What is Dual Diagnosis, Know Its Types, Symptoms, Treatment

What is Dual Diagnosis?

The concept of dual diagnosis was introduced as early as 20 years ago. Earlier, there was not enough awareness or knowledge regarding this method. With scientific advancement in the field of psychology and psychiatry, it was explored further.

Dual diagnosis is a method of treatment in which people suffering from two different but interdependent psychiatric problems are treated. For example, a patient who is addicted to alcohol or drugs and at the same time suffering from mental illness needs dual diagnosis therapy. In this method, both the ailments are treated simultaneously or sequentially.

Dealing with dual diagnosis can be costly, painful and time consuming. People who have suffered from mental illness and substances abuse alone know how horrible is it to handle their lifestyle and work at the same time. For them, the life itself becomes a challenge. The worst condition is when a person becomes his own enemy. Violent behavior towards other, self-threat and suicidal tendency are common in such cases; since they feel insecure in the whole world and feels it is an impossible place to survive.

It is due to dual diagnosis therapy that most of the people suffering from such horrible condition get proper treatment and return back to their normal state. The extensive amount of care and medication with round the clock care and supervision has made it one of the most promising methods of diagnosis.

Types of Dual Diagnosis

It is generally observed that people who abuse substances are mentally ill. People who at first develop addictions are likely to suffer from mental illness later due to the effects of the substances. Also, people who are suffering from mental illness switch to addiction to get temporary relief. This is a continuous cycle of addiction and mental illness. Both are interdependent on each other because each one is potentially dangerous. Here are the two methods through which this co-occurring disease is diagnosed-

  • Sequential Dual Diagnosis: In this type of therapy, at first the main problem of concern is treated by counselling and medication. Once that is dealt with, then the other underlying psychiatric problem is solved.
  • Separate Dual Diagnosis: In this type of therapy, both the ailments are treated simultaneously by different sets of doctors. The addiction and the psychiatric problem are handled simultaneously.

Common Problems that can be Solved by Dual Diagnosis

The common psychiatric condition which can co-exist and dealt with dual diagnosis and therapy are:

  • Attention Deficit Hyperactive Disorder: People who suffer from attention deficit hyperactive disorder are inclined towards abusing different addictive substance as a way to cope with their insecurities and symptoms. Stimulants are also prescribed by various doctors in such case which can become habit for the patients.
  • Bipolar Disorder: It had been observed that most of the people suffering from bipolar disorder are victim of addiction. Most of the people in order to treat depression opt for self-treatment. They become alcoholic and addictive to drugs in order to get temporary relief.
  • Borderline Personality Disorder and Dual Diagnosis: Reports show that majority of the people suffering from borderline personality disorder are alcoholic or addicted to something or the other. Hence, dual diagnosis is done and the therapy works well for them.
  • Depression: 1 out of 10 people suffers from depression in today’s time. This is a serious rate of declining mental health of people. To self-help, people switch to drugs and alcohol for temporary relief. Hallucinatory affects makes them feel good and they feel a temporary escape from all the problems. This makes the problem even worse.
  • Eating Disorders and Dual Diagnosis: Eating disorder may make the person weak and they suffer from inferiority complex. This may hamper their self-confidence and liveliness. People with eating disorders are generally addicted to drugs that suppress appetite.

Symptoms that Calls for Dual Diagnosis

  • Sudden change in general behavior and personality
  • Changes in sleeping pattern and insomnia
  • Erratic and impulsive behavior
  • Delusional thinking or cognitive impairment
  • Poor performance at workplace and schools.

Is there a Need for Hospitalization in Dual Diagnosis?

Since in cases of dual diagnosis both mind and the body gets affected, it becomes important that the patient is taken care of properly. Thus, in dual diagnosis, the team of doctors tries to provide a medical supervision with care and integrity. During an inpatient program, hospitalization is required. The patient in such cases is taken care of round the clock. The appointed team of doctors carries out dual diagnosis with step by step process. Hospitalization can be a good option for the people who can afford to spend time, money and energy. The initial phases are quite tough. The mind and the body do not accept or adapt to the environment very easily. The patient may crave for substances to abuse. Doctors help them with substitute medication and extensive counselling. The whole treatment is a step by step process that needs to be sorted accordingly. It also varies from patient to patient, the level of addiction and the mental health. Some may recover fast and some take very long time to accept the reality.

