Dual Diagnosis: The Relationship Between Substance Use and Mental Illness

Learn more about the relationship between substance use and mental illness and how to get necessary help.

Understanding Dual Diagnosis

Dual diagnosis, also known as a co-occurring disorder or comorbidity, refers to the coexistence of a mental health disorder, such as depression or anxiety, alongside a substance use disorder (SUD), like alcohol or drug addiction, in the same individual.

Dual diagnosis in mental health is a condition that affects millions of people worldwide. Research has shown that people with mental health disorders are more likely to use substances to cope with their symptoms.1

It’s essential to recognize and understand the factors that contribute to substance use and mental illness. That way, integrated treatment approaches can be developed to help people with dual diagnoses lead healthier lives.

substance use and mental illness

How Do Substance Use and Mental Illness Co-Occur?

About 50% of adults with mental illness have high co-occurring substance use disorder rates.1 To understand the dual diagnosis of substance use and mental illness, it’s important to know how these conditions co-occur.
Substance use and mental illness often co-occur due to:


People with mental health disorders are more likely to use substances to cope or find temporary relief. Although these substances provide short-term relief, they cause long-term dependency, leading to addiction.


About 40-60% of a person’s vulnerability to drug use can be linked to genetics.2 A person’s vulnerability to substance use and mental illness may be due to an inherited component.


Experiencing trauma, especially during childhood, can lead to post-traumatic stress disorder (PTSD). This can increase the risk of substance abuse as a coping mechanism. People who have PTSD may turn to substance use to reduce their anxiety and depression.

Altered Brain Chemistry

Substances like alcohol, opioids, and marijuana are powerful enough to alter the brain’s chemistry. They interact with neurotransmitters, which send signals between brain cells.
These interactions lead to changes in the brain, causing:
  • Anxiety
  • Depression
  • Frequent mood swings

Social Isolation

Isolation and social withdrawal are common for people with mental health conditions. It can also contribute to a decline in mental well-being. To cope with isolation, people with mental health disorders may turn to alcohol and drug use.

Factors Contributing to the Dual Diagnosis of Substance Use and Mental Illness

The dual diagnosis of substance use and mental illness, also known as comorbidity, is influenced by various factors. At Ethos Wellness, we recognize these contributing factors and categorize them into several key areas.
These areas include:

Environmental Influences

A person’s environment can influence their susceptibility to dual diagnosis of substance use and mental illness. Environmental factors can shape a person’s behaviors and vulnerabilities.
Environmental factors include:
  • Early life experiences
  • Family systems
  • Peer pressure
  • Accessibility to substances


Persistent stress related to family, work, or life events can contribute to mental health disorders. Substance use may be seen as the only way to cope with and reduce stress-related symptoms. This can lead to the development of substance use disorders.

Psychological Factors

Psychological factors play a significant role in influencing dual diagnosis. Common psychological factors contributing to both conditions include:
  • Low self-esteem
  • Poor coping skills
  • Emotional dysregulation
For these people, alcohol and drug use may seem like ideal coping mechanisms.

Access to Treatment

Not having timely access to treatment contributes to dual diagnosis. Limited or late access to treatment can hinder persons from getting the care they need for either condition. This increases the likelihood of co-occurrence.

Substance-Induced Mental Illnesses

The use of certain substances can induce symptoms of mental health disorders. For example, prolonged stimulant use can lead to symptoms resembling anxiety or psychosis.
After prolonged use, it may be challenging to differentiate between symptoms caused by substances and those caused by pre-existing mental health disorders.

How Substance Use and Mental Illness Affects Health and Well-Being

Substance use and mental illness can have an adverse impact on a person’s health and well-being. At Ethos Wellness, we prepare our patients for the negative impacts of such diagnosis.
Below are several ways in which the co-occurrence of these conditions affects a person.

Impaired Functioning

Comorbidity can impair a person’s ability to function in various areas of life. A person’s family, work, or social life may be compromised, leading to:
  • Job loss
  • Strained relationships
  • Social isolation

Increased Hospitalization Rate

When dealing with substance use and mental health disorders, a person’s risk of hospitalization is higher. Hospitalization is also a safety measure for people at risk of self-harm to themselves and others. The downside to an increased hospitalization rate is the cost, which insurance can reduce.

Greater Risk of Self-Harm and Suicide

Suicidal ideation and attempts are risk factors of comorbidity. Substance use and mental health symptoms can contribute to hopelessness and despair. The interaction of medications with substances may also cause extreme lows and mood swings, influencing suicidal ideations.

Diminished Physical Health

Substance use can negatively impact physical health, leading to medical issues such as liver disease and cardiovascular problems. These health problems are long-term, and they can negatively impact well-being.

