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05-09 Predisposing risk factors may lead to dual diagnosis

Predisposing risk factors may lead to dual diagnosis

Dual diagnosis is a term used when mental illness and substance use occur together in the same person, either simultaneously or one right after the other. According to the National Institute on Drug Abuse (NIDA), about half of those with mental disorders use drugs compared to the general population, and about half of those with drug use disorders also have a mental illness.

How does dual diagnosis develop?

Drugs and alcohol are sometimes used to “self-medicate” symptoms of an underlying mood disorder or mental illness long before diagnosis. Conversely, drug and alcohol use can cause so much depression, anxiety or even psychosis that users meet the criteria for a mental illness. Each illness characteristically alters the course of the other in those who have dual diagnosis.

Substance use and mental disorders share some other characteristic features that help to explain why the two so often occur together. Some of the characteristics that these disorders share include:

  • Genetic markers: Both substance use and mental disorders are known to run in families. According to the NIDA, dual diagnosis research involves the search for genes that increase vulnerability to addiction and mental illness. Genes that determine how people respond to stress are of particular interest.
  • Brain regions: The reward center of the brain consists of structures, pathways and chemicals that directly influence mood and emotions, and thus behavior as well. Addictive substances are addictive because they alter brain chemicals so dramatically. Psychiatric medications are also based on brain chemical theory. Researchers are working to find the most effective way to alter brain chemicals without causing addiction.
  • Stages of brain development: While the brain is always growing new neuropathways, the age up to early adulthood is the most critical period of development. During childhood and adolescence, the brain goes through periods of rapid changes and is particularly susceptible to the effects of drugs, alcohol and other toxins. For example, having a first alcoholic beverage before age 18 significantly increases the risk of alcoholism later in life. Schizophrenia and other mental disorders have also been considered to be neurodevelopmental in origin.
  • Exposure to traumatic events: Sixty percent of adults seeking substance use treatment and 80 percent referred for mental health services experienced physical, sexual or emotional abuse during childhood. High rates of post-traumatic stress disorder (PTSD), substance use disorders, and dual diagnoses are also seen in American servicemen and servicewomen. Other traumatic situations — intimate partner violence, disasters, exploitation and other tragedies — are extremely common in America today, and survivors sometimes develop PTSD. Those with PTSD are at risk for substance use.

Response to therapy: Perhaps because of the biological and situational similarities, substance use and mental disorders both respond well to many of the same treatments. Individual, group and family therapies that use cognitive, behavioral, dialectical and solution-focused approaches are very effective. Medications, nutritional and experiential therapy also help to restore normal brain function. Cognitive rehabilitation allows normal brain development to resume. Detoxification and healthy lifestyle habits prevent future exacerbations, along with the establishment of a sober support network.

Which came first?

Trying to figure out which illness began first or caused the other is difficult and unhelpful. Instead, giving priority to understanding the underlying conditions can make treatment most effective and minimize symptoms. Chronic symptoms can be greatly reduced by avoiding drugs and alcohol, establishing healthy lifestyle habits and participating in a sober support group.

Acute episodes can occur for a variety of reasons, and professional treatment may become necessary. Treatment provides stabilization, insight into symptom triggers and prevention of future episodes. Recovering in a safe, healthy environment can provide those with dual diagnosis and their families the right start to a brighter future.

Sovereign Health Rancho San Diego treats adolescents with eating disorders, mental health problems, substance use and dual diagnosis. Our programs integrate state-of-the-art neurocognitive treatments with alternative approaches like experiential therapies. Experiential therapies help foster creative expression and help heal the spirit. To learn more about specialized programs at Sovereign Health, please call our 24/7 helpline.

About the author

Dana Connolly, Ph.D., is a senior staff writer for the Sovereign Health Group, where she translates current research into practical information. She earned her Ph.D. in research and theory development from New York University and has decades of experience in clinical care, medical research and health education. The Sovereign Health Group is a health information resource and Dr. Connolly helps to ensure excellence in our model. For more information and other inquiries about this article, contact the author at

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