Co-occurring mental health conditions and substance use (dual diagnosis)

Dual diagnosis is an older term for having a substance use disorder and another mental health condition at the same time. Current sources, including the National Institute on Drug Abuse (NIDA), usually say "co-occurring disorders." The overlap is common, and it affects how treatment is planned. This page explains what is known and where the answers depend on a person's own situation.

How often the conditions overlap

NIDA cites the 2023 National Survey on Drug Use and Health, which found that 35 percent of adults aged 18 and over in the United States who have another mental disorder also have a substance use disorder. That figure describes one survey year and one country, so it is a snapshot rather than a fixed rate. NIDA's page was last updated in 2024.

The conditions that most often appear together with substance use, according to NIDA, include anxiety, depression, post-traumatic stress disorder (PTSD), disorders involving psychosis, and borderline and antisocial personality disorders. NIDA's page also names bipolar disorder, schizophrenia, conduct disorder, and attention deficit/hyperactivity disorder in discussing the overlap. Having one of these conditions does not mean a person has the others.

Why they occur together

There is no single explanation. NIDA describes shared risk factors, including inherited characteristics, adverse social environments, trauma and stress. It also says that substance use problems may involve similar changes to brain circuitry as some mental disorders, that a mental disorder can raise the risk of misusing substances, and that substance use can contribute to or worsen a mental disorder.

Trauma gets particular attention. NIDA notes that one analysis found over 30 percent of adults with a substance use disorder had childhood trauma, and that childhood trauma increases the risk for substance use, other mental disorders, suicidality and physical health conditions. How care can respond to trauma is covered in trauma-informed care.

Why integrated treatment is favored

When a person has more than one condition, one question is whether to treat them one after the other or together. NIDA's answer is that it is usually better to treat co-occurring conditions at the same time rather than separately, and it says research suggests this can make all the treatments more effective and improve health outcomes. It describes the need for an integrated approach, meaning one coordinated plan rather than separate tracks that do not talk to each other.

The same source says people entering treatment for a mental disorder such as PTSD can be screened for substance use disorders, and the reverse also applies. In practice, this means asking about both from the start. A person who is already in care for one condition can ask whether the other has been considered.

What integrated care can include

Integrated care is a way of organizing treatment, not a single therapy. Depending on the person, it can draw on several tools covered elsewhere on this site:

• Talk therapies such as cognitive behavioral therapy, which NIDA describes as helping people recognize, avoid and cope with the situations in which they are most likely to use.
• Dialectical behavior therapy.
• Medication, where a clinician judges it appropriate. A page on medications used in treatment gives an outline, and any decision about starting, changing or stopping a medicine belongs with the prescriber.
• Learning about the conditions themselves, which is the aim of psychoeducation.

This list is not a recommendation for any person. The right mix depends on which conditions are present, how severe they are, and what has helped before.

Examples named by NIDA

NIDA's page names several conditions that commonly appear together with substance use. The general pattern it describes is the same for each: the mental health condition can raise the risk of substance use, and substance use can contribute to or worsen the condition.

• Depression and anxiety. Both are listed among the mental disorders commonly co-occurring with substance use disorders.
• PTSD. NIDA gives it as an example of a condition for which people entering treatment can be screened for substance use disorders. It is also the condition most closely tied in the sources to trauma, discussed above.
• Bipolar disorder. NIDA's page names it, alongside schizophrenia and impulse-control disorders, in its discussion of overlap.

Each of these needs assessment by a qualified clinician. Telling apart which symptoms come from substance use, from another condition, or from both is a professional task, not something to settle alone.

Crisis and safety

Co-occurring conditions can raise the stakes in a difficult moment. According to the 988 Suicide & Crisis Lifeline's own website, the Lifeline is available 24 hours a day, every day, by call, text or chat, and it is for everyone, including people facing emotional distress or alcohol or drug use concerns. The site presents it as a United States service.

What to ask for

A person looking for care can ask whether a program assesses for both substance use and other mental health conditions, and whether it treats them within one plan. The National Institute on Alcohol Abuse and Alcoholism also advises asking any program what treatment it offers, whether it is tailored to the individual, and how it handles a return to use. For the first steps, see what happens when you ask for help.

Questions to ask a clinician

• Will I be assessed for mental health conditions as well as substance use?
• Who coordinates my care if I see more than one professional?
• Will my therapy and any medication be planned together?
• How will you tell whether symptoms come from substance use, another condition, or both?
• What is the plan if my mood or safety gets worse?