Dual Diagnosis

Dear Dr. Bob,

I just came out of a drug and alcohol rehab program and my counselor says I might have depression or be "dual diagnosis". What is that?

Tom, SF

Dear Tom,
Dual diagnosis is a term used both in mental health and chemical dependency fields to describe a client's condition when both a psychiatric disorder and a drug or alcohol problem occurs. Often times the signs or symptoms can mask or mimic each other. For instance, a hangover or coming down from meth could look like depression, or depression can be mistaken for chronic marijuana use. The "high" of stimulants looks similar to a manic phase of Bi-Polar and vice versa. And hallucinations, usually auditory or visual are the hallmarks of psychosis and hallucinogenic drugs like LSD.


It used to be drug and/or alcohol problems were seen as symptomatic of an underlying psychiatric disorder, the psychiatric disorder would be treated first, hoping the drug or alcohol symptoms would go away as the patient got better. Treating the underlying issues while the client is still actively using drugs and alcohol has proven ineffective. Now chemical dependency is seen as both: a primary problem and symptomatic of underlying issues. Therefore, the easier and more effective treatment approach is to remove the drugs and alcohol, in essence, get sober and see what other thought, mood, or personality issues remain.


Should there be thought, mood, or personality problems that remain a barrier to long term recovery and good mental health, working a good program of meetings and steps with your sponsor, and seeking professional help, would be in order.
Dr. B.