Those who live with mental illnesses don’t deal with them in a vacuum. Challenges such as housing, poverty, poor physical health and discrimination add layers of difficulty to pursuing stability. And one of these challenges, substance use, can have a particularly profound impact.
The combination of mental illness and substance use disorder is known as co-occurring disorders or dual diagnosis, and it’s relatively common. According to the 2023 National Survey on Drug Use and Health, approximately a third of American adults who lived with a mental illness in 2023—20.4 million adults—also dealt with a substance use disorder. Among those who lived with serious mental illnesses such as bipolar disorder, schizophrenia, schizoaffective disorder and major depression, that percentage was even higher: Nearly half dealt with a substance use disorder.
For these individuals, the impact is especially pronounced. The survey report states, “The combined presence of [substance use disorders] and mental disorders … results in more profound functional impairment; worse treatment outcomes; higher morbidity and mortality; increased treatment costs; and higher risk for homelessness, incarceration, and suicide than if people had only one of these disorders.”
But, though co-occurring disorders are prevalent and life-altering, they’re often misunderstood, and misconceptions about them can prevent those living with them from receiving accurate diagnoses and effective treatment. Below are four common myths about dual diagnosis.
Myth #1: Mental illnesses and substance use disorders are unrelated.
Substance use disorders and mental illnesses share some common underlying causes, including genetics, brain composition, trauma and stress. But that’s not the only connection: Each aspect of dual diagnosis can contribute to the development of the other. Some of those dealing with co-occurring disorders first begin using drugs or alcohol to cope with symptoms of a mental illness. For others, substance use can be a factor in the onset of a mental health condition or exacerbate an existing condition.
Myth #2: It’s obvious when someone is dealing with co-occurring disorders.
Neither mental illness nor substance abuse has a “type.” Both can impact anyone of any age, race and socioeconomic status, and it may not be obvious when someone is struggling. Also, since the symptoms of many mental illnesses and substance use are similar, those who are diagnosed with one may be less likely to receive a diagnosis of the other. This is often compounded by the fact that substance use can mask the symptoms of some mental illnesses.
Myth #3: Mental health treatment includes treatment for substance use disorders.
SAMHSA states that “Integrating both screening and treatment for mental and substance use disorders leads to a better quality of care and health outcomes for those living with co-occurring disorders by treating the whole person.” But, although many current treatment guidelines recommend that people living with co-occurring disorders receive treatment that addresses both substance use and mental illness, many receive treatment for just one.
In 2023, 62.4% of adults dealing with dual diagnoses received substance use treatment or mental health treatment in the past year. Just 18.6% received both. And approximately two in five individuals received treatment for neither.
Numerous factors prevent those living with co-occurring disorders from getting treatment for both mental illness and substance use disorder. Historically, individuals struggling with substance use have sometimes been excluded from receiving mental health services because of their use of drugs or alcohol; others have not been able to access treatment for substance use due to their mental health symptoms.
Though attitudes about treatment have shifted, seeking help for dual diagnosis often involves navigating two sets of care providers and systems. While programs that integrate care for both substance use and mental illness are becoming more common, options are limited, and they’re still unavailable or inaccessible to many.
Myth #4: Treatment for co-occurring disorders doesn’t work.
There’s no “cure” for mental illnesses or substance use disorders, and pursuing stability when living with dual diagnosis isn’t always a straightforward or linear process. But as SAMHSA states, “Together with early detection, integrated treatment can improve outcomes and quality of life for people with co-occurring disorders.” Those receiving professional help for both aspects of dual diagnosis are often able to reduce or discontinue their substance use and see improvement in their mental health symptoms and in quality of life.
In addition, support from a caring community can help those experiencing co-occurring disorders take steps toward stability. The Well Community offers resources, case management services and a stigma-free environment for those who are struggling with dual diagnosis. Your generosity will help us continue to come alongside them.