Skip to main content

It’s common for people who develop substance use disorders also to have mental health issues — and vice versa. This condition is known as dual diagnosis or comorbidity.

“There is a high rate of both these issues being together in one individual and both needing to be addressed,” explained Neera Gupta, MD, a psychiatrist at MetroHealth and Assistant Professor at the Case Western Reserve University School of Medicine. She also serves as Medical Director of Recovery Resources, Associate Director of MetroHealth’s Addiction Medicine Fellowship and runs MetroHealth’s outpatient addiction clinics. “Substance use disorders share a lot of the same genetics with mental health issues. They’re really part and parcel of the same disorders.”

Mental health disorders that frequently occur in people with alcohol or drug problems include depression, anxiety, post-traumatic stress disorder, bipolar disorder, attention-deficit disorder or psychotic illnesses such as schizophrenia. Environmental factors such as early childhood traumatic events also contribute to the development of substance use and mental health disorders.

The solution to helping patients with dual diagnosis, according to Dr. Gupta, is integrated treatment, or treating both issues simultaneously.

“It’s the standard of care that we treat both at the same time in as few places as possible,” Dr. Gupta said. “If we can’t integrate that care, then it’s really important to collaborate and communicate with all the people involved with the care of that patient.”

“It’s the standard of care that we treat both at the same time in as few places as possible,” said Dr. Gupta. “If we can’t integrate that care, then it’s really important to collaborate and communicate with all the people involved with the care of that patient.”

How Loved Ones Can Help

Many times people with mental health and drug and alcohol problems won’t ask for help. Loved ones can look out for red flags like isolation and physical symptoms, such as changes in weight, appearance of skin, sleep patterns and rapid changes in emotional states that are out of character.

“If someone has a feeling that something is off with an individual, don’t ignore the gut feeling,” Dr. Gupta said. “Trust it and allow for an open dialogue. It’s worth opening those lines of communication.”

Her advice is to approach these conversations with compassion to help your loved one overcome the stigma of getting help. Simply state what you’ve observed (“I notice you haven’t been engaged in family events, and I care,” for example) and connect your loved one with a professional who can do a mental health evaluation.

“It’s important to have a non-judgmental, accepting way to deal with these patients so they can get the help they need,” Dr. Gupta said. “There’s