Our Mental Health Expert Explains What It Means To Receive A Dual Diagnosis

With one out of five people experiencing a mental health condition every year, mental illness can create a ripple effect within our families and communities, according to the National Alliance on Mental Illness (NAMI). The uncertainty of COVID took a toll on our mental health, with one in 15 people experiencing both mental illness and a substance use disorder.

Having two mental health disorders at once is called a dual diagnosis, says licensed clinical social worker and psychotherapist Amy Calmann. "One example of dual diagnosis would be someone with bipolar disorder who is dependent on alcohol," she said. "Another example is someone with depression who is reliant on opioids like heroin, or on the synthetic opioid prescription medication, Fentanyl." She says it's a challenge to know for sure if one condition caused another.

These days, a dual diagnosis is often referred to as a "co-occurring diagnosis." Calmann says many symptoms of mental health disorders overlap, which can make a dual diagnosis more likely to occur. "Over half of people who have depression also have symptoms of anxiety, and the same for those with anxiety who also have symptoms of depression," she said.

If you or someone you know needs help with mental health, please contact the Crisis Text Line by texting HOME to 741741, call the National Alliance on Mental Illness helpline at 1-800-950-NAMI (6264), or visit the National Institute of Mental Health website.

Dual diagnosis is common

Although a dual diagnosis doesn't necessarily include a substance use disorder, Calmann says that 50% of people with a mental health disorder will also experience a substance use disorder. Someone might develop a substance use disorder first, while others might use substances to handle their mental health symptoms. "For example, someone with social anxiety disorder might become dependent on alcohol because they find that drinking helps relieve their anxiety when they are in social groups," she said. "When they are drinking, they can talk to friends more easily, or attend events that they would have otherwise avoided." Calmann adds that using substances can make mental illness worse even if the substance provides temporary relief of their symptoms.

Calmann stresses the need for an integrative approach in rehabilitation facilities for substance use disorders in light of dual diagnoses. "There are often subtleties within the interplay that can occur between disorders," she said. "If you only treat one disorder, there may be little or no improvement in one or both disorders, as it's possible that the disorders are linked in some way." She says that more programs are recognizing how important it is to treat both conditions.

The difficulty in treating symptoms of dual diagnosis

Calmann says that managing symptoms of both disorders can be daunting because some symptoms of one disorder might decrease. That's why she suggests a holistic approach to treat dual diagnosis. "In my practice, when I see that someone is finding relief in some ways but not in others, I think about using alternative methods to help them find relief from symptoms that are originating from multiple diagnoses," she said. For example, she might use Cognitive Behavioral Therapy (CBT) as a method of handling someone's anxiety in combination with talk therapy and medication.

Although medications can be effective in treating one mental health condition, treating someone with a dual diagnosis can be tricky. Medications to treat mood disorders might interact with substances someone is using, rendering the medication less effective in treating mood disorder symptoms. People taking stimulant medication for Attention Deficit Hyperactivity Disorder (ADHD) might see improved focus, but these medications can also aggravate anxiety. This can cause complications for someone with a dual diagnosis of ADHD and anxiety. "In that case, it might be better for someone to try a non-stimulant medication to treat ADHD, as it may have a lower probability of amplifying their anxiety symptoms," Calmann said.