Dual Diagnosis and Recovery

What is dual diagnosis?

Dual diagnosis is the term used when a person has a mood disorder such as depression or bipolar disorder (also known as manic depression) and a problem with alcohol or drugs. A person who has a dual diagnosis has two separate illnesses, and each illness needs its own treatment plan.

There is help and hope.

Mood disorders and alcohol/drug problems are both treatable illnesses. They are not moral weaknesses or character flaws. They can affect anyone, regardless of age, ethnicity or economic background. Studies have shown that more than half of the people who have depression or bipolar disorder also use alcohol and/or drugs.

What is self-medication?

Sometimes people may use alcohol or drugs to help cover up or mask symptoms of a mood disorder. For example, if a person’s mind is racing because of mania, a drink of alcohol may slow it down. If a person has intense sadness or hopelessness because of depression, a drug may help him or her feel happy or hopeful for a period of time. This “self-medication” may appear to help, but it actually makes things worse. After the temporary effects of the alcohol or drugs wear off, a person’s symptoms are often worse than ever. Self-medication can cause a person’s mood disorder to stay undiagnosed for a long time.

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What are the symptoms of mood disorders?

Knowing the symptoms of mood disorders can help you decide to seek help. You can’t diagnose yourself. Only a health care professional can diagnose and treat a mood disorder. When a person’s mood switches between depression and mania, it is called bipolar disorder (also known as manic depression).

Symptoms of Depression

When a person has five or more of the following symptoms, including feelings of sadness or loss of interest or pleasure, or if these symptoms interfere with a person’s life, s/he may have major (clinical) depression and should see a health care professional.

  • Feeling sad, crying a lot
  • Major changes in appetite and sleep patterns
  • Irritability, anger
  • Worry, anxiety
  • Pessimism, indifference, feeling like nothing will ever go right
  • Loss of energy, constant exhaustion
  • Unexplained aches and pains
  • Feelings of guilt, worthlessness and/or hopelessness
  • Not able to concentrate or make decisions
  • Not able to enjoy things once enjoyed, not wanting to socialize
  • Recurring thoughts of death or suicide

If you or someone you know has thoughts of death or suicide, contact a medical professional, clergy member, loved one, friend or crisis line such as 1-800-273-8255 (TALK)immediately, or go to your nearest hospital emergency room.

Symptoms of Mania

When a person has three or more of the following symptoms, including an unusually excited, irritable or energized mood for a week or more, or if these symptoms interfere with a person’s life, s/he may be having a manic episode and should see a health care professional.

  • Increased physical and mental activity and energy
  • Extreme optimism and self-confidence
  • Grandiose thoughts, increased sense of self-importance
  • Irritability
  • Aggressive behavior
  • Decreased need for sleep without feeling tired
  • Racing speech, racing thoughts
  • Impulsiveness, poor judgment
  • Reckless behavior such as spending sprees, major business decisions, careless driving and sexual promiscuity
  • In severe cases, delusions (thinking things that aren’t true) and hallucinations (seeing or hearing things that don’t exist)

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Why is it important to treat both the mood disorder and the alcohol/drug use?

When neither illness is treated, one illness can make the other worse. When only one illness is treated, treatment is less likely to be effective. When both illnesses are treated, the chances for a full and lasting recovery are greatly improved, and it is easier to return to a full and productive life.

Why is it important to stay clean and sober when getting treatment?
Mixing alcohol or drugs with medication can have serious and dangerous effects. Many medications, including over-the-counter medications, interact with alcohol or drugs in harmful ways. It is also unlikely that you will benefit from talk therapy if you are under the influence.

What should I expect from treatment?

You may need to go to more than one doctor and attend more than one support group. All of your treatment providers should be aware that you have a dual diagnosis. Treatment for your mood disorder may include counseling or psychotherapy, medication and DBSA support groups where you can share your experience living with depression or bipolar disorder. Treatment for your alcohol and/or drug use may include some type of recovery group. If you are drinking or using every day, you and your doctor may decide that you need to check into a hospital or treatment center so you can be treated for physical withdrawal symptoms. After treating the withdrawal, you will need to treat the addiction. This may include a residential or outpatient alcohol/drug treatment center, a 12-step group or another group that focuses on living without substances. In these groups, you will learn how others stopped drinking or using, how to cope with cravings and urges to drink or use, and how to live comfortably without the use of alcohol or drugs.

Talk therapy (psychotherapy) can help you learn to cope with symptoms of depression and/or mania, and change the patterns of thinking that may be making them worse. Therapy can also help you look at your drinking/using habits and work on staying clean and sober. You may get therapy from a psychiatrist, a psychologist, a social worker, a therapist, a counselor, a nurse or another health professional.

