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Dual diagnosis is the presence of two or more serious psychiatric disorders, such as both alcoholism and drug dependence, or both alcoholism and bipolar disorder, or any other combination of two or more psychiatric diagnoses. Physicians often refer to these serious concurrent illnesses as comorbidities.

Many people who are substance abusers have one or more psychiatric problems, such as anxiety disorders or depression. Some individuals who abuse drugs and/or alcohol have attention deficit hyperactivity disorder, which has usually not been diagnosed or treated. A low percentage of individuals have schizophrenia, a serious psychiatric disorder, and individuals who have this disorder are also prone to substance abuse. In addition, individuals who have obsessive compulsive disorder (OCD) or eating disorders have an increased risk for substance abuse.

Some experts hypothesize that individuals who have psychiatric disorders may use drugs or alcohol in an effort to self-treat their symptoms. However, it is also true that sometimes preceding substance abuse can lead to a psychiatric disorder or even a psychosis, particularly with drugs such as amphetamines, cocaine, or methamphetamine. Often it is impossible to determine which factor, the psychiatric disorder or the substance abuse, is the driving factor or the trigger of the other factor. Some individuals are also genetically predisposed to developing psychiatric problems.

It is often difficult to find a treatment center that is equipped to deal with a person with both a psychiatric problem and a drug or alcohol problem because most treatment centers concentrate on one major problem alone, such as a psychiatric disorder or substance abuse. However, according to a 2006 DASIS Report, published by the Drug and Alcohol Services Information System, of the 13,454 public and private substance abuse treatment centers in the United States that responded to their survey in 2004, 4,756 (35 percent) reported having programs or groups for clients with both substance abuse and mental health disorders. These facilities were more likely to accept Medicare (46 percent) than facilities that did not have such programs for patients with dual diagnosis (29 percent), and they were also more likely to accept Medicaid (64 percent) versus facilities without such programs (48 percent).

It is also true that often individuals who have substance abuse issues and psychiatric problems will not seek out or accept treatment unless they are compelled to do so by a court or as a condition to avoid jail or prison or to have a chance of regaining custody of a child who was removed from them because of neglect or abuse.

References:

Office of Applied Studies. "Facilities Offering Special Programs of Groups for Clients with Co-Occurring Disorders: 2004." The DASIS Report 2. Rockville, Md.: Substance Abuse and Mental Health Services Administration, 2006.

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