So What is a Dual Diagnosis?

Dual diagnosis – what is it?

One of the terms I’ve frequently heard in the various “recovery” circles I’ve encountered over the past five years is “dual diagnosis.” People would talk of their loved one or themselves as having a “dual diagnosis.” I was curious what that was about and learned that a person who has an alcohol (or drug) abuse problem or an alcohol (or drug) addiction and also suffers from an emotional/psychiatric problem (mental health illness) is said to have a dual diagnosis. (The other term often used is “co-occurring disorder” – the mental health illness and alcohol abuse/addiction co-occur.)

Research is now showing that “many, if not most, people who are addicted to alcohol or other drugs suffer from another mental health disorder at some point.” (1) Mental health illnesses that frequently co-occur with alcohol addiction or abuse, include:

  • ADHD (attention deficit hyperactive disorder),
  • bipolar disorder,
  • conduct disorder,
  • depression,
  • post-traumatic stress disorder, and
  • schizophrenia.

It generally occurs as follows: 1) a person with an untreated minor or major mental health illness starts drinking to self-medicate; or 2) a person develops signs of a mental health illness after alcohol use. (2)

It is critical to understand that both the addiction and the co-occurring mental health illness must be addressed at the same time. (3) To accurately assess the mental health illness, the drinking of alcohol must be stopped. Only then can treatment providers determine the proper medication and/or treatment regime needed to successfully treat the mental health illness. Bringing the mental illness under control then helps reduce the compulsion to self-medicate (with alcohol or other substances) and assists with effective treatment of alcohol abuse or addiction.

If the co-occurring mental health illness is not treated or dealt with at the same time, however, it is less likely the alcoholic will be able to successfully abstain from alcohol if addiction is involved (a.k.a. alcoholism). (4) This is because the alcohol is their coping mechanism. If there is no other coping mechanism(s) in place, such as therapy and/or prescribed medications, h/she will likely turn to alcohol to self medicate. Additionally, the medications an individual takes to treat his/her mental illness are not effective if alcohol is being consumed.

So why is this helpful to know? If your one is grappling with their alcohol use – talks about wanting to cut back or you observe they’re drinking frequently and/or abusively on repeated occasions – they may, in fact, be suffering from a mental health illness and trying to cope with that by abusing alcohol (or other drugs, for that matter). This knowledge may be especially helpful if you are dealing with a teen with ADHD, a spouse with depression or a loved one who is a veteran or has recently returned from deployment in Iraq or Afghanistan with PTSD. AND, if your loved one has been diagnosed with a mental health illness, it may be helpful for them to know the potential consequences of alcohol abuse (or in some cases, even use).

I’ll provide a list of additional resources in a future blog, but for now, let us know your thoughts.

©2008 Lisa Frederiksen, Rev. 5.7.10.  This entry has been included to provide information. Every effort has been made to make it as accurate as possible, but no warrant of fitness is implied. The information provided is on an “as is” basis and readers should consult a therapist, attorney, treatment center program manager, medical doctor and/or other professional for dealing with emotional and/or legal issues or if seeking advice.
(1), <>
(2) Ibid.
(3) Ibid.
(4) Ibid.
So What is a Dual Diagnosis?


Lisa Frederiksen

Lisa Frederiksen

Author | Speaker | Consultant | Founder at
Lisa is the author of hundreds of articles and 11 books, including "If You Loved Me, You'd Stop!," "Addiction Recovery: What Helps, What Doesn't," and "Secondhand Drinking: the Phenomenon That Affects Millions." She is a national keynote speaker with over 25 years speaking experience, consultant, and founder of She has spent more than 14 years studying 21st century brain research in order to write, speak, and consult on substance use disorders prevention, intervention and treatment; mental disorders; addiction (aka substance use disorders) as a brain disease; adolescent addiction treatment vs adult addiction treatment; effective treatment for co-occurring disorders (having both a substance use and mental disorder); secondhand drinking | drugging; help for the family; and related subjects. In 2015, she founded SHD Prevention, providing training and consulting to companies, public agencies, unions, nonprofits and other entities to address the workplace impacts of employee secondhand drinking and alcohol misuse.
Lisa Frederiksen

Latest posts by Lisa Frederiksen (see all)

10 Responses to So What is a Dual Diagnosis?

  1. Karen says:

    I was so glad to find information regarding dual diagnosis – alcohol and bi-polar. I have a family member who now I can put together the manic times he over used alcohol to calm down (self medicate) his racing mind. I found your information to be very helpful in determining why, the insanity increased and he was angry and resentful about confronting the problem. Well, it turned out to be two problems – a dual diagnosis. The doctors put him on lithium for the bi-polar, but it did nothing because he would binge drink. It wasn’t until many horrible encounters, legal and hospitalizations, that the alcohol was addressed. Luckly, he agreed to go to AA and has been sobor for a year and a half. This in turn has made the lithium work very well to combat his bi-polar symptoms. Thank you for such valid and resourceful information on the topic.

  2. Lynn says:

    Thanks so much for this clear explanation of the term ‘dual diagnosis’. I found it very helpful.

  3. Liz says:

    Thank you so much for this information. It brings a new perspective to alcoholsim that I have never encountered.