Medication to help with symptoms of depression and mania may be prescribed by a physician or psychiatrist. You and your doctor will work together to find the right medication(s) for you. Different people have different responses to medication, and many people need to try several before they find the best one(s). Though it may not be easy, be patient when starting new medications and wait for them to work. Don’t lose hope. Some can take four to eight weeks before you feel their full effects.

Keep your own records of treatment—how you feel each day, what medications and dosages you take and how they affect you, and any alcohol or drug use. DBSA’s Personal Calendar can be very helpful with this.

Medications that affect the brain may also affect other systems of the body, and cause side effects such as dry mouth, constipation, sleepiness, blurred vision, weight gain, weight loss, dizziness or sexual problems. You might feel the side effects before you feel the helpful effects of your medication. Many times, these side effects will go away in a few weeks. If they don’t go away immediately, don’t be discouraged. There are ways to reduce or get rid of them.

  • Change the time you take your medication to help with sleepiness or sleeplessness.
  • Take it with food to help with nausea.
  • Your doctor may change your dosage or prescribe another medication.

Tell your doctor about any side effects you are having. You and your doctor should work together to make decisions about medication.

Never stop taking your medication or change your dosage without talking to your doctor first.

Am I still clean and sober if I take medication?
Absolutely. Taking medication as prescribed by a doctor is not the same as using alcohol or street drugs to feel better. Medications affect the same brain chemicals that alcohol and street drugs do. But medication balances the levels of these chemicals instead of making them rise and fall. Medications help keep your brain chemicals, and your moods, more predictable and stable. They can help you to be yourself.

Medications do not impair your judgment. They do not give you a false sense of courage. They do not cause you to crave another pill soon after you’ve taken the first. They are not mixed or “cut” with other dangerous chemicals. They have been tested and found to be safe and effective.

The goal of medication treatment is to help you become stable and healthy. Medications manage your symptoms, rather than masking them. They help you take control and work toward positive changes in your life. Your doctor also monitors your medications, and if you have any problems, s/he can help you decide what changes need to be made.

Some drug and alcohol recovery groups may believe that you can’t be clean and sober if you take medications prescribed by a doctor. This belief is just plain wrong. Medication for your mood disorder is no different than medication for another illness such as asthma, high blood pressure or diabetes. If your recovery group challenges your use of medication, it is probably best for you to become part of another group that understands the concept of dual diagnosis. The good news is there are many different recovery groups to choose from. Don’t give up hope. If you keep looking, you will find other people who are dually diagnosed and receive treatment for both illnesses.

How do DBSA support groups help?

It is helpful to be part of a group of people who have had similar experiences and can understand and offer support. You may feel worried or ashamed at first. Most people in DBSA groups struggled with these feelings too—they can relate. Keep going to the meetings, it will get easier. You may also meet people who can help you start a special group for people who are dually diagnosed. DBSA has a grassroots network of more than 1,000 support groups. When combined with treatment, DBSA support groups:

  • Can help you understand and stick with your treatment plan and avoid hospitalization.
  • Provide a place for mutual acceptance, understanding and self-discovery.
  • Help you understand that a mood disorder does not define who you are.
  • Give you the opportunity to benefit from the experiences of those who have “been there.”

Support group participants are people with mood disorders and/or their family members. Contact DBSA at 1-800-826-3632 or go online to locate the DBSA support group nearest you. If there is no group in your area, DBSA can help you start one.

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What are some signs of problem drinking/using?


A lot A little Not at all
You have strong urges or needs to drink or use.
Loss of control
You are unable to stop drinking or using once you have begun. You get drunk or high even when you don’t want or intend to. Even after alcohol and drugs cause major problems, you continue drinking or using.
Physical dependence
You have withdrawal symptoms such as nausea, sweating, shakiness or anxiety when you stop drinking or using. You might take a drink or a drug as soon as you wake up.
You need more alcohol or drugs to get the same effect.
Physical illnesses can be caused or worsened by drinking/drug use. Or it may take you longer to recover from illness when you’re drinking/using.
Lying about how much you are drinking/using.
Being annoyed when people point out or criticize your behavior.
Feeling guilty about your drinking or drug use.
Hiding your drinking or drug use from others. Drinking or using when you’re alone.
Not meeting responsibilities to family, friends, work or school.
Making rules for yourself in an effort to drink/use less, usually without success.
Risk-taking such as driving under the influence or sharing needles.
Not remembering what you did when you were under the influence.

How do I know if I have a problem with alcohol or drugs?

Be honest with yourself about your drinking and drug use. Talk honestly with a trusted friend or a health care professional about your drinking and/or using habits. Or try going to an open meeting of an alcohol or drug recovery group, where all are welcome. Spend some time with people who had problems with alcohol or drugs and are now clean and sober. Listen to their stories and ask yourself if you can relate.

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How can I stop drinking/using?

