The majority of individuals struggling with drug or alcohol use disorders also have some sort of additional mental health problem. Technically speaking, the generally agreed upon percentages of folks who have dual diagnosis or “Double Trouble,” is 50% for an alcohol use disorder and 70-85% for a drug use disorder. This means that half to 2/3rds of all people struggling with drug or alcohol use essentially have another sort of mental illness. It is essential therefore to be sure to treat the accompanying mental illness. Most typically people coming to our office or any drug and alcohol treatment center or outpatient clinic are also presenting with depression or anxiety. The number one mental illness in the United States is the set of depressive illnesses and the number two illness would be the anxiety disorders.  Alcohol and drug use can be both a result or symptom of anxiety and depression and it can also be a cause. Working in therapy clients and therapists attempt to determine which came first but this isn’t always so easy.

Since anxiety, depression and other mental health disorders are part and parcel of substance use disorders it is important to see a licensed professional counselor or psychologist to help you treat the potential underlying causes of the substance use disorder. Depression, anxiety and other forms of mental illness are very treatable. Cognitive behavior therapy, relaxation exercises, behavioral therapies, group and individual therapy can all help address depressive and anxiety symptoms. These treatments can help reduce anxiety, improve communication skills and aid in relapse prevention.

Psychiatry and medication management may be an important part of dual diagnosis treatment as well. Approximately thirty percent of our patients or clients see psychiatrists for mental health or substance abuse medication management.  We refer to conservative psychiatrists who are particularly careful about not over medicating and who are knowledgeable in treating the underlying depression, anxiety or other forms of mental illness.

Addiction psychiatrists in particular will be savvy about prescribing medications which are not addictive and don’t create their own problems. Addiction psychiatrists who we use are able to prescribe medications like Suboxone, Naltrexone and Vivitrol in shot and implant versions in order to help with cravings and maintenance.

The resources below should provide additional information on dual diagnoses and the underlying mental disorders related to the substance use disorders.


Most common forms of mental illness in the united states –


Dual Diagnosis and Recovery (2003, Depression and Bipolar Support Alliance) – This brochure outlines the symptoms of depression and mania, offers a checklist of some of the symptoms of problem drinking; answers some questions such as Am I still clean and sober if I take medication? and What if I relapse?, guidance for loved ones who want to help, and resources.  If you would prefer to view this as a web page, go here –

Information on how anxiety and alcohol abuse interact and how to treat them.

Mental Health America (MHA) (formerly the National Mental Health Association) – Community-based network with affiliates.  One of their primary goals is public education.  Another is action and advocacy on a national level.  They have concise information about dual diagnosis (listed as “co-occurring disorders”) and address insurance reimbursement, including appealing denials.