Screening and Assessment of Co-Occurring Disorders
In the realm of substance abuse and mental health treatment, a dual diagnosis refers to the phenomenon of having a substance use disorder (SUD) and one or more co-occurring psychiatric disorders simultaneously. These co-occurring psychiatric conditions may include a range of mental illnesses that are identified in the American Psychiatric Association’s Diagnosis and Statistical Manual of Mental Disorders (DSM-V), such as schizophrenia, post-traumatic stress disorder (PTSD), bipolar disorder, depressive disorders, or generalized anxiety disorder.1,2
Dual diagnoses are common—according to MedlinePlus, approximately half of people struggling with addiction also have a co-occurring mental health disorder at some point in their lives, and vice versa.3 It’s not always easy to understand which disorder manifested first, and one disorder doesn’t always directly lead to the other. Sometimes, people with addictions may develop a mental health disorder due to substance use in and of itself. However, people with mental health disorders may self-medicate their symptoms with substances to find relief, which can influence the development of a substance use disorder.3
Different terms are sometimes used to refer to a dual diagnosis, but all of these terms refer to the same phenomenon. You may hear the terms comorbidity, dual pathology, co-occurring conditions, or co-occurring disorders when people talk about a dual diagnosis.
The terms comorbid or co-occurring simply mean disorders that occur together. Sometimes these terms are also used to refer to the presence of physical health disorders, (for example, a stimulant use disorder with co-occurring heart disease or high blood pressure).4
However, the term dual diagnosis isn’t typically used by clinicians to refer to co-occurring addiction and physical health issues.5 They are more often used to refer to co-occurring addiction and another psychiatric illness.3,6
Statistics on Mental Health & Substance Use Disorders
According to the 2019 National Survey on Drug Use and Health, 3.8% of adults over the age of 18, or 9.5 million people, had any co-occurring mental illness (AMI) and SUD, such as anxiety or depression.7 The term AMI means any mental, behavioral, or emotional disorder that has a sufficient duration to meet DSM criteria.7 Around 1.4% of adults, or 3.6 million people, had a serious mental illness (SMI) and SUD.7 An SMI is a diagnosable disorder that seriously impacts a person’s functioning. This includes disorders like major depression, schizophrenia, and bipolar disorder, as well as other DSM disorders that cause significant impairment to a person’s functioning and well-being.4
Treatment is important to address both disorders. Unfortunately, many people with dual diagnoses don’t get the help they need. According to the National Institute on Drug Abuse (NIDA), 52.5% of people with dual diagnosis didn’t receive any treatment, 34.5% received only mental health care, 9.1% received both mental health and substance abuse treatment, and 3.9% received substance treatment alone.8
How Are Co-Occurring Disorders Diagnosed & Assessed?
Co-occurring disorders are diagnosed through screening and multi-level assessments that seek to understand a person through various perspectives relevant to their symptoms and service needs. This comprehensive evaluation typically takes into account a person’s entire physical and mental health history in chronological order, as well as their history of substance abuse, previous substance abuse treatment, periods of extended abstinence, and relapses. Additional information is collected on a person’s strengths, limitations, skill deficits, and cultural barriers related to following a recommended treatment regimen for substance use disorders or mental health conditions.9
Screening patients is a necessary first step that ensures patients at a substance abuse treatment facility receive a full and correct diagnosis (or diagnoses if the patient has co-occurring disorders), and therefore the correct treatment regimen.9
Sometimes screenings are conducted to determine whether additional, more specific assessments will be necessary, such as one that’s designed to pinpoint whether or not a patient has a specific mental health condition.
People who enter treatment for mental illness must be screened for substance use disorders and should also be screened for mental illness. However, it can be difficult to diagnose co-occurring disorders, because symptoms of various mental health conditions and substance use disorders often overlap. Comprehensive assessment tools aid in the diagnostic process.4
Sometimes there are factors that can hinder a diagnosis and prompt treatment providers to re-screen or perform additional assessments. For example, people who are going through substance withdrawal can present with certain psychiatric symptoms that point to a co-occurring disorder (e.g., depression). When this happens, a patient will and intermittently as they progress in their treatment. In addition, a patient who was misusing multiple substances may cause more complications in diagnosis and treatment.4
Assessment Tools for Co-Occurring Disorders
Though each provider may use different dual diagnosis assessments, some tools used in the assessment, screening, and diagnosis of substance use disorders and co-occurring mental health conditions may include:10
- Addiction Severity Index (ASI).
- Alcohol Use Disorder Identification Test.
- Mental Health Screening Form III.
- Columbia-Suicide Severity Rating Scale.
- Michigan Alcoholism Screening Test.
- The Stages of Change Readiness and Treatment Eagerness Scale.
- The University of Rhode Island Change and Assessment Scale.
- Drug Use Disorder Identification Test.
- Psychiatric Research Interview for Substance and Mental Disorders (PRISM).
- Structured Clinical Interview for DSM-V (SCID-5).
- Symptom Checklist-90-Revised.
- Inventory of Depressive Symptoms.
- Montgomery Asberg Depression Rating Scale.
- Young Mania Rating Scale.
- Angst Hypomania Check List.
Can Rehab Treat My Addiction & Mental Health Issues?
Many outpatient and inpatient rehabs are able to treat co-occurring disorders. Research has shown that integrated co-occurring disorder treatment treatment that addresses symptoms of both disorders is superior to treating each disorder separately. Integrated treatment can involve a combination of therapies, such as cognitive-behavioral therapy (CBT), motivational, and functional approaches.4 If you are interested in co-occurring disorder treatment, you should know that help is available, and your insurance may cover all or part of the cost of integrated treatment.
Insurance Coverage for Co-Occurring Disorder Treatment
If you’re wondering whether your health insurance may cover dual diagnosis treatment at an American Addiction Centers rehab near you, simply fill out the form below with the required information and an AAC admissions navigator will reach out to you shortly with your treatment options.
Find Dual Diagnosis Treatment Near You
- National Alliance on Mental Illness. (2020). Substance Use Disorders.
- Substance Abuse and Mental Health Services Administration. (2020). Co-Occurring Disorders and Other Health Conditions.
- S. National Library of Medicine. (2021). MedlinePlus: Dual Diagnosis.
- National Institute on Drug Abuse. (2020). Common Comorbidities with Substance Use Disorders Research Report.
- Hryb, K., Kirkhart, R., & Talbert, R. (2007). A call for standardized definition of dual diagnosis. Psychiatry, 4(9), 15–16.
- Canaway, R., & Merkes, M. (2010). Barriers to comorbidity service delivery: the complexities of dual diagnosis and the need to agree on terminology and conceptual frameworks. Australian Health Review, 34(3), 262–268.
- Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality.
- National Institute on Drug Abuse. (2018). Comorbidity: Substance Use and Other Mental Disorders.
- SAMHSA. (2020). Tip 45.
- Langås, A. M., Malt, U. F., & Opjordsmoen, S. (2011). Comorbid mental disorders in substance users from a single catchment area–a clinical study. BMC psychiatry, 11, 25.