Comorbidity and Its Impact on Substance Use and Mental Illness Treatment

The idea of comorbidity between substance use and mental illnesses does not imply that one condition caused the other, even if one appeared first.3

What is Comorbidity?

Comorbidity, in the context of substance use and mental illness, refers to the presence of both conditions. This co-occurrence influences and worsens either condition. Studies have shown that people with SUD are at a higher risk of having a mental health condition and vice versa.4
Comorbidity has a huge impact on people and healthcare systems. Some of the impacts of comorbidity between substance use and mental illness include:
  • More severe symptoms than either disorder alone
  • A higher risk of relapse
  • A higher hospitalization rate
  • Higher suicide ideation and attempt rate
  • More complex diagnoses and treatment 
  • Long-term health challenges

Significance of Comorbidity in Treatment

The importance of comorbidity in treatment cannot be overstated. Ethos Wellness understands and addresses comorbidity for these reasons:
  • It makes diagnosis easier for our professionals 
  • It makes it easier to manage both disorders together and in isolation
  • It improves treatment outcomes by reducing substance use and improving mental health
  • It reduces the risk of relapse
  • Treatment plans are tailored to each person’s needs
  • It’s easier to teach coping skills to manage both disorders
  • It helps to improve a person’s quality of life

Common Mental Health Disorders that Occur with Substance Use

At Ethos Wellness, we offer treatment for a wide range of mental health conditions that may co-occur with substance use disorder.
These mental health conditions include:


Major depressive disorder is common in people who also have SUD. The use of substances like opioids and alcohol to provide temporary relief worsens depression. It may even make depression longer and harder to treat.


Anxiety and panic attacks are common co-occurring conditions. People may depend on substances to reduce anxiety. This can lead to the development of a substance use disorder.

Bipolar Disorder

People with bipolar disorder may misuse substances during manic episodes. They do this to intensify euphoria or self-medicate during extreme highs and lows.

Using stimulants like cocaine may increase energy levels and trigger manic episodes in people with bipolar. It also complicates mood swings and stabilization.


Substance use can worsen the symptoms and effects of schizophrenia. It intensifies:
  • Paranoia
  • Hallucinations
  • Delusions
  • Emotions

Substance use can also interfere with the effectiveness of prescribed antipsychotic medication. It can also increase relapse and eventual hospitalization rates.

Post-Traumatic Stress Disorder

Many people with PTSD use substances like alcohol or drugs to cope with:

  • Distressing memories
  • Nightmares
  • Hypervigilance
Substance use may interfere with therapy and treatment, worsening PTSD symptoms.

How Symptoms of Substance Use and Mental Illness Interact

The symptoms of substance use and mental illness often interact in complex ways. Such interaction creates a challenging clinical diagnosis. Interaction may vary depending on the specific mental health disorder and the substance used.
Here’s how these symptoms can interact:

Temporary Relief

For people with SUD, substances can provide temporary relief from mental health symptoms. Being intoxicated helps them reduce symptoms such as:
  • Depression
  • Anxiety
  • Hallucinations
Temporary relief may reinforce substance use as a coping mechanism, encouraging addiction.

Increased Severity

Substance use can intensify the severity of mental health symptoms. For example, alcohol and certain drugs may provide temporary relief from anxiety. 

But, when it wears off, it creates a cycle where people use substances to escape emotional pain, worsening their mental health symptoms.

Increased Risk of Substance-Induced Disorders

Prolonged or heavy substance use can lead to the development of substance-induced mental health disorders. For example, amphetamine use can cause symptoms resembling schizophrenia. This leads to a dual diagnosis of substance-induced psychosis and a mental health disorder.

Response to Stress

Substance use can disrupt the body’s stress response system. This increases the risk of developing or worsening mental health disorders.
Disruption of the body’s stress response system can contribute to:
  • Anxiety
  • Depression
  • PTSD
  • Dysregulation of the brain’s fear circuitry

Withdrawal Effects

Withdrawal from substances can mimic symptoms of mental illness. For example, opioid withdrawal may mimic anxiety and depressive symptoms, challenging diagnosis.

How this Interaction Complicates Diagnosis and Treatment

Ethos Wellness understands that the interaction between substance use and mental illness can complicate diagnosis and treatment in several ways.
They include:
  • Mimicking or overlapping symptoms of mental illness
  • Temporarily reducing symptoms of mental disorders, making examination and assessment challenging 
  • Creating room for misdiagnosis and delayed diagnosis
  • Complicating medication management due to the interference of substances with prescribed medication
  • Increasing relapse risk increases due to self-medication
  • Causing people to be resistant to treatment or less engaged in the recovery process

Integrated Treatment Options for People with Substance Use and Mental Illness

Integrated treatment approaches for persons with co-occurring disorders are essential and need high-intensity interventions. Each treatment is made to address the complex needs of each person.
Below are some integrated treatment approaches available at Ethos Wellness.

