The term dual diagnosis (known in Spain as ‘patología dual’) is used when the same person has both an addiction (to a substance or to a behaviour such as gambling) and another mental health condition, such as depression, an anxiety disorder, bipolar disorder or a personality disorder. The two problems feed into and worsen each other, which is why they need to be treated at the same time and in a coordinated way.
What is dual diagnosis?
These are not two independent problems that happen to coincide. In dual diagnosis, the addiction and the mental health condition are intertwined: substance use changes the course of the condition, and the condition shapes the substance use. A common example: someone with anxiety starts drinking to calm down; alcohol brings relief for a few hours, but over time it increases the underlying anxiety and creates dependence, and the person drinks more to compensate.
It is a common situation among people who ask for help with an addiction, and also among people seen by mental health services. Detecting it early makes a big difference to the outlook, because it avoids treatments that only look at one part of the problem.
Conditions most often linked to addiction
- Anxiety disorders: generalised anxiety, panic attacks or social phobia, and also obsessive-compulsive disorder.
- Mood disorders: depression and bipolar disorder.
- Psychotic disorders: such as schizophrenia.
- Personality disorders: particularly borderline and antisocial personality disorder.
- ADHD: attention deficit hyperactivity disorder, including in adults.
- Post-traumatic stress disorder: after experiences such as violence, abuse or serious accidents.
Any addiction can be part of a dual diagnosis: alcohol, cocaine, cannabis, psychotropic medication, opioids or non-substance addictions.
Which comes first, the addiction or the mental health condition?
It can happen in either order:
- The mental health condition first: the person starts using to relieve sadness, distress, insomnia or other symptoms. This is often described as ‘self-medicating’.
- Substance use first: continued use of a substance triggers or brings out a condition, as happens with some forms of anxiety, depression or psychosis associated with cannabis or stimulants.
- Shared roots: genetic predisposition, traumatic experiences, ongoing stress or social exclusion can contribute to both problems at once.
Knowing the order helps to understand each person’s story, but in every case treatment must address both conditions.
Signs that may point to dual diagnosis
- Using in order to ‘function’: to sleep, calm your nerves, lift your mood or concentrate.
- Emotional distress does not improve, or gets worse, when trying to stop using.
- There have been separate addiction or mental health treatments without lasting improvement.
- There are sudden mood swings, extreme mistrust, strange perceptions or thoughts of death.
- Relapses coincide with emotional crises.
If there are thoughts of suicide or an immediate risk, call 112, the European emergency number. You can also call 024, Spain’s suicide prevention helpline.
How it is diagnosed
The diagnosis should be made by a team trained in both addiction and mental health. It is not always straightforward: the effects of a substance, or of withdrawal from it, can resemble those of a mental health condition, and vice versa. That is why the assessment usually includes:
- a detailed interview about substance use, symptoms and how they have developed;
- personal, family and medical history;
- observing how the symptoms change when substance use is reduced or stopped;
- if needed, additional tests and information provided by the family.
Dual diagnosis: integrated treatment
The recommended approach is integrated treatment: the same team, or very closely coordinated teams, address the addiction and the mental health condition with a shared plan. When only one part is treated, the person often ends up caught between services and relapses become more likely.
What it usually includes
- Psychiatric care: assessment and, if indicated, medication for the mental health condition, adjusted to the person’s substance use.
- Psychotherapy, individual and group, to understand the role substance use plays, manage emotions and prevent relapse.
- Supervised detoxification when necessary. Alcohol and benzodiazepines should not be stopped suddenly without medical supervision.
- Work with the family, who need information and support to help without wearing themselves out.
- Social support with housing, employment or relationships when the situation requires it.
The intensity is adapted to each stage: treatment can be outpatient or, at the most difficult times, take place in a residential service. You can find out about our outpatient treatment and our family support programme.
When to ask for help
If you recognise yourself, or someone close to you, in what you have read, do not wait for one of the two problems to be resolved before addressing the other. The sooner they are assessed together, the easier it is to find treatment that fits. Fundación Salud y Comunidad (FSC) has experience in caring for people with addiction and other mental health conditions, and offers a free first appointment in Barcelona. Call +34 93 424 04 00.
Frequently asked questions
What is dual diagnosis in a nutshell?
It is the simultaneous presence of an addiction and another mental health condition in the same person. Each influences the other, which is why they are treated together.
Can dual diagnosis be treated?
Yes. Integrated treatment, which combines psychiatric care, psychotherapy and family and social support, helps many people to stabilise and improve their quality of life. It is usually a medium- to long-term process.
Who treats dual diagnosis, a psychiatrist or a psychologist?
Both, as part of a coordinated team with experience in addiction. The psychiatrist assesses and adjusts medication when needed, and the psychologist works on therapy and relapse prevention, often with the support of social work.
Can cannabis cause a mental health condition?
In vulnerable people, cannabis can trigger psychotic episodes and worsen anxiety or depression. The risk is higher when use starts in adolescence and is frequent.
What can the family of a person with dual diagnosis do?
Learn about both conditions, avoid blaming and not carry the situation alone. Getting professional guidance for the family helps you support your loved one better and look after yourselves too.