What is Dual Diagnosis? Co-occurring Mental Health Conditions

Dual diagnosis means that someone has both a mental health condition and a substance use disorder (SUD) at the same time. It’s important to note that the presence of both types of conditions is common, and many effective treatment options exist. A 2022 study in Psychiatry Research found that over 25% of people with a mental health diagnosis in the past year also met criteria for dual diagnosis. Because symptoms of mental health and substance use conditions overlap, having the right diagnosis gives you and your mental health team important information that can help with creating a treatment plan.

In this article, we’ll explore what dual diagnosis means, the signs to look for, why mental health and substance use conditions often occur together, and what to expect from diagnosis and treatment.

What is dual diagnosis?

Dual diagnosis means that someone has both a diagnosis of a mental health condition and a substance use condition at the same time. For example, a person may have an alcohol or drug use disorder along with a mental health condition. Some mental health conditions that commonly occur alongside substance use include major depressive disorder (MDD), anxiety disorders, bipolar disorder, personality disorders, and post-traumatic stress disorder (PTSD).

How common are co-occurring disorders?

Co-occurring disorders are quite common, and include the presence of more than one physical or behavioral health condition. About 21.2 million adults in the U.S. have a co-occurring disorder, according to the SAMHSA's 2024 Survey on Drug Use and Health. 

Signs of a dual diagnosis

Dual diagnosis symptoms can include symptoms of both mental health and substance use conditions. Because symptoms of mental health and substance use conditions often overlap, this isn’t a checklist to follow. Instead, a good rule of thumb is that any symptoms that are persistent or impacting your daily life are signs that it is worth seeking support.

Mental health symptoms to notice

• Ongoing feelings of sadness or hopelessness
• Extreme mood changes
• Changes in sleep or eating habits
• Difficulty functioning at work or school
• Withdrawing from friends or families
• Disinterest in previously enjoyed activities
• Difficulty concentrating or making decisions
• Low energy or brain fog

Substance use patterns to notice

• Using more of a substance than you plan to
• Trying to stop using a substance but being unable to
• Having strong cravings or desires for a substance
• Using substances alone and secretly
• Neglecting responsibilities and disengaging from previously enjoyed activities
• Engaging in risky behaviors
• Needing more of the substance to feel the same effects (tolerance)
• Experiencing withdrawal symptoms when stopping the substance (tremors, sweating, nausea, anxiety)

Why mental health and substance use conditions often occur together

Mental health and substance use conditions often occur together because they share similar risk factors. For example, factors such as stress, trauma, and genetics can contribute to both mental health and substance use conditions.

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Mental health and substance use conditions can also contribute to each other. For example, someone with a mental health condition might start using substances to deal with the difficult symptoms that the mental health condition causes. Likewise, substance use can make mental health issues worse or cause new psychiatric symptoms. Sometimes, it can be difficult to tell if symptoms are coming from a mental health condition, substance use, or both. 

How dual diagnosis is diagnosed

A licensed mental health professional diagnoses co-occurring conditions through a thorough psychiatric evaluation. This may include:

• Clinical interview
• Screening and assessment tools
• Medical evaluation
• Mental health history and background

Dual diagnosis treatment: what integrated care looks like

Integrated treatment is generally recommended because it addresses both conditions in the same treatment plan. 

Therapy approaches

Therapy approaches are focused on developing coping skills and learning how to manage both conditions. These may be offered as individual therapy, group therapy, family therapy, or a combination of these therapy types. Common therapy approaches used for dual diagnosis include:

• Cognitive behavioral therapy (CBT): Helps identify triggers and develop stress management and problem-solving skills.
• Dialectical behavior therapy (DBT): Teaches skills for emotional regulation, mindfulness, distress tolerance, and interpersonal effectiveness.
• Motivational interviewing (MI): Builds motivation for change.
• Contingency management: Uses tangible rewards to reinforce positive behaviors that support recovery.

Medication and dual diagnosis

Some medications can help manage symptoms of mental health conditions, while other medications can reduce cravings associated with substance use disorders. Some medications may also help treat symptoms of both conditions.

Why integrated care works better

Integrated care tends to work better because mental health and substance use conditions are interconnected, with symptoms of one condition often triggering or making symptoms of another condition worse. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), integrated treatment is associated with an increased chance of successful treatment and recovery for both disorders, improved quality of life, and reduced symptoms.

Levels of care for dual diagnosis

You and your care team choose your level of care based on your symptom severity, safety risk, and ability to function. For dual diagnosis, care levels vary. They range from flexible outpatient treatment to secure inpatient care.

