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Addiction and Mental Health: Understanding Dual Diagnosis

Medically Reviewed by
Virmarie Diaz Fernandez, MD FAPA
April 2, 2025

Co-occurring Disorders: Addiction And Mental Health

Individuals with mental health disorders are more susceptible to developing substance use disorders, and vice versa. For example, someone with depression may turn to alcohol or drugs as a way to cope with their symptoms, leading to addiction. At the same time, the effects of substance use can trigger mental health issues or make existing mental conditions worse.

When someone has an addiction and a mental health problem, it is known as a co-occurring disorder. This is also called a dual diagnosis. This situation is more common than you might think.

The relationship between addictions and mental health is bi-directional and complex. It’s not always clear which condition came first. But we know they can fuel and perpetuate each other. This creates a vicious cycle that can be challenging to break without proper intervention and support.

Dual Diagnosis

A dual diagnosis refers to the co-existence of a substance use disorder and a mental health disorder in an individual. It can sometimes be hard to make a dual diagnosis because some symptoms of substance use disorder and certain mental health conditions can overlap. 

But it’s important to get a proper diagnosis because treatment is most effective when both conditions are being addressed at the same time.

Dual Diagnosis Treatment

Co-occurring conditions can interact with each other and make symptoms worse. Treating one but not the other can undermine progress and increase the risk of relapse.

If you are struggling with addiction and mental health, you might consider a holistic treatment program over other rehab alternatives. Holistic programs focus on all important aspects of a person’s health – mental, physical and emotional. 

At Eleanor Health, we provide treatment services for substance use disorder and co-occurring mental health conditions with a holistic approach.

The Link Between Addiction and Mental Health

The relationship between substance use disorders often looks like a “chicken or the egg” scenario. But there are three factors that can explain why people find themselves struggling with a dual diagnosis.

  • Risk factors: If your family has a history of mental health disorders or substance use disorder, you might be more at risk than other people. Some genes can make you more vulnerable to developing these disorders. Environmental factors, including traumatic experiences, prolonged stress or being exposed to SUD during childhood or as a teen can also increase the risk.
  • Self-medication: People with mental health disorders like anxiety, depression or PTSD sometimes turn to drugs or alcohol as a form of self-medication. This is because these substances can provide temporary relief from some uncomfortable symptoms of these mental conditions. However, relying on these substances eventually makes symptoms worse.
  • Changes in the brain: Both mental health disorders and substance use can cause changes in your brain structure that impact how the brain reacts to certain stimuli. Drugs and alcohol trigger a rewarding effect in the brain. People with mental health disorders might experience a more heightened effect from these substances. On the other hand, drugs and alcohol (whether you have a substance use disorder or not) can trigger certain changes in your brain that make you more at risk of developing a mental health disorder.

Opioid Use Disorder and Mental Health

Opioid use disorder (OUD) is a brain disease characterized by a compulsive urge to use opioids, despite harmful consequences. Opioids include prescription painkillers and illicit drugs like heroin. Misusing opioids raises the likelihood of developing a mental health disorder, and it can make the symptoms of existing mental health disorders worse.

Common cases of dual diagnosis with OUD include:

  • Opioid Use and Anxiety
  • Opioid Use and Depression
  • Opioid Use and PTSD

Opioid painkillers are not the only prescription medication that can be highly addictive. Benzodiazepines (anti-anxiety medications) and stimulants (used to treat ADHD and other conditions), when misused, can contribute to the development or worsening of mental health disorders.

Individuals may initially be prescribed these medications for legitimate medical reasons, but over time, they can develop a dependence or addiction. This can lead to a range of mental health issues, including anxiety, depression, and cognitive impairment.

Alcohol Use Disorder and Mental Health

Alcohol use disorder (AUD) is a brain disease characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. Many people that struggle with mental health can drink alcohol safely. But many people can’t. If alcohol starts affecting your mental health, you might want to look into a dual diagnosis. Alcohol can make existing mental health disorders worse, or increase the likelihood of developing one.

Learn more about alcohol addiction and mental health:

  • Alcohol Use and Anxiety
  • Alcohol Use and Depression
  • Alcohol Use and PTSD

How to Treat Co-occurring Addiction and Mental Health Disorders?

Dual diagnosis treatment is a specialized approach designed to address both substance use disorders and mental health conditions simultaneously. This integrated approach recognizes the interconnected nature of these conditions and the need for comprehensive care.

At Eleanor Health, treatment for co-occurring disorders includes:

There are certain medications that can help people get off drugs or alcohol. These can often be used in combination with prescription medications used to tackle the symptoms of mental health conditions, like anxiety and depression. 

Your clinical care team will create a treatment plan that works for you and your recovery needs. The FDA has cleared a list of medications for opioid use disorder (MOUD) and a list of medications for alcohol use disorder (MAUD).

A doctor prescribing medications for Medication-Assisted Treatment (MAT)
A person speaks with a counselor.

Evidence-based therapies, such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and motivational interviewing (MI), can help individuals develop coping strategies, modify harmful thought patterns, and build resilience for long-term success. Working with a therapist helps deal with both SUDs and mental health challenges.

An important part of recovery is finding common ground with someone who’s been where you are, knows what it’s like and can help you get through it with real-life advice. Peer support can take many forms. At Eleanor Health, you work with a Peer Recovery Specialist that provides the community, accountability, and ongoing support needed throughout the recovery process.

Individuals sit in a support group for therapy
Two people embracing the benefits of lifestyle changes

Making positive lifestyle changes, such as improving nutrition, increasing physical activity, and developing healthy coping mechanisms, can support overall well-being and promote long-term recovery.

Virmarie Diaz Fernandez, MD FAPA

Dr. Diaz Fernandez holds Board Certification from the American Board of Psychiatry and Neurology and is recognized as a Fellow of the American Psychiatric Association. She began her medical education at the University of Puerto Rico Medical School, where she completed her medical training and the first year of her Psychiatry Residency. She relocated to Gainesville, Florida, to complete her Psychiatry Residency at the University of Central Florida, serving as Chief Resident during her final two years. Her dedication to continuous professional development is reflected in her additional certifications in WPATH, Nutritional Psychiatry, Mindfulness, and Women’s Mental Health. Her clinical expertise spans both inpatient and outpatient settings, with a focus on minority mental health populations, including the LGBTQ+ and Latinx communities. She also has significant experience in working with survivors of human trafficking and providing Medication-Assisted Treatment (MAT). In her administrative career, Dr. Diaz Fernandez has served in pivotal roles such as Medical Director and National Medical Director, where she has shaped policies and quality measures to enhance mental health service delivery. Her leadership extends to education and mentorship, where she supervises and collaborates with mid-level providers, developing curricula and resources to enhance their professional growth. Her professional interests include interventional psychiatry, addiction, and community mental health, where she leverages her extensive expertise to make a meaningful impact on her patients and the broader community.

Addiction & recovery Blog Mental Health

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