Dual Diagnosis & Addiction

Mental Health & Addiction

Are mental health disorders the cause or consequence of addiction? Find out more.

What is a Co-occurring Disorder? 

A co-occurring disorder is when an individual has an addiction and other mental health disorders, such as anxiety or depression. It can include a singular mental health disorder or multiple. This can make recovery more complicated because as you deal with the addiction, underlying mental health issues may be unmasked. This can often be because people use addictive substances and behaviours like substance misuse, alcohol abuse and gambling as a coping strategy for their mental disorders. 

Co-occurring disorders are also known as dual diagnosis. Dual diagnosis is a term that means you have a mental health disorder and a substance use disorder at the same time. It is crucial to have an accurate diagnosis to create the correct treatment plan to give you the best chance of success.

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Why Are Co-occurring Disorders Important to Diagnose?

If you want recovery to be long-lasting and successful, it is essential to resolve underlying co-occurring disorders. Addiction can be challenging to treat due to its complex nature of biological, social and psychological factors. When combined with co-occurring disorders, an individualised approach to resolving mental health issues and addiction is important. 

Seldom will one condition be resolved independently. It is often the combined treatment of both through professional assessment, a nurturing environment and ongoing support that an individual can overcome addiction and co-occurring disorders.

On the other hand, when co-occurring disorders are not addressed, a person will not notice a deterioration in their mental well-being at a later point. This can increase the chance of a relapse occurring or the development of a different type of addiction or harmful behaviour. By working through the co-occurring disorder in rehab, you will be working through the underlying causes of your addiction and addressing it.

Who is at Risk of Co-Occurring Disorders? 

There is a significant overlap between risk factors for mental illness and substance misuse. Many of the people who suffer from addiction are also diagnosed with a mental health disorder and vice versa. 

Studies have shown that people who struggle with mental health conditions have a higher chance of becoming addicted to substances. Although addiction can affect anyone, some factors could lead a person to also suffer co-occurring disorders:

  • People with a family history of substance abuse or addiction
  • Genetics
  • Family history of mental health issues
  • Prenatal exposure to certain drugs
  • Trauma 
  • Difficult childhood (sexual abuse or physical abuse)
  • Stress 
  • Negative family environment 
  • Poor access to healthcare and support

Signs and Symptoms of Co-Occurring Disorders 

Even on its own, it may be difficult to recognise an addiction in a loved one. A person with an addiction may manage to keep it secret from friends, family, colleagues and even partners. However, a co-occurring disorder may be more noticeable due to the impact on the mental health of the individual.

If you are worried that a close one could be suffering from a dual diagnosis, look out for some of these signs and symptoms:

Behavioural Changes

  • Withdrawal from family and friends
  • Sudden change in behaviours
  • Risky/reckless behaviour 
  • Turning towards alcohol or drugs
  • Money problems
  • Lack of personal hygiene 
  • Struggling with daily activities


Around 1 in 6 people suffer from depression in the UK. As one of the most common mental health issues, it is important to know the signs and symptoms. Depression is the development of a low mood that can go on for a long period. It is usual for our mood to go up and down from time to time, but in depression, people will often experience persistent low mood. There can also be a cluster of other signs and symptoms:

  • People with a family history of substance abuse or addiction
  • Genetics
  • Family history of mental health issues
  • Prenatal exposure to certain drugs
  • Trauma 
  • Difficult childhood (sexual abuse or physical abuse)
  • Stress 
  • Negative family environment 
  • Poor access to healthcare and support


Most people will experience anxiety from time to time, however, when you have anxiety most days and it starts to affect your day-to-day life then this could be an anxiety disorder. You may also not be aware your symptoms are due to anxiety as they can be nonspecific at times:

  • Struggling to concentrate 
  • Finding it challenging to relax 
  • Feeling fearful and thinking bad things might happen
  • Worrying too much
  • Feeling tense 
  • Feeling shaky 
  • Feeling sweaty or hot 
  • Feeling your heart beat faster (palpitations)
  • Headaches 
  • Tightness in stomach/ chest/ neck 
  • Struggling to sleep
  • Obsessive thoughts 

