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Dual Diagnosis vs. Co-Occurring Disorders

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What are Co-Occurring Disorders?

Dual diagnosis is a term used to describe the coexistence of a mental illness and a substance use disorder (SUD). These are also known as co-occurring disorders, since they exist simultaneously and are often related.

For example, if someone has depression (a common mental health disorder) and misuses alcohol (alcohol use disorder or AUD), a doctor would likely consider it a dual diagnosis. 

A dual diagnosis makes challenging situations even more difficult. More specifically, a co-occurring mental health disorder adds complexity to standard substance abuse treatment.

Co-occurring disorders are common among people with substance use issues. Statistics show that approximately 50 percent of people with severe mental illness also struggle with some type of SUD.1

Why are Co-occurring Mental Health Disorders So Common for People with SUD?

Co-occurring disorders are common among people with SUDs because:

  • SUDs and many mental health disorders share common risk factors
  • People with mental illness sometimes self-medicate and turn to substances to cope with untreated symptoms
  • Substance use worsens mental health problems

In these cases, successful treatment requires treating both the SUD and the mental health disorder. 

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Common Co-Occurring Mental Health Disorders

Some of the most common mental health disorders occurring in conjunction with SUD include:

Alcohol Use Disorder and Mental Illness

Alcohol is one of the most common substances people with mental health problems misuse. This is partly because it’s legal, widely available, and easily accessible.

People with mental illnesses tend to misuse alcohol because:

  • They have genetic risk factors for alcoholism and mental health disorders
  • Of common risk factors, including socioeconomic status and environmental influences
  • They believe alcohol offers a short-term “solution” for dealing with mental health symptoms

Mental health issues can contribute to the development and continuance of alcoholism. And, long-term alcohol use can contribute to and worsen existing mental health issues.

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Co-Occurring vs. Dual Diagnosis

Co-occurring disorders and dual diagnosis are similar.

A co-occurring disorder is when someone receives a diagnosis of two or more conditions occurring simultaneously. One or both of these diagnoses might be related to substance use, but they don’t have to be. 

For example, someone can have both bipolar disorder and PTSD. Or, they can have both bipolar disorder and alcohol use disorder (AUD). Co-occurring disorders can also apply to other health conditions, such as diabetes, hypertension, and heart disease.

Dual diagnosis, on the other hand, almost always refers to one or more mental health issues that develop in conjunction with substance use issues. It doesn’t matter if the addiction or the mental health issue came first.

The main difference between dual diagnosis and co-occurring disorders is the nature of the diagnosis. 

In co-occurring disorders, there are two or more separate diagnoses that may or may not include substance abuse. In dual diagnosis, the mental illness or substance abuse often leads to the development of the other (a substance use disorder or mental illness). The two are linked and require simultaneous treatment.

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Treatment for Co-Occurring Disorders

Regardless of which came first, the mental illness or the substance abuse issue, they must be treated simultaneously. This gives someone the best chance of long-term sobriety. 

The best treatment for dual diagnosis is something called an integrated approach. This means healthcare providers use specific therapeutic techniques to address both disorders at the same time. An integrated approach is comprehensive and customized. 

For example, someone diagnosed with alcohol use disorder (AUD) and anxiety may benefit from:

  • Medication to ease alcohol withdrawal symptoms during medical detox
  • Medication to treat anxiety symptoms
  • Behavioral therapy and/or psychotherapy to address AUD and anxiety
  • Group counseling for AUD
  • Long-term aftercare planning to reduce the risk of relapse or recurrence of anxiety and/or the AUD
  • Mental health and AUD education to help develop coping skills and understand the disorders

Does Insurance Cover Drug and Alcohol Rehab?

Yes. Health insurance covers the cost of addiction treatment for alcohol and drug addiction. Legally, insurance companies must cover the cost of treatment for SUD and mental health conditions the same as they do for any other disease or illness. 

Health insurance plans offer varying levels of care. Speak to your insurance provider to determine which treatment options are available to you. Treatment cost also varies depending on the facility, its amenities, and the type of treatment you choose. 

Outpatient rehab often costs less than an inpatient alcohol detox or drug rehab program. However, when someone needs mental health services, inpatient rehab is often the best option. This is because treating and managing alcohol withdrawal is complex when it co-occurs with mental health conditions. 

Discuss treatment options and advice with your doctor or by contacting a treatment center. 

Keep in mind: Even if you have coverage, you might still have to pay some out-of-pocket costs. If you are concerned about your ability to pay, there are several options available:

  1. Some treatment facilities offer financial assistance
  2. Community addiction treatment programs may assist with the cost of treating co-occurring disorders
  3. Private financing options, such as credit cards
  4. Loans from friends and family
Updated on April 12, 2022
7 sources cited
  1. Drake, Robert E, et al. “Management of Persons with Co-Occurring Severe Mental Illness and Substance Use Disorder: Program Implications.” World Psychiatry : Official Journal of the World Psychiatric Association (WPA), vol. 6, no. 3, 2007, pp. 131–6. 
  2. Shivani, Ramesh. “Alcoholism and Psychiatric Disorders.” Nih.gov, 2019. 
  3. Alcohol Use Disorder and Co-Occurring Mental Health Conditions | Alcohol Research: Current Reviews.” Arcr.niaaa.nih.gov. 
  4. Co-Occurring Disorders and Other Health Conditions.” www.samhsa.gov, 19 Aug. 2020. 
  5. National Institute of Mental Health. “NIMH» Substance Use and Co-Occurring Mental Disorders.” www.nimh.nih.gov, Mar. 2021. 
  6. Flynn, Patrick M., and Barry S. Brown. “Co-Occurring Disorders in Substance Abuse Treatment: Issues and Prospects.” Journal of Substance Abuse Treatment, vol. 34, no. 1, Jan. 2008, pp. 36–47. 
  7. National Institute on Alcohol Abuse and Alcoholism. “Understanding Alcohol Use Disorder | National Institute on Alcohol Abuse and Alcoholism (NIAAA).” www.niaaa.nih.gov, Dec. 2020.

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