Mental Illness and Substance Abuse: The Challenge of Dual Diagnosis

According to the National Institute on Drug Abuse, approximately one in four individuals over the age of 18 live with both a serious mental illness and substance abuse disorder. Serious mental illness is defined at the federal level as having a diagnosable behavioral, mental, or emotional disorder that impedes or completely destroys a person’s ability to participate in one or more major life activities. The government classifies schizophrenia, depression, and bipolar disorder as SMIs, among several other disorders.

The number of youths who live with both mental illness and substance abuse disorder is even higher. Though there are fewer studies on the comorbidity between the two in adolescents, the studies that have been done reveal that more than 60 percent of youths in community-based substance abuse treatment programs also meet the criteria for mental illness.

Substance Abuse IS Mental Illness

Many people differentiate between substance abuse and mental illness, but the National Institute of Mental Health suggests that the two are one and the same. Substance abuse disorder affects a person’s ability to prioritize and alters his or her short- and long-term desires. Like mental illness, drug use can interfere with one’s social obligations, responsibilities such as work and school, and relationships.

Among the list of substances that the NIMH considers to be abusive include alcohol and tobacco. In fact, many individuals that abuse substances turn frequently to these two products.

As many as 7.9 million individuals across the nation live with both substance abuse disorder and mental illness. Having two illnesses at the same time is known as “comorbidity” and can make dual recovery treatment exponentially more difficult.

Challenge of Dual Diagnosis and Treatment

Dual diagnosis of mental illness and drug addiction pose a unique challenge to physicians as patients with both have to brain disorders that influence one another. This leads doctors to wonder: which influences which and which requires treatment? Or do both require treatment? Will the treatment of one adversely affect the other?

Another thing physicians must consider is that mental illness and addiction involve many of the same molecules, pathways, and chemicals in the brain. Because of this, they share many resemblances. Some of those similarities are as follows:

  • In both alcoholism and mood disorders, a serotonin transporter is particularly active.
  • The brains of individuals who have schizophrenia and/or addiction to certain stimulants such as cocaine show increased dopamine activity.
  • Additionally, both people with schizophrenia and cocaine users demonstrate a dysfunctional reward pathway when dopamine activity increases.
  • Recent studies suggest that the brain in one in four individuals who smoke marijuana have a catechol-o-methyltransferase gene variant that makes them more likely to develop schizophrenia as a result of their marijuana use.

There are several other findings that suggest a link between mental illness and substance abuse, findings that, instead of helping, make it exponentially more difficult for health care professionals to provide an accurate dual diagnosis or to perform a dual treatment. For instance, one study reveals that 70 percent of schizophrenics smoke, while another reveals that stimulants such as cocaine can cause mania, anxiety, panic attacks and sleep disorders. Depression occurs when the reward center of the brain receives little to no natural stimulation.

Physicians may face many challenges when it comes to the dual diagnosis of drug abuse and mental illness. However, an accurate diagnosis is necessary to get afflicted individuals on the path to recovery.


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