Detoxification remains an important part of dual diagnosis. After a few hours of the first doze, several symptoms might occur which may make the patient impatient and difficult to handle. Sometimes, the after-effects of detoxification are violent and sensitive. The patient turns violent, self-harming and anxious. Thus, it may not be possible for a single doctor to handle the situation. In an inpatient hospitalization program, there is a medical team that looks after the patient.

Various Phases of Dual Diagnosis Treatment

  • Phase 1 (Engagement and Stabilization) of Dual Diagnosis: The main aim of this program is to stabilize the acute mental and physical problems. The patient is persuaded, motivated and targeted to make an involuntary move. The second aim is to the make the patients aware of the importance of the treatment once they get back to a stabilized state of mental health. This program may take several weeks or even less depending upon how the patient cooperates with the medical team. For early recovery, the doctors must help the patient to overcome the obstacles and at the same time the patient must be obedient and honest from their side.
  • Phase 2 (Early Recover): In this phase, the aim is to make the patient restrict himself from abusing chemicals, avoiding places, people and moods that initiate abusing chemical. He is also trained to cope with the symptoms of mental health and to involve himself in various support groups for substance abuse that creates awareness about the threats of abusing chemicals. At first the patient is indulged into the stabilization program. Here he is treated to stabilize the acute mental condition. This goes for the first three month. It may take longer depending upon how the body of the patient adapts to the environment and medication. Some may recover early but some may take long time to cross this first phase.
  • Phase 3 (Middle Recovery) of Dual Diagnosis Treatment: In this phase, the patient learns to develop his personality with intrapersonal and interpersonal skill, for example, coping with anger, depression, mood swings, mental problem, persuasive thinking etc. The various interpersonal skills that are developed are dealing with people, handling mental health, improving communication, relationship skills and support system. This phase may take 4 to 12 months depending on the condition of the patient. The medication is not completely tapered off until several months have passed and the patient is stable.
  • Phase 4 (Late Recovery) of Dual Diagnosis: This phase is also known as maintenance phase. In this phase, the experts help the patient to learn any skills that they are lacking. An in-depth analysis of the present situation is also done. Further, the intrapersonal and the interpersonal skills of the patient are explored in depth. Various layers of personality are redesigned.

Goals of the Dual Diagnosis Treatment

The goals of the dual diagnosis treatment include:

The first goal is to create awareness in the patient. Its takes a lot of time to nurture the patient and turn him into a new person. However, dual diagnosis aims at making people aware of the side affects of abusing chemicals and to make them resistant to drugs, and alcohol and deal with associated depression and anxiety etc. The program has been designed in such a manner that everything occurs slowly so that the patient may cope up with the treatment.

The next goal is to stabilize acute psychiatric problems. Abusing chemicals slowly leads to depressed mental state. The person may develop serious psychiatric problems. Thus, various interpersonal and intrapersonal skill development activities is organized to make people participate into it. Through these programs personality and ethical development occurs in these patients. In the long run, this helps them to cope with persuasive environment, people and places that initiate chemical abuse.

The team of doctors helps the patient to work towards a healthy lifestyle. There are various aspects to a healthy living. The patient is tutored and made aware of healthcare and its benefits. They are taught to develop healthy family relationship, peer relationship and manage stress. Thus, the aim is to reshape the person into a healthy and socialized person.


A stich on time saves nine. Understanding the symptoms of drug abuse and acting at the earliest is the best medical help possible. One must not ignore such symptoms but immediately act upon them. There are various medical consultation steps and various support groups for substance abuse that can help to find the best option available in your city. Dual diagnosis can be really difficult to manage and hence, one must take an action to treat substance abuse early before it reaches a point where another psychiatric condition crops up.

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:November 9, 2018

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