The first step in stopping is admitting that you need to stop. You need to admit and believe that alcohol or drug use is doing you more harm than good, and that it always will. You need to believe there is a better way to live, and be willing to try to live that way. Thinking about a life without alcohol or drugs can be scary. If thinking about the future makes you anxious, tell yourself you will stay clean and sober for just one day. If one day seems too long, tell yourself you won’t drink or use for the next hour. Take life day by day, hour by hour, or minute by minute, whatever you can manage. The most important thing is that you don’t pick up a drink or a drug right now. You don’t need to worry about the rest of your life right now. Just concentrate on staying away from the first drink or the first drug. As you meet people in support groups and build a network of support, you will have people to call when you feel like drinking or using, who can help you through the hard times.

How do alcohol/drug recovery groups work?

There are many different kinds of alcohol and drug recovery groups. Most groups are made up of people who have learned to live successfully without drinking or using, and share their experience with others. Many groups use the 12-step method, which asks you to look at your behavior patterns, make amends for things you have done wrong in the past, and reach out to help others. Some drug and alcohol recovery groups have a spiritual element, and ask participants to believe in a higher power—a force that is greater than they are. This does not mean you have to accept religious ideas you don’t believe in. You may choose to believe in the power of the group—people coming together to help one another, or the power of the fact that others around you are able to stay clean and sober.

What if I relapse?

A return to drinking or using after a period of being clean and sober is called a relapse or a slip. If you relapse, the best thing you can do is get sober or clean as soon as possible and get back to your treatment. Contact a trusted friend, family member or health professional for support. Keep going to your support groups and talk therapy. Stick with your treatment plan. Get additional medical help if you need it. If you slip, it doesn’t mean you won’t be able to build a clean and sober life. You don’t have to be ashamed, angry at yourself or discouraged about your recovery. Focus your energy on not taking a drink or drug right now. Ask yourself what you can learn from this slip. Were there triggers that led to it? Were you sticking with your treatment plan? Are there things you can do differently next time?

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What else can I do to improve my health?

  • Find ways to enjoy your clean and sober life. Explore new hobbies, do volunteer work, spend time with clean and sober family and friends.
  • Stay away from the places, things and people that make you want to drink or use. Eventually, you may 12 be able to feel comfortable at gatherings where people are drinking if you have a good reason to be there. It’s best to avoid gatherings that are only for the purpose of drinking or using.
  • Know that you can say no. In any situation, it’s ok not to drink. If you don’t want people to ask why you’re not drinking, drink juice or a soda with lemon or lime.
  • Know your triggers and temptations. Learn what situations cause you to want a drink or a drug, such as a fight with a loved one or a bad day at work. With your support network, find other ways of coping with these triggers before they lead to a relapse.
  • Be accountable. When you were drinking/using, you may have been inconsiderate of others. Where possible, apologize for things you’ve done if apologizing will not hurt the person more. Pay back money you owe. If you’ve stolen from people or businesses, return or pay for what you’ve taken, anonymously if necessary.
  • Keep records of your moods, treatment and behavior. Use DBSA’s Personal Calendar to help discover behavior patterns and work on them.
  • Learn relaxation exercises to help reduce stress.
  • Eat healthy, balanced meals, exercise regularly and get a full night’s sleep every night.
  • Stick to the treatment plan(s) prescribed by your health care provider(s).

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How can I help a loved one?

  • Educate yourself about mood disorders and alcohol/drug dependence.
  • Don’t blame yourself. Keep in mind that your loved one has two treatable medical illnesses. You didn’t cause either one, and you can’t cure either one.
  • Don’t take responsibility for making your loved one well. Encourage him or her to get professional medical help for both illnesses.
  • Approach the person to talk about getting help when you are calm, and when s/he seems relatively sober/clean and calm. Don’t threaten to call the police or put the person in the hospital unless you mean it and are prepared to follow through.
  • Don’t make it easier for your loved one to continue self-destructive behavior. Don’t loan money if you know it will be used to buy drugs or alcohol. Don’t lie to others to cover up your loved one’s drinking or drug use.
  • Don’t preach or lecture. Talk to the person about specific things that have happened because of his or her substance abuse and untreated mood disorder that are visible and obvious. For example, s/he may have health, work, family or money problems.
  • Don’t use guilt to motivate the person to get help.
  • Realize that your loved one’s illnesses can affect his or her thoughts and views. Know that with good treatment, hopeless and self-defeating thoughts and attitudes can be overcome.
  • Do your best to give support and be patient throughout the recovery process. Don’t expect the person to recover immediately.
  • Allow your loved one to spend the time s/he needs with support groups and treatment as s/he recovers.
  • Get support for yourself, whether or not your loved one gets help. Join a support group for friends and family. Seek professional help if you need it.
  • Never give up hope.

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The following organizations may provide additional help. DBSA assumes no responsibility for the content or accuracy of the material they provide.