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Dual Diagnosis: What is the Relationship Between Substance Abuse and Mental Illness?

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Recovery is something you have to work on every single day, and it’s something that doesn’t get a day off.

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What is a dual diagnosis? This is when someone is diagnosed with a mental health disorder while also dealing with an addiction or substance abuse problem. We often recognize depression or anxiety as illnesses, thus a diagnosis. However, struggles with drugs or alcohol count as a diagnosis as well: substance abuse disorder. This is because addiction can devastate a life in as many aspects as a more commonly recognized mental illness.

Substance abuse can be a symptom of mental illness. Mental illness can also result from substance abuse. It’s hard to say which comes first, the researchers are still debating about it to this day. However, we do know that there are 3 main theories for why dual diagnosis happens so frequently.


1. Self-medication

According to this theory, mental illness causes substance abuse. Minor or developing symptoms are the first signs of trouble that arise. These cause the individual suffering which he or she then “treats” with drugs or alcohol. A common example of this would be a young person with growing anxiety drinking alcohol to regain a feeling of calm. A full-blown mental illness isn’t always present at first, but rather “pre-diagnosis” symptoms. These might include mild or occasional bouts of symptoms we would associate with any true mental illness.

2. Common Vulnerability Model

This model offers that mental illness and substance abuse come from the same deeper psychological problem. In other words, there is some vulnerability in the patient for developing both conditions. According to this theory, neither the mental illness nor the substance abuse truly comes first; they develop together at the same time. Researchers have identified some brain structures and deficits in functionality that are linked to both types of disorder. We also know that things like family history, childhood abuse, trauma, and stress are common risk factors for both mental illness and substance abuse.

3. Substance creates mental illness

Some researchers argue that substance use can produce the symptoms of mental illness. You may be familiar with the warnings that alcohol and marijuana are depressants. This means it depresses your nervous system in the immediate sense by slowing down function in certain areas of the brain. It also means that these substances produce at least temporary symptoms of depression. The researchers argue that continued use of substance, depressants or otherwise, will produce the symptoms of mental illness over time. According to this explanation, the substance use comes first and then the mental illness.

Most psychologists and other mental health experts agree that there is likely a bit of all three of these explanations occurring together in dual diagnosis. Evidence exists to support each one, so the debate continues.

What we already know for sure is that mental illness and substance abuse do occur together and they also aggravate each other; it’s truly a vicious cycle. This relationship is why we cannot treat one without also treating the other. If we were to focus strictly on “getting clean”, the underlying mental illness will continue to torment us. That stress and emotional weight would likely lead to relapse. On the other hand, if we tried to “cure” the mental illness, the substance abuse would get in the way. We couldn’t break the self-medicating cycle that keeps us from truly doing the work of healing. Escaping anxiety with a drug or alcohol is not a cure; it’s just that, an escape that’s only momentary.


In the past twenty years, there’s been a rise in treatment specifically for dual diagnosis cases. Before we recognized the importance of treating both at the same time, standard procedure was to “get clean” first, and then move on to the mental illness. We know now that this isn’t the best solution.

To ensure the best results in cases where a dual diagnosis is present, we should seek care that achieves all of the following:

  • Parallel treatment of both substance abuse disorders and other mental health disorders by experts in both areas.
  • Proper use of psychotropic medication like anti-depressants, anti-psychotic drugs, and anti-anxiety drugs. The medical professionals administering these medications must be experienced with dual diagnosis conditions.
  • Supportive and non-judgmental therapy or negative therapy situations.
  • Inclusion of family and social counseling work. This may take the form of group therapy, family therapy, or workshops dedicated to our social network.

Even after realizing in the 1990’s that parallel treatment produces the best results for dual-diagnosis patients, treatment generally continues to follow the old model. This may be due to an unwillingness to change or lack of resources. Regardless of why this is, unfortunately, there are few options for those seeking dual-diagnosis treatment. At Breathe Life Healing Centers, parallel treatment is our focus. We believe that to break free from addiction we need to treat the patient in all aspects of life. Spirituality, mental health, physical health: all of these things are key to getting clean. We hope that you will reach out to us so that we can provide you with care from experienced and knowledgeable experts who understand dual-diagnosis.

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