  4. Jasmine says:

    Hi. It’s late but I wanted to ask a quick question: Do you recommend alternative treatments for depression if it persists after sobriety has stabilised? I think I and many others self-medicated, telling each other that it was either that or anti-depressants, like we were using only to function because for whatever reason we didn’t want to take lithium or other meds. I know you have studied the brain extensively so your input would be valuable. Having suffered awful bouts of depression and drug/alcohol abuse (although depression came before the drugs) myself I believe I would have been given such a dual diagnosis. I honestly need to make a list of all the things I want in life to be happy, and if I am still unhappy than I will accept being mentally ill. Until then I plan to stay off alcohol but what if I am still unhappy? I am adamant about not taking meds. So then what? I don’t want to waste any more time not living life as a happy person but I feel as if I have tried almost everything else…Do you recomment EMDR? Omega fatty acids and vitamin B supplements? I feel as if I have really really tried but nothing has worked. Then again I have been using substances to calm myself as well, so perhaps my efforts all these years (aromatherapy, herbal therapy, art therapy, jungian psychotherapy–many many things including moving to cities I like better, exercise, pursuit of knowledge etc have been tried…) were bound to fail because of the alcohol and pot (and some earlier dabbling in LSD and cocaine) use? I am early in recovery (four weeks today!!!) so I know I must be patient (not my strong point) but I have tried and tried for fifteen years to rid myself of depression and anxiety (I don’t like labels, but) disorders but NOTHING seems to work.

    So I recap: If I get my life back in order and I am still unhappy, do you have suggestions that do not involve anti-depressants?

    ps I do not judge others for their anti-depressant use, I just don’t want to use myself.

  5. LisaF says:

    First of all — congratulations!!! 4 weeks — that is wonderful.

    You’ve raised some very good questions. Before I respond, I need to make it clear that I am not a therapist nor medical doctor so this is not advice. I’ll just share what I’ve learned in my research. To answer your last Q, first, from what I’ve learned, if you do have a mental health illness, it is unlikely the various non-medical treatments you’ve tried will work. But, this is not bad — really. Unfortunately, mental illness gets much of the same stigma attached as does addiction. But let me share some reserach with you that may help…[Since I’m answering in the comments, I don’t have the link capability, so cut and paste the links in your browser]:

    I suggest you start with this one: “Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery,” provides substance abuse counselors the “what,” “why,” and “how-to” of working with clients with depressive symptoms and substance use disorders, covering topics such as counseling approaches, clinical settings, cultural concerns, counselor roles and responsibilities, screening and assessment, treatment planning and processes, and continuing care.” It is free, and although it’s for counselors, etc., it should give you some ideas. Here’s the link:

    Also try this one: “A Consumer’s Guide to Mental Health Services Decade of the Brain NIH.” It’s also under SAMHSA (Substance Abuse and Mental Health Services Administration)’s National Mental Health Information Center.
    The opening statement reads, “Twenty percent of adult Americans – or one in five – will have a mental illness during their lifetime that is severe enough to require treatment, and many more have problems that prevent them from enjoying their lives.”

    I hope this helps you with a place to start. I am sure it’s soooooooooooo frustrating to not feel a lot better now that you’ve stopped drinking. Just know that BOTH depression and addiction can be fully treated! Another thing to know is that anti-depresssants don’t necessarily have to go for the rest of your life, depending on your diagnosis, of course. I, myself, took them for a while some 12 years ago for what I was told was “situational depression.” Probably the best thing you can do is find a highly qualified person (one who is trained AND experienced in treating co-occuring addiction and mental illness) and get a professional assessment and consultation. You don’t have to do anything else after that, but it may put your mind at rest — you’d know for sure what you are dealing with.

    I hope this helps…it takes a HUGE amount of courage to do what you’re doing.

  6. lisaf says:

    Hi Jasmine,
    I just found another link that seems like it’d be very helpful. It’s titled, “Dual Diagnosis:
    Information and Treatment for Co-occurring Disorders,”
    Look around the site…there are other pages on depression that seem as if they may answer questions as well.

  7. […] When I lecture at a treatment center or talk with parents and other groups whose work or lives put them in contact with either alcohol or mental health illness or both, the question about mental illness (e.g., depression, PTSD, ADHD, bipolar) and whether there’s a connection between it and alcohol (or any substance) abuse often comes up. In treatment center circles, when a person is diagnosed with both a mental illness and addiction, this is referred to as a dual diagnosis (check this link to one of my previous posts for a more detailed explanation of dual diagnosis). […]

  8. […] It involves treating the contributing factors to crime – substance abuse and mental illness. [This post discusses the connection between mental illness and alcohol abuse/addiction]. As I’ve presented in several posts on this site, when a person is in the throws of an […]

  9. A Couple Of My Favorite Alcoholism Videos | Addiction Recovery Basics says:

    […] – Changing the Conversations » Blog Archive … […]

  10. […] “dual diagnosis” in the world of addiction treatment. Please see previous post, “What Is a Dual Diagnosis?” for more information. The reason for this post, however, it to bring your attention to NAMI […]

Leave a reply