Dual Diagnosis: Co-Occurring Struggles

For many who live from mental health conditions, an extra layer of challenges makes it harder to pursue stability: substance use disorders. The Substance Abuse and Mental Health Services Administration (SAMHSA) explains that “Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.”

When a mental illness and a substance use disorder are paired together, their impact is often multiplied rather than merely combined. This combination of conditions is known as dual diagnosis or co-occurring disorders. Read on to learn the basics of this two-sided struggle that impacts over 19 million Americans.

Dual diagnosis is common.

The 2021 National Survey on Drug Use and Health found that a third of adults in United States who deal with a mental illness also live with a substance use disorder. Among those living with serious mental health conditions (such as bipolar disorder and schizophrenia), that number jumps even higher: 43.5% deal with a dual diagnosis.

Dual diagnosis is common for numerous reasons. Sometimes, those living with mental illnesses turn to drugs or alcohol to cope with the symptoms of their conditions. In turn, the use of some substances can cause or worsen some mental health symptoms. Additionally, substance use disorders and mental illnesses share some common underlying causes, including genetics, brain composition, trauma and stress.

Co-occurring disorders bring compounding challenges.

Dealing with both a mental illness and a substance use disorder can amplify the impact of both conditions on a person’s daily life. Mental Health America states, “For people struggling with co-occurring mental health and substance abuse disorders, physical safety and overall health risks are greater; the impairment of life skills is greater; and the chances for successful treatment are much less – all of which contribute to stigma.”

Many Well Community members have experienced these compounding challenges. Ryan,* who lives with bipolar disorder, began to struggle with a substance use disorder as well during a time when the symptoms of his mental illness seemed especially unmanageable. As his co-occurring conditions compounded one another, he lost his part-time job, became homeless and was cut off from many of the support systems that had helped him maintain stability.

Treatment for both is vital—but rare.

Although integrated intervention—treating both the mental illness and the substance use concurrently and in a coordinated way—is the most effective way to treat co-occurring disorders, this sort of care is the exception rather than the norm. According to the National Institute on Drug Abuse, just 9% of individuals dealing with dual diagnosis receive treatment for both conditions. Over half don’t receive treatment for either.

Numerous hurdles prevent those living with dual diagnosis from receiving integrated treatment. Cost is often a major factor, as is a lack of availability of programs that address both mental illness and substance use disorders, particularly for those on Medicaid. Ryan, for example, needed to move out of the area to receive treatment that was accessible to him—a move that has taken him away from family and from people at the Well who have provided a support system for him. But, with integrated treatment, he is doing much better and has been able to reconnect with his children. Stigma and myths about treatment also play a role as do the ways that co-occurring conditions impact the brain and influence a person’s perception of their need for treatment.

Amid the challenges of addressing dual diagnoses, support from others who understand and care can play a vital role in helping those living with co-occurring disorders pursue stability. The Well Community offers resources, case management services and a stigma-free environment for those who are struggling with these compounding challenges. Your generosity will help us continue to come alongside them in this intertwined struggle.

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*Name has been changed.

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