• Standard outpatient therapy: Consists of a one-on-one therapy session every week or every two weeks. This level of care works best for people who are able to manage their daily responsibilities and care for themselves.
• Intensive outpatient program (IOP): This program offers several hours of structured treatment at least three days a week, often more. The exact schedule varies by program, but can include group therapy, individual therapy, and skill building. Some IOPs also offer medication management. IOPs often work best for individuals who need more support than standard outpatient therapy provides, but who are still able to keep up with their daily responsibilities. People attending IOP may live at home or in a supportive environment such as a sober living home. IOP is often helpful for those transitioning down from a more intensive level of care, such as residential treatment.
• Partial hospitalization program (PHP): Offers intensive treatment during the day for six hours. Participants return home or to another supportive environment, such as a sober living home, after the program ends each night. PHPs are usually suggested for those who require medical monitoring, and for those whose symptoms are so impactful that they’re not able to keep up with their daily responsibilities but who can keep themselves safe. It can also be used as a step down from an inpatient program.
• Residential treatment: This level of care is best for people who have repeatedly tried and were unsuccessful at stopping their substance use in an outpatient level of care. In those cases, people often benefit from the safe and supportive environment residential offers. It’s also ideal for people who have medical complications due to underlying medical conditions or from their substance use, for example, requiring medically-assisted detox.
• Inpatient treatment/hospitalization: 24/7 support and supervision and crisis stabilization. Inpatient care is best for someone who is unable to keep themselves safe or care for themselves at home. It offers a secure, safe environment for symptoms to stabilize.

What to do during a dual diagnosis crisis

If you or someone else is in danger, facing a life-threatening emergency, or can't stay safe, call 911 or go to the nearest emergency room. You can also call or text 988 for crisis support. 

How Willow Health can help

If you don’t need the ER but feel you can’t wait for a program, Willow Health can help. Willow Health offers virtual crisis stabilization in New York. Urgent intake appointments are available within 48 hours to get started on a personalized care plan. Start your journey now. 

Frequently asked questions

Is dual diagnosis the same as co-occurring disorders?

Dual diagnosis refers to having both a mental health condition and a substance use condition, while co-occuring disorders references having more than one physical or behavioral health condition. Dual diagnosis is a specific type of co-occuring disorder that has it’s own name due to its high prevelance.

Which condition gets treated first?

With a dual diagnosis, it’s best to treat both conditions at the same time. This is because they are closely connected, and symptoms of one condition often trigger or worsen symptoms of another. 

Can you get dual diagnosis treatment virtually?

Yes, many outpatient mental health treatments are available virtually. These include standard outpatient therapy, IOPs, and crisis stabilization programs. Research shows that virtual treatments can be as effective as in-person treatments. For example, a 2020 review published in Clinical Psychology Review found that videoconferenced treatment and in-person treatment have similar effects.

Does insurance cover dual diagnosis treatment?

Yes, insurance covers many treatments for mental health conditions, including dual diagnosis. However, coverage may vary by insurance provider, plan, and location. It's best to check with your provider directly. 

What's the recovery outlook for dual diagnosis?

Recovery is possible. However, the outlook depends on several factors. These include symptom severity, medical and social factors, and access to proper dual diagnosis treatment. Treating both conditions together can help people manage symptoms, reduce substance use, and improve quality of life. According to SAMHSA, about 50% of individuals with dual diagnosis respond well to basic treatment and enter stable remission within 2 to 3 years.

Sources

Batastini, A. B., Paprzycki, P., Jones, A. C. T., & MacLean, N. (2021). Are videoconferenced mental and behavioral health services just as good as in-person? A meta-analysis of a fast-growing practice. Clinical Psychology Review, 83, Article 101944. https://doi.org/10.1016/j.cpr.2020.101944 

Jegede, O., Rhee, T. G., Stefanovics, E. A., Zhou, B., & Rosenheck, R. A. (2022). Rates and correlates of dual diagnosis among adults with psychiatric and substance use disorders in a nationally representative U.S. sample. Psychiatry Research, 315, 114720. https://doi.org/10.1016/j.psychres.2022.114720 

National Institute of Mental Health. (n.d.). Substance use and mental health. National Institutes of Health. https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health

Substance Abuse and Mental Health Services Administration. (2025). 2024 National Survey on Drug Use and Health (NSDUH) releases. U.S. Department of Health and Human Services. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases/2024 

Substance Abuse and Mental Health Services Administration. (2019). Building your program: A guide to implementing evidence-based practices. U.S. Department of Health and Human Services. https://library.samhsa.gov/sites/default/files/ebp-kit-building-your-program-10112019.pdf

Substance Abuse and Mental Health Services Administration. (n.d.). Co-occurring disorders. U.S. Department of Health and Human Services. https://www.samhsa.gov/mental-health/serious-mental-illness/co-occurring-disorders