When you have both a substance abuse problem and a mental health issue such as depression, bipolar disorder, or anxiety, it is called a co-occurring disorder or dual diagnosis. Dealing with substance abuse, alcoholism, or drug addiction is never easy, and it’s even more difficult when you’re also struggling with mental health problems.

Dual diagnosis is the term to describe those suffering from a mental health condition (such as schizophrenia, personality disorders and bipolar disorders); as well as having a substance misuse problem. Dual diagnosis can also be referred to as ‘co-occurring or ‘comorbid’ disorders or conditions.

In co-occurring disorders, both the mental health issue and the drug or alcohol addiction have their own unique symptoms that may get in the way of your ability to function at work or school, maintain a stable home life, handle life’s difficulties, and relate to others. To make the situation more complicated, the co-occurring disorders also affect each other. When a mental health problem goes untreated, the substance abuse problem usually gets worse. And when alcohol or drug abuse increases, mental health problems usually increase too.

Why do people take drugs?

People take drugs for many different reasons. You may begin out of curiosity, rebelliousness, or because your friends take them. You may enjoy taking them and want to repeat the experience. You may take drugs when you’re unhappy, stressed or trying to cope with problems in your life. If you have a mental health diagnosis, you may use drugs to help you cope with the symptoms.

Drugs can act as a temporary prop to get you through difficult times. However, drugs can make difficult feelings and emotions even worse. And in the long term, any feelings of relief won’t last. You may find yourself using more and more drugs to deal with your problems and risk becoming dependent on them – which can create new problems for you.

It is reported that 70% of individuals with mental health disorders who engage in community resources in the UK, also have substance abuse issues.              


Furthermore, a recent survey in the UK identified that a third of individuals who are at risk of alcohol and drug use disorders, also use mental health services, and those with more severe mental health disorders have been found to be more likely to smoke, and misuse alcohol and other recreational drugs.

Risk factors, signs and treatment

Due to the degree of prevalence of both mental health and substance abuse disorders combined, it is important for GPs to remain aware of the risk factors, signs, symptoms and treatments available for these disorders.

Co-morbid substance use and mental health both have shared risk factors. For example, individuals can have a genetic pre-disposition towards the development of substance use and mental health disorders, which in turn can increase the chances of them co-occurring. Additionally, using substances can exacerbate pre-existing mental health disorders and individuals might use substances to cope with their mental health challenges.

Identifying co-morbid mental health and substance misuse is often akin to the philosophical conundrum of “what came first, the chicken or the egg?” as both disorders can often mimic or causes the onset of the other, and it can often go unnoticed or misdiagnosed.

Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse. 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness. Of all people diagnosed as mentally ill, 29 percent abuse alcohol or drugs.

Along with the genetic connection, another individual health trait that can correspond with a higher risk of addiction is the presence of pre-existing mental health disorders. People who struggle with various mental health conditions can be more likely to abuse and become dependent on substances. These conditions include but are not limited to:

  • Depression, bipolar disorder, or other mood disorders
  • Anxiety or panic disorder
  • Post-traumatic stress disorder
  • Schizophrenia and other psychotic disorders
  • Antisocial personality disorder

For example, as explained by Brain Facts, multiple studies over the last decades have demonstrated a strong link between schizophrenia and addiction to nicotine. In fact, it has been shown that nicotine can even temporarily lessen some of the symptoms of schizophrenia. The use of cigarettes to manage these symptoms is a phenomenon known as self-medication, which is a common source of substance abuse that later becomes addiction.


People with high levels of dopamine in the brain may have a lower sensitivity to its effects, meaning that they need to have more intense experiences in order to feel the pleasure that this brain chemical causes. This, in turn, can be bound into the person’s experience using drugs and alcohol, which directly affect the dopamine system. In this way, the adventure-seeking, risk-taking personality can have a higher likelihood of experimenting with and, later, becoming addicted to these substances.


Familiar Co-Occurring Maladies

The misuse of pills and liquor can be caused by underlying mental health concerns, including loneliness, loneliness, and shame. People abuse these things to adapt to a broad variety of passions and activities, such as distress, stress, blame, and humiliation.

The Following Disorders are Prevalent Co-Occurring Disorders


In many cases, people abuse substances to feel joy or pleasure, even if artificially, even if they need to become numb to their emotional pain. Depression is one of the most common mental illnesses across the globe, affecting millions of people worldwide. But substance-induced depression, also recognized as drug-induced happiness, also happens with alcohol and other drugs after the first elation has worn off. Substance abuse then increases, as the individual desires both euphoria and to avoid contradictory emotions. A bad series thus occurs where depression intensifies dependence and vice versa.


Many individuals with anxiety and mental illness turn to substance abuse for relief or to ease the burden every day. There are many types of anxiety and it is one of the most prevalent mental health disorders. In social situations, drinking can reduce anxiety, and prescription drugs can take away anxiety. As anxiety and mental illness sufferers consume substances to cope with their symptoms, their dependency on those substances increases, making them more vulnerable to addiction and making their anxiety worse.

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Drug abuse can make you feel unworthy, hopeless, and suicidal. Feelings of hopelessness can trigger you to use more substances like stimulants to feel good. The negative side effects of abusing the drug tend to lead to more drug abuse and a greater risk of self-harm and mental illness.

Bipolar Disorder

Those who suffer from Bipolar disorders and mental illness experience excessive and unruly scenes of both sadness and obsession due to an imbalance in brain chemicals. The cruelty of these incidents is typically reduced through the abuse of drugs, which ultimately leads to increasingly irregular brain activity. Some studies suggest that bipolar depression and mental illness may be associated with substance abuse disorders when compared to conditions not diagnosed with bipolar disorder.

Post-Traumatic Stress Disorder

People with PTSD experience conditions such as traumatic brain injury (TBI) and PTSD more frequently than individuals who do not. Many veterans return from war with PTSD from their traumatizing combat experiences. The development of PTSD may be accompanied by psychological, physical, or sexual abuse.

Many different symptoms may indicate post-traumatic stress disorder, such as flashbacks, intrusive thoughts, horrors, and hyper-vigilance. Additionally, medications and liquor are temporary remedies for PTSD. The indications of PTSD may occur sooner, create more serious contradictory emotions, or interrupt sleep schedules. As PTSD symptoms can be debilitating, some victims lose control and abuse drugs or alcohol to cope.

Borderline Personality DisORDER

BPD is a mood disorder characterized by sudden mood swings, extreme temperamental restlessness, unpredictable behaviour, scattered thoughts of self, others, and the environment, and trouble forming steady connections. Around 6% of adults in America suffer from this disorder. People who suffer from these symptoms often abuse drugs and alcohol to adapt to “controllable” symptoms. This temporary relief is usually short-lived, and can sometimes aggravate symptoms of mental illness.