Comprehensive Assessments

Treatment procedures begin with an assessment to understand the patient’s condition. Assessments help determine the severity of the disorders and how best to treat them. It also addresses medical concerns and the patient’s social and environmental triggers.


Evidence-based therapies are effective in treating co-occurring disorders. Examples include:
Our therapists at Ethos help address both substance use and mental illness at the same time.


Effective medications exist to manage both substance use and mental illness symptoms. These medications can:
  • Address cravings
  • Treat withdrawal symptoms
  • Stabilize mood
Medications may include disulfiram, bupropion, or varenicline.5

Group and Family Therapy

Group and family therapy services allow patients to share their struggles and experiences. It’s also educational and a means of support from family and peers.

The Role of Medication-Assisted Treatment in Treating Substance Use and Mental Illness

Medication-assisted treatment (MAT) is crucial in addressing the dual diagnosis of substance use and mental illness. It can help manage the complex needs of persons with co-occurring disorders. We use MAT at Ethos Wellness for:

Stabilization of SUD

MAT is using medication in combination with counseling and therapy to stabilize and manage SUD. It involves prescribing FDA-approved medications that target specific substances like opioids and alcohol to:6
  • Reduce cravings
  • Treat withdrawal symptoms
  • Sustain recovery 

Managing Dual Diagnosis Symptoms

MAT can aid in the management of mental health symptoms. When substance use is a coping mechanism for mental health issues, MAT can help break this cycle by reducing the need for self-medication. It provides other medication options that can help people manage their symptoms.

Enhancing Engagement in Treatment

MAT can help increase a person’s interest in their treatment program. When patients get relief from their mental health symptoms due to prescribed medications, they’re more likely to engage in therapy and other treatment programs.

Promoting Stability

Achieving stability for people with comorbidity is one of the goals of MAT. Medications create a healthy foundation for addressing mental health symptoms. It also helps them develop healthier coping strategies and achieve their recovery goals.

Reducing Relapse Risk

People with co-occurring disorders are at a higher risk of relapse if their substance use disorders are not properly addressed. Medication provides long-term maintenance by reducing the risk of relapse and helping people maintain abstinence from substance use.

substance use and mental illness

How Does the Stigma around Dual Diagnosis Prevent People from Seeking Treatment?

The shame and stigma around dual diagnosis can have detrimental effects on people seeking help. This stigma can negatively impact treatment by:
  • Keeping people from seeking help early
  • Discouraging people from engaging in their treatment program
  • Encouraging social isolation from friends and family
  • Leading to self-hate and stigmatization
  • Delaying the recovery process 
  • Causing relapse

How Ethos Wellness Can Help

If you or someone you know is showing signs of substance use and mental illness, Ethos Wellness is the best place for you. We have a people-first, principle-driven approach that puts patients and team members above all.

Our wellness facility offers specialized and personalized mental health care for conditions ranging from substance use disorders to mood and personality disorders.

Our Mission

Ethos Wellness aims to provide our patients with an integrated continuum of clinical care. Our priority is to help patients and their families in achieving healing and long-term wellness. With our well-equipped treatment facility, your recovery is certain.

What We Treat

Ethos Wellness is equipped to treat a wide variety of conditions, including:
  • Substance use disorders
  • Eating disorders
  • Co-occurring disorders 
  • Trauma
  • Anxiety 

Our Services

Some of our treatment services include:
  • Dual diagnosis treatment 
  • Co-ed rehab
  • Cognitive-behavioral therapy 
  • Outpatient therapy
  • Psychoeducational groups
  • Yoga
  • PTSD therapy 
Our services are tailored to each patient’s needs. We have 24/7 professionals who monitor and guide each treatment process. We are dedicated to helping you meet your recovery goals and prevent relapse.

Insurance Coverage

To mitigate the cost of treatment, we accept insurance schemes like:
  • Aetna
  • Blue Cross Blue Shield
  • Cigna/Evernote
  • United Healthcare
  • Magellan Healthcare

Contact Ethos Wellness Today

If you or your loved one is experiencing difficulties with substance use and mental illness, it’s essential that you get help early. Our goal at Ethos Wellness is to help people live happier and healthier lives.

We encourage you to contact us to learn more about our available treatment programs. Your recovery and well-being are our number one priority.

Table of Contents

Questions About Treatment?

Reach out to our Ethos Wellness team today for direction and guidance in your recovery journey. We’re here to provide you with the whole-person, personalized support you need for the sustainable wellness you deserve.