Dual diagnosis, also called co-occurring disorders, means that a mental health condition and a substance use disorder are present together. It is common, and each condition can make the other harder to manage. This page explains the idea and what coordinated care generally looks like. It is educational only.
Why the combination matters
Substances can imitate or worsen symptoms of depression, anxiety and other conditions, and untreated symptoms can push some people toward alcohol or drugs. Treating only one problem often leaves the other to undermine progress. Clinicians therefore try to assess both at the same time, and sorting out what came first may take time and sometimes a period of abstinence.
What integrated care usually includes
- A single assessment that covers psychiatric symptoms and substance use
- Coordination between the prescriber, therapist and any addiction treatment program
- Medication choices that account for both conditions and for risks such as misuse or interactions
- Psychotherapy that addresses both mood or anxiety symptoms and relapse prevention
- A plan for what happens after the initial phase of treatment
Role of TMS
When depression is part of the picture, a psychiatrist may discuss TMS as one option for the depressive symptoms, provided screening shows it is safe. Active substance use can affect screening and how well a course can be completed. Beyond smoking cessation, TMS for substance use is investigational. See the depression guide and the addiction guide.
Questions to ask
- Is there a psychiatrist who can diagnose and treat both conditions?
- How are the mental health and substance use parts of the plan coordinated?
- What happens if there is a setback during treatment?
- Which parts are likely to be covered by my insurance?
Help lines
For emotional crisis call or text 988, the US Suicide & Crisis Lifeline. For treatment referrals, the SAMHSA National Helpline is free and confidential at 1-800-662-HELP (4357). In an emergency call 911.