Dual Diagnosis vs. Co-Occurring Disorders: Signs, Risk Factors, Treatment

Dual diagnosis and co-occurring disorders are believed by many to mean the same thing, that a person has both a substance use disorder (SUD) and a mental health disorder. One may be more significant than the other, or they may be equal in severity. Each is diagnosable using the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM5).

In 2019, 9.5 million American adults age 18 and older suffered from co-occurring disorders. Most adults with a dual diagnosis received either mental health services or substance abuse services. Only 7.8% received treatment for both diseases, however. Mental health disorders that most commonly occur with substance use disorders include depression, anxiety, personality disorders, and schizophrenia.

Signs of Dual Diagnosis or Co-Occurring Disorders

When looking for signs of co-occurring disorders, you may recognize the signs of a substance use disorder separate from the signs of mental illness. Some symptoms will overlap. Many people drink alcohol or misuse drugs to mask the pain caused by depression, anxiety, or trauma. Misusing substances can make mental health symptoms worse.

Others use substances to cope with their problems or pain. This is called self-medicating, and it is more common than you may think. If you have a dual diagnosis or co-occurring disorder, your mental health symptoms will appear even when sober. Knowing the signs to look for in both a substance use disorder and mental health disorder can benefit you when trying to determine if they are co-occurring.

Signs of a Substance Use Disorder

Diagnosing a substance use disorder or mental health disorder must only be done by a qualified and licensed treatment professional. They use the DSM5 lists eleven criteria of a substance use disorder. Meeting two to three of the criteria means the SUD is mild. Meeting three to six criteria means it is moderate, and six or more criteria represent a severe SUD. The criteria include:

• • • Wanting or trying to cut back or quit misusing substances but can’t.
    • Needing more and more of the substance to feel the same effects.
    • Putting yourself in dangerous situations when seeking or using substances.
    • Neglecting responsibilities at work, home, school, or socially.
    • Stopping or cutting back on the substance leads to withdrawal symptoms.
    • Using more significant amounts or for more extended periods than intended.
    • Spending most of your time seeking, using, or recovering from substance use.
    • Continuing to use it even though it has caused broken relationships with family and friends.
    • Continuing to use it even though it has caused physical or mental health problems to worsen.
    • Craving alcohol or drugs occurs regularly.
    • Giving up activities you once enjoyed so you can spend more time drinking or using drugs.

After learning if you meet the criteria for mild, moderate, or severe substance use disorder, the licensed treatment professional can compare them to your mental health symptoms to determine which dual diagnosis or co-occurring disorder is present.

Signs of Co-Occurring Depression or Anxiety

If you have co-occurring depression, you will have symptoms for longer than two weeks, including feeling:

• • • Sad for most of each day.
    • Overly tired and lack energy.
    • Aches, pains in muscles, bones, joints, etc.
    • Loss of pleasure.
    • Loss of interest in daily activities.
    • Hopeless, guilty, unworthy, etc.

Sleep disturbances such as insomnia or oversleeping are common in depression and anxiety. You may also experience appetite and weight changes. Below are other symptoms of an anxiety disorder.

• • • Excessive worry even when there is nothing to worry about.
    • Becomes irritable, agitated, or defensive quickly.
    • Heart and breath rates increase.
    • Becomes restless, fidgety, or on edge.
    • Trouble focusing or concentrating due to worrying thoughts.

Signs and Symptoms of Personality Disorders

Types of personality disorders include antisocial, avoidant, borderline, dependent, histrionic, narcissistic, obsessive-compulsive, paranoid, schizoid, and schizotypal. Borderline personality disorder is the most common type. Symptoms may include:

• • • Fear of being abandoned and going to extreme lengths to avoid separation.
    • Changes in how you view yourself can occur quickly.
    • Paranoia is caused by stress that may include losing contact with reality.
    • Participating in dangerous activities that can put you at risk of harm
    • Self-harm or suicidal ideations or threats.
    • Mood swings are very different and last for a few hours or days.
    • Anger or sarcasm that is not appropriate.

Another personality disorder being discussed more today is a narcissistic personality disorder. People often misuse this title to label people they don’t like. However, the only person that can genuinely diagnose someone with this disorder is a licensed treatment professional. Signs of narcissistic personality disorder may include:

• • • Inflating their sense of self-importance.
    • Feeling entitled to what others have, even their time.
    • Needing to be the center of attention.
    • Needing to be admired by others.
    • Feeling superior and wanting to associate with other people they deem exceptional.
    • Getting angry when you don’t get attention.
    • Bragging and being unable to empathize with or recognize the needs of others.
    • Wanting only the best material things available.

Treatment for Dual Diagnosis or Co-Occurring Disorders

The most crucial treatment for co-occurring disorders is that they must both be treated simultaneously. Treating an alcohol use disorder but not depression means the depression will continue when you are sober and could lead to a relapse. Trying to treat a mental health disorder while continuing to misuse drugs or alcohol will not work. The substances prevent your brain from healing or benefiting from medications and therapies. There is no one-size-fits-all treatment plan.

Working with a licensed mental health professional, an evaluation will be conducted to create a treatment plan based on your unique needs. Treatment is usually a combination of medications and individual, group, and family therapies. Depending on the severity of your substance use disorder, inpatient or residential treatment may be recommended in the beginning. Other options include partial hospitalization and intensive outpatient programs.

Contact us today if you think you may have a dual diagnosis or co-occurring disorder. We can help you find out for sure and if so, help you develop the right treatment plan.