Symptoms & Signs of Dual Diagnosis & Co-Occurring Disorders

In the U.S. and throughout the world, there is significant overlap between people affected by diagnosable substance use problems and people affected by mental health issues. Doctors, public health officials and researchers use either of two terms to identify this overlap: dual diagnosis[i] and co-occurring disorder[ii]. The symptoms and signs of co-existing substance problems and mental illness vary from person to person. In fact, the variations are so great that doctors use special screening procedures to avoid misdiagnosing their patients.

Basics of Dual Diagnosis and Co-Occurring Disorders

Whenever the same person experiences symptoms of two physical or mental conditions at the same time (or in quick succession), doctors refer to those overlapping conditions as a comorbidity. The overlap between substance problems and mental illness is one of the most common comorbidities in the U.S.[iii] and across the globe.

The connection between substance abuse/addiction and poor mental health runs deep. Data consistently shows that people coping with the impact of anxiety disorders, mood disorders and other illnesses develop diagnosable substance use problems more often than the average in the total population. They also show that people coping with the impact of drug, medication or alcohol-related issues have an increased tendency to develop mental illness.

It’s worth noting that the line drawn between substance use disorders and dual diagnosis/co-occurring disorders is somewhat artificial. The American Psychiatric Association views all diagnosable varieties of substance abuse and addiction as forms of mental illness. That’s true, in part, because addiction changes the long-term function of the brain. In addition, both abuse and addiction can lead to changes in thought and behavior that increase the risks for personal and social harm.

Dual Diagnosis Signs and Symptoms

In any given person, the signs and symptoms of dual diagnosis/co-occurring disorders depend on two main factors: the type of substance use problem in effect and the type of mental illness in effect. For example, a person affected by major depression and alcohol use disorder (alcohol abuse/alcoholism) may have overlapping problems that include:

• A persistent “down mood”
• An inability to control the frequency of alcohol use or the amount of alcohol consumed
• Persistent alterations in normal patterns of sleep
• A rising tolerance to alcohol’s intoxicating effects
• A persistent inability to think clearly
• Exposure to personal or social harms caused by repeated involvement in excessive drinking
• Constant or near-constant feelings of worthlessness
• Susceptibility to symptoms of withdrawal when alcohol use ends or the time between drinking sessions increases
• Suicidal thinking or suicidal behavior (including planning and/or active suicide attempts)

However, there are two other important facts to consider. The symptoms of substance abuse/addiction can vary to a great degree, even in two or more people who consume the same amounts of the same substance. In addition, depression and other mental illnesses can have varying effects, and these conditions often look quite different in different people. In combination, these facts mean that no one can say for sure how the symptoms of dual diagnosis/co-occurring disorders will manifest in any specific person.

How Do Doctors Identify Co-Occurring Disorders?

If the symptoms of dual diagnosis/co-occurring disorders are so variable, how do doctors make their diagnoses? To begin with, when working with their patients, doctors must be alert to the fact that substance problems and other mental health issues often go hand in hand. Without this in mind, potential symptoms of overlapping conditions can go unnoticed.

Doctors can also use screening procedures[iv] designed to identify overlapping symptoms of substance-related issues and mental illness. These procedures include such things as:

• Reviewing medical records for a prior diagnosis of a substance problem or separate mental health problem
• Reviewing medical records for prior treatment (including hospitalization) for a substance problem or separate mental health problem
• Reviewing medical records for previous use of antidepressants or other medications used in the treatment of mental illness or substance problems
• Reviewing records for any previous exposure to sexual abuse, physical abuse or any other severe form of trauma
• Checking for a family history of mental health issues and/or substance-related issues
• Checking for unusual thoughts or behaviors that could indicate the presence of substance or mental health problems
• Checking for appearance-related factors (e.g., poor grooming, severe dental problems) that could indicate substance or mental health problems
• Checking for any current indications of suicidal thought or behavior
• Checking for any current indications of unusual aggression toward others

Impact on Symptom Severity

There is another important potential indicator for dual diagnosis/co-occurring disorders. In many cases, the substance- or mental illness-related symptoms in affected people are unusually severe. The presence of severe symptoms does not mean that a person with substance problems or a mental illness qualifies for a co-occurring disorder diagnosis. However, intense problems should serve as a warning sign.

Missed Opportunities

Unfortunately, doctors overlook signs and symptoms of dual diagnosis/co-occurring disorders with some regularity. In part, this fact is a consequence of the difficulties involved in identifying overlapping symptoms of mental illness and substance use problems. However, in addition, not all physicians are familiar with the screening procedures needed to draw attention to those symptoms. In recent years, improved awareness of the problem among general physicians, addiction specialists and mental health professionals has led to a decrease in missed diagnoses and an increase in treatment.

Seeking Help

It takes a coordinated effort to address the symptoms of dual diagnosis disorders. This effort includes case-by-case input from both mental health specialists and addiction treatment specialists. At Transformations Treatment Center, we offer individualized treatment programs that help build a foundation for a healthy recovery and a life of sobriety.