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is a medical condition that can make you feel restless, have trouble concentrating, and also act on impulses. While most people are diagnosed with it in childhood, it is often missed and may be labelled as a child being ‘naughty’ or ‘disruptive’. This label can often stick with children as they progress through school and become a barrier to the diagnosis of ADHD

Further signs and symptoms of ADHD include:

  • Being restless and struggling to sit still 
  • Problems with organisation 
  • Not meeting deadlines or completing tasks 
  • Difficulty following instructions 
  • Feeling impatient 
  • Struggling to cope with stress
  • Impulsive thoughts 
  • Risk-taking behaviours 
  • Relationship problems 

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Obsessive Compulsive Disorder (OCD)

People who have OCD tend to have obsessive thoughts and compulsive behaviours. These intrusive thoughts and behaviours can start to affect your life. From simple things like extending the amount of time it takes before leaving the home, to more severe cases where people are not able to leave their home due to their obsessive thoughts and fears.

Obsessive Thoughts

  • Fear of bad things happening
  • Fear of contamination from disease/illness 
  • Fear of harming self or others 
  • Fear of making a mistake which can lead to harm e.g leaving the oven on 
  • Need for order or symmetry 

Compulsive Behaviours

  • Repeating words in your head 
  • Ordering and arranging things 
  • Cleaning and washing hands 
  • Checking things e.g. light switches/ door locks
  • Hoarding objects
  • Counting 

Bipolar Disorder

In Bipolar disorder, your mood may swing from depression (feeling low) to mania (feeling euphoric and high). While we can all experience mood swings, people who have bipolar disorder tend to have them at an extreme level and for more extended periods. Signs and symptoms of bipolar disorder include:

Depressive Phase

  • Low energy 
  • Feeling hopeless or helpless
  • No motivation 
  • No interest in things
  • Guilt and despair
  • Pessimistic about things 
  • Sleeping problems 

Mania Phase 

  • Feeling elated and very happy
  • High energy levels
  • Not sleeping 
  • Feeling of importance 
  • Easily distracted 
  • Full of new and exciting ideas
  • Losing track of time 
  • Delusional thinking e.g. that you have superpowers 
  • Hallucinations – seeing and hearing things 
  • Risk-taking behaviour 
  • Bad decision-making – e.g spending lots of money

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Post Traumatic Stress Disorder (PTSD)

PTSD often stems from a traumatic event in the patient’s past. This can lead to nightmares, flashbacks or the person reliving the traumatic event. Often, individuals will resort to substance misuse and alcohol abuse as a coping strategy to try and ‘block out’ some of these intrusive thoughts and flashbacks. Unfortunately, this can often make things worse as their addiction develops. They then have to deal with the destructive consequences of both illnesses. Further symptoms of PTSD also include: 

  • Recurrent flashbacks of events
  • Nightmares about the event
  • Distressing thoughts or ideas 
  • Recurrent memories 
  • Feeling tense and easily startled 
  • Sleep problems and irritability
  • Avoidance behaviour – like avoiding the location of the event 
  • Feeling tense and on guard, 

Some less common co-occurring disorders include Schizophrenia, Emotionally Unstable Personality Disorders and Conduct Disorders. All of these can impact the process of rehab, and it is crucial to recognise that successful recovery often involves a holistic approach that addresses underlying co-occurring disorders, and an individualised approach is taken for each person’s unique circumstances.

How Do You Treat Co-occurring Disorders?

Before starting any treatment, the first step is to open up to a loved one about the difficulties you are dealing with and seek professional advice. Understanding that you are not alone in this, as 1 in 4 people in the UK experience mental health issues during a year.

At Castle Craig treatment often depends on the type of co-occurring disorder and an evidence-based approach is used.

All patients receive a comprehensive mental health assessment conducted by a professional before starting treatment at Castle Craig. We understand that addiction is complex, and nobody is the same – it’s thus important for our team to understand the crucial connection between mental health issues and addiction. This allows us to create a successful path to recovery. Contact our team today to get help.

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