Do you know the difference between dual diagnosis vs co-occurring disorders? While they may seem the same, each is unique in how they play a role in a person diagnosed with one or the other.
Defining Dual Diagnosis vs Co-Occurring Disorders
A dual diagnosis and a co-occurring disorder are synonymous terms, but the two also carry separate meanings depending on the context of the discussion. Medically, a dual diagnosis is a diagnosis of any two given conditions.
In the context of a mental health crisis, a dual diagnosis may be a diagnosis of two separate conditions like depression and anxiety, but more often than not, the term is used in mental health circles to refer to a mental disorder and substance use problem.
A co-occurring disorder, meanwhile, almost always refers to a mental disorder that has been identified in co-occurrence with a substance use disorder.
Last but not least, comorbidity is another term commonly used when discussing mental health issues and substance use problems, although comorbidity is also used to describe any series of conditions (it can be more than two!) that are directly or indirectly linked to the primary condition (i.e., cancer and depression, or chronic pain and drug use).
- A dual diagnosis usually refers to a mental health issue and substance use problem but can be used to refer to any combination of two medical diagnoses.
- A co-occurring disorder is a mental health disorder identified alongside or after substance use disorder (addiction).
- A comorbid condition is any one of multiple different conditions identified after a primary condition, also known as a coexisting health problem.
Between the three, most mental health organizations in the United States currently refer to a concurrent diagnosis of a mental health disorder and a substance use disorder as co-occurring disorders. The term dual diagnosis might still be found in older literature and is thus used online.
What Are Co-Occurring Disorders?
A co-occurring disorder is a concurrent diagnosis of a mental health disorder and a substance use disorder.
This isn’t a rare occurrence by any means – in fact, people with substance use problems are far more likely than the general population to be diagnosed with a mental health problem, and vice versa.
- Shared risk factors, i.e., a common cause. Whether it’s a harsh childhood, a poor parent-child relationship, socioeconomic factors, family history, or all of the above. Conditions like depression and anxiety share risk factors with substance use disorder, which means a person can feasibly develop both concurrently.
- A one-way relationship, moving towards drug use. In this case, the toll of a mental health diagnosis and its primary symptoms might have pushed a person to start using drugs as a way to cope or as a way to self-medicate.
- A second one-way relationship, where drugs are a major cause. In this case, long-term drug use exacerbated existing issues or perhaps led to the onset of new symptoms and a mental health diagnosis. More simply put, the drugs led to a concurrent mental illness.
All three reasons are likely, and all three reasons may interact with each other in any given person’s experiences with mental illness and drug use. Sometimes, one influences the other. Sometimes, both were the result of years of willing and unwilled choices, voluntary and involuntary decisions, and accumulated experiences.
Laying blame is difficult, complex, and fruitless. In most cases, no person or thing can individually bear the responsibility for the development of mental health problems like depression or substance misuse. While it’s important to find out how a person’s symptoms and diagnoses evolved over time, the focus shouldn’t be on who to blame but on how to address the issue.
Why Are Co-Occurring Disorders Unique?
A co-occurring disorder is a greater problem than the sum of its parts. Managing and addressing depression is one thing. It is difficult. It takes time. First-line treatments might not always work, and both therapists and their clients must be patient as different treatment modalities are tried.
Treating substance use disorder is also very difficult. Some people can smoke for fifteen years and quit at the drop of a hat – they might experience mood swings and a few withdrawal symptoms, but their cravings eventually stop, and the urge to recommit to the habit is never powerful enough. They’re the lucky ones. People who are diagnosed with an addiction can’t stop, and it takes years of support and hard work to feel comfortable in one’s recovery.
But when the two forces combine, things get even trickier. Now the addiction is reinforced by negative thoughts and overwhelming psychological symptoms. Now drug use is one of the few coping skills a person has against their intrusive thoughts and anxieties. Now the symptoms of their mental disorder are reinforced by the damage done over years of dedicated substance overuse.
Treating either is difficult but treating both requires a holistic approach that addresses neither substance misuse nor just the mental health issues but the entire person. It is a long-term project.
Are Co-Occurring Disorders Treated Differently?
Facilities and specialists that focus on dual diagnoses or co-occurring disorders always emphasize a comprehensive approach – taking into account a person’s medical history, family history, and biopsychosocial factors.
Treatment methods might also vary from case to case. Therapy and, in some cases, medication may be the first-line treatments. But additional modalities are often explored depending on the co-occurring disorder being treated. Such treatment modalities can include:
- Family therapy
- Mindfulness training
- Equine therapy
- Somatic experiencing
- And more.
Are Co-Occurring Disorders Harder to Treat?
Co-occurring disorders can be difficult to treat, but the right environment and trained professionals make treatment a little easier. Every person’s case is different, and some people may progress faster than others. However, like other cases of a substance use disorder, there’s an argument to be made that recovery is a lifelong journey and something to be worked at for years, even decades.
Intensive outpatient or residential treatment at a specialized mental health center is recommended for cases of co-occurring disorders. This is because a specialized drug-free environment with peers in similar situations and dedicated, experienced staff members can make a huge difference.