Alcohol and Dual Diagnosis

One of the most common and difficult complications of alcoholism is dual diagnosis, or when the patient has one or several mental health conditions in addition to their addiction. While dual diagnosis is possible with any mental health condition, some of the most common include depression, anxiety, bipolar disorder, and obsessive-compulsive disorder.

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What Is Dual Diagnosis?

Dual diagnosis is one of the most commonly used terms to describe when someone has both a substance abuse disorder like alcoholism and a separate mental health condition or conditions such as depression. Other commonly used terms include co-occurring disorders, co-morbid disorders, and comorbidity.

Dual diagnosis is extremely common. Although some mental health conditions are more or less likely to appear among alcoholics, alcoholics are much more likely to suffer from a mental health condition of some kind than non-alcoholics. Similarly, an individual with a mental health condition is much more likely to develop alcoholism than an individual without a mental health disorder. Approximately 7.9 million Americans classify as dual-diagnosis (with any substance and any disorder). Among this population, alcohol is by far the most commonly abused substance, much like in the population as a whole.

The link between alcohol and mental health is very close and complex. Many individuals with mental health issues turn to alcohol as a method of escape or self-medication. Many mental health conditions make it more difficult for individuals to stop drinking, either over the course of a single night or over an extended period. This increases the likelihood of alcoholism and other risky drinking behaviors like binge drinking. However, alcohol use actually makes the symptoms of many mental health conditions worse, brings them on prematurely and more frequently, and extends their durations. There is research that suggests that alcoholism can actually cause certain mental health conditions, especially depression, but those conclusions are controversial.

In the past, alcoholism and mental health were rarely treated together. It was common for mental health professionals to require their patents to stop drinking before treatment. At that time, the interactions between alcohol and mental health were more poorly understood, and it was thought that they had to be treated separately. Now there is a much greater understanding that the two must be tackled simultaneously for the greatest likelihood of success.

Common Dual Diagnosis Conditions With Alcohol

Alcoholism can impact sufferers of any mental illness. However, sufferers of some conditions are much more likely to be alcoholics than others, and vice versa. Some of the most common include:


Perhaps the most common mental health condition, depression is also the most frequent dual diagnosis condition present alongside alcoholism. Depression sufferers frequently turn to alcohol to help them alleviate the worst symptoms of their condition, such as sadness, hopelessness, loneliness, and suicidal thoughts. Unfortunately, the long-term result is often the opposite, and alcohol generally greatly worsens depression symptoms.


Almost 18% of Americans suffer from some form of anxiety issues at one point in their life. Alcohol is superficially attractive to anxiety sufferers because it can temporarily relax them and break their focus. Many individuals with social anxiety in particular feel that alcohol makes them more confidant in social situations. However, alcohol generally makes anxiety worse over time, especially because alcohol influenced decisions often put individuals in high anxiety situations.

Bipolar disorder

Bipolar disorder and alcohol abuse are very frequently paired. Some studies have concluded that the majority of bipolar sufferers develop addiction issues at some point in their lives, of which alcohol is the most frequent. This includes 61% of Bipolar I patients, and 48% of Bipolar II patients. Bipolar patients are attracted to alcohol for different reasons at different parts of their cycle, but it is dangerous at any point. Alcohol use during manic phases is especially risky because it fuels the increasingly reckless and careless behavior associated with mania.

Obsessive-compulsive disorder (OCD)

Approximately 25% of OCD sufferers also deal with alcohol abuse issues. Alcohol appeals to OCD sufferers because it takes their focus away from their symptoms and distracts them. As is the case with most mental illnesses, however, alcohol actually makes OCD symptoms worse over time. This quickly escalates to an addiction as the worse the symptoms get, the more the individual drinks to escape them, and the more the individual drinks, the worse the symptoms get.

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Impact of Dual Diagnosis on Treatment

An Older Man In A Counseling Session To Help Him Overcome Alcoholism And Dual Diagnosis The presence of any dual diagnosis condition makes the treatment of alcoholism more difficult. Similarly, the presence of alcoholism makes the treatment of any mental illness more difficult. There are a number of reasons for this.

Because the symptoms of alcohol abuse and many mental health conditions are so similar, it is often very difficult, if not impossible, to properly diagnose a patient until they have stopped using alcohol. This is especially true when a patient suffers from multiple mental illnesses. Without proper diagnosis, proper treatment is unlikely.

Treatment itself is more complicated as well. To maximize the chances of success, both the alcoholism and the dual diagnosis condition should be treated concurrently. Doing so will reduce the symptoms of both. The less the individual drinks, the less severe and frequent their symptoms will be, and the less they will feel the need to drink to escape them. However, this will take more specialized treatment. The patient will need to be treated by both mental health and addiction experts. Until recently, most mental health patients had little experience in handling addiction, though this is changing. Most rehab facilities, on the other hand, have extensive experience dealing with many mental health conditions, as so many of their patients suffer from them.

Dual diagnosis can make recovery more challenging for many individuals, especially those that have not dealt with the mental condition in a meaningful way in many years, or in many cases, ever. Also, some conditions make relapse more likely due to associated lapses in judgment. In no way does that mean that treatment is impossible, however. Most alcoholics with a dual diagnosis can dramatically improve with proper treatment, and many successfully maintain their sobriety.

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Symptoms of Dual Diagnosis

Although every mental illness has different symptoms (and this is especially true when they are mixed with alcohol), there are some symptoms that are shared by many. Here are some common warning signs that many with a dual diagnosis exhibit:

  • Increasing isolation from family and friends
  • Increased or decreased appetite
  • Reduced energy and motivation
  • Difficulty concentrating and completing tasks
  • Decreasing performance at work and in personal life
  • Irritability, mood swings, and anxiety
  • Making excuses for alcohol use and strange behavior

Dual Diagnosis Treatment Options

There are many therapy options for treating dual diagnosis conditions and alcoholism. Some of the most common include:

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Dual diagnosis is very serious. The combination of alcoholism and mental illness can dramatically impact a sufferer’s life, and those of their families, for the worse. Personal relationships, jobs, health, and finances can all be impacted. Perhaps the biggest risk involves those mental illnesses that can lead to suicidal thoughts, which alcohol can dramatically increase. If you or a loved one have considered suicide, you need help now. There are dedicated treatment providers waiting to help you or your loved one overcome alcoholism and mental illness; contact one to find the right rehab option for you.

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