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Dual Diagnosis

Dual Diagnosis

Dual diagnosis (also referred to as co-occurring conditions or comorbidities) is a term used for people who are struggling with both a mental health condition and a substance use disorder. In some people, these multiple disorders develop at the same time, while in others, either one of the conditions can precede the other.

Some people who have a mental health condition use drugs or alcohol as a way to self-medicate their symptoms. Although these substances may provide short-term relief, they typically exacerbate mental health problems in the long run.

In other people, using drugs or alcohol may cause changes in the brain that contribute to the development of psychiatric disorders.


Approximately 7.9 million American adults have both a mental health condition and substance use disorder, according to a 2014 National Survey on Drug Use and Health. Although both women and men are at risk of dual diagnosis, men make up over 50% of those affected. The prevalence of dual diagnosis in adults is highest in people aged 18-25, followed by those 26-49, and is least common in those who are 50 or over.

Among adolescents aged 12-17, the percentage who use drugs is higher in those who have depression. Young people in this age group with depression are more likely to use marijuana, hallucinogens, inhalants, and prescription drugs and to be heavy drinkers.

Scientific evidence shows that among adolescents seeking treatment for substance abuse, 50-90% also suffer from some form of psychiatric disorder.


Addictions may occur with any mental health disorder, but some of the more common conditions include:

  • ADD/ADHD: Children and adults with untreated ADD/ADHD are also at increased risk for addiction. According to one study, half of all people with ADHD will develop a substance abuse problem if it remains untreated. A 2005 report in the journal Pediatrics found that having prior or current ADHD also makes you more prone to become addicted at an earlier age and results in a greater intensity of abuse.
  • Anxiety: People with anxiety are twice as likely to abuse drugs and alcohol compared with the general population, according to the National Institute on Drug Abuse.https://www.amenclinics.com/conditions/depression/
  • Depression: Substance abuse is about twice as common in depressed people as in people who don’t have this condition. Many people with depression use alcohol to numb their feelings, but alcohol is a central nervous system depressant that can trigger symptoms associated with depression.
  • Post-Traumatic Stress Disorder (PTSD): Some studies suggest that over half of all people with PTSD also struggle with substance abuse.
  • Bipolar Disorder: People with bipolar disorder may use drugs and alcohol as a coping mechanism for their mood swings, but research also shows that drug abuse may cause changes in the brain that contribute to the development of bipolar disorder.
  • Schizophrenia: About half of all people suffering from schizophrenia report having abused drugs and/or alcohol. Many drugs, including marijuana, can increase the severity of schizophrenia symptoms.
  • Psychosis: There is an increased risk of psychosis in people who use marijuana.


A number of factors may contribute to addiction and mental illness.

  • Brain abnormalities: Based on the world’s largest database of brain scans related to behavior—over 150,000 and growing—it has become clear that mental health conditions and addiction issues are actually brain problems.
  • Genetics: Some genes may predispose certain people to a vulnerability for addiction and mental health problems.
  • Exposure to trauma or stress: People who have experienced trauma are at a much higher risk of developing a mental health condition and are also at increased risk of substance use disorders.
  • Head Injuries: Brain imaging studies show that even mild physical trauma can damage the brain and increase your risk of addiction and mental health problems. Alcoholism and drug abuse, as well as ADD/ADHD, anxiety, and depression are all more common in people who have experienced head injuries.
  • Exposure to environmental toxins: Common environmental toxins, such as mold, insecticides, tobacco smoke, paint, nail polish, and phthalates (found in thousands of plastic products), pose a risk to brain function and increase the incidence of brain disorders, such as ADD/ADHD. Brain scans of indoor painters show some of the highest levels of brain damage. Any damage to the brain can increase your vulnerability to addiction.
  • Dementia: Dementia has been linked to an increased risk of addiction and compulsive behaviors. When elderly people who have lived their entire lives without a problem suddenly start abusing drugs or alcohol and suffering from a mental health condition, it’s worth investigating if some form of dementia may be involved.


Considering there are so many different mental health conditions that can co-occur with addiction, there can be a wide range of symptoms with dual diagnosis.

Symptoms of substance use disorders may include:

  • Using increasing amounts of the substance
  • Inability to quit without experiencing cravings or symptoms of withdrawal
  • Getting defensive whenever someone question you about your habits
  • Feelings of guilt about your substance use
  • Feeling powerless to change your habit
  • Withdrawal from family and friends
  • Neglecting responsibilities—not caring for kids or pets, forgetting to pay bills
  • Stealing to fuel your addiction
  • Feeling like you need the substance in order to function

Symptoms of mental health conditions can include impulsivity, nervousness, feeling numb or hopeless, extreme mood swings, and more.


In the traditional healthcare system, it can be very hard to get an accurate diagnosis of both addiction and mental illness. Symptoms of substance abuse or withdrawal can be similar to those of certain mental health conditions, so it’s possible for providers to miss an underlying psychiatric disorder. Getting an accurate dual diagnosis is critical to healing and recovery. Addressing the underlying mental health condition and brain-related issues is the key to helping you be successful in an addiction treatment program.


Brain SPECT imaging can evaluate the health of your brain and detect any areas that aren’t functioning optimally. Getting a clear picture of your brain health can help identify brain problems, such as abnormal blood flow, head injuries, ADD/ADHD, depression, anxiety, or dementia, which are associated with increased risk of addiction and relapse.

Based on our brain imaging work, we have also discovered that not all addictions and mental health conditions are alike. We have identified 6 types of brain patterns associated with addiction and 7 types of depression, anxiety, and ADD/ADHD. Knowing your type is key to getting the most effective treatment.

Brain scans can be a very powerful tool in the treatment of dual diagnosis because it helps:

  • Break through denial
  • Determine which co-existing conditions require treatment
  • Decrease shame and stigma
  • Show that addiction is a brain disorder, not a personal weakness or character flaw
  • Increase treatment compliance
  • Evaluate if treatment is working correctly or needs to be adjusted


At Amen Clinics, we use brain SPECT imaging as part of a comprehensive evaluation to diagnose and treat people struggling with addictions and mental health disorders. This helps us identify your particular type of addiction as well as any co-occurring conditions and their specific type. In addition, we assess any biological, psychological, social, and spiritual factors that may be contributing to dual diagnosis.

When it comes to treatment, one size does not fit all! What works for one person may not work for another—or could even make your symptoms worse! Based on your type of addiction and co-occurring disorders, as well as the other factors in your life, we can create a personalized treatment plan for you. At Amen Clinics, we believe in using the least toxic, most effective therapies and strategies to optimize your brain function and help you regain control of your life.

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