. There are multiple potential causes and behaviors related to co-occurring disorders. However, there are some symptoms that you may have experienced that are related to having a dual diagnosis. These include:

  • Sudden, noticeable changes in your behavior or social life, including a difference in work, social, family, or school.
  • Becoming secretive about your behavior, including where you are going, who you are with, and how you spend your time.
  • Physical changes including Changes in sleep pattern, unexplained weight gain or loss, sudden and rapid changes in hygiene.
  • Increasing isolation and withdrawing from the important relationships in your life.
  • Intense emotional reactions to situations you previously were able to cope with
  • Rapid mood swings that are noticeable to those around you

Again, it is essential to be aware that these symptoms may change depending on your substance use and mental health symptoms. If you recognize any of these symptoms, it’s a good idea to contact your healthcare provider, who will guide you towards treatment.

What comes first: Addiction or mental illness?

To some extent, this is a chicken and an egg problem. The truth is that substance use disorders can fuel mental illness, and the reverse is also true. Each person’s circumstances are different, so it is impossible to make a definitive statement about what came first for you.

However, some statements can be made that can provide answers to this question. First, the mental illnesses noted above can cause a variety of mental anguish and pain. As a result, you may try self-medicating, turning to drugs or alcohol to feel better.

While substance use may briefly ease the pain caused by mental illness, it only leads to more problems in the long run. Because many substances can cause physical changes in the body and brain, these changes can intensify the underlying mental illness.

Integrated Treatment Overview

Treating a co-occurring disorder is best addressed in a rehab/therapy program that simultaneously treats both mental illness and substance use conditions. This is the ideal treatment as treating one of these illnesses, such as substance use, is very likely to help treat co-occurring mental illness. This is called Integrated Treatment, and it has been developed to address these challenges.

It does so in many ways, including:

  • Ensuring that any therapy addresses both the mental health and substance abuse components together
  • Therapy methods support both diagnoses, and your clinicians make any adjustments in treatment your individualized plan and progress.
  • Treatment is approached in stages, involving trust-building, increasing motivation, and controlling the disorders’ symptoms.
  • Treatment is holistic, involving social support, family relationships, coping skills, potential medication, and more.

Steps to Treating Co-Occurring Disorders

The steps you take to address a dual diagnosis will vary based on the specific treatment you select and what sort of symptoms you experience. In many cases, some similarities are maintained regardless of what you need to treat, such as:

Assessment: A mental health professional will interview you for an evaluation to understand your needs, your background, and your supports. Questions will focus on both your substance use and your mental health. This will inform your clinician’s diagnosis and treatment recommendations.

Detox: Depending on the substance you are using, and how long you’ve used it, a medically supervised detox may be your first step in treatment.

Treatment: There are a variety of treatment choices for you. By working with a medical professional, they can determine whether in- or outpatient treatment is appropriate. Medication may be a part of recovery for you, and that may include anti-depressants and/or mood stabilizers.

Aftercare: It’s important to realize rehab/treatment is the beginning of a lifelong journey of recovery. A crucial piece of your treatment is a comprehensive plan that may include therapy, medication management, and sobriety supports.

At Crystal Lake Healing, our clinicians provide expert, evidence-based integrated treatment for your dual diagnosis. Our therapists and medical staff will provide the therapy, medications, and support you need as you begin to reclaim your life. Call or chat with us now to begin your healing journey.


Your path to recovery is waiting
and we’re here to help.

Our admissions specialist are available 24/7 to listen to your story
and get you started with next steps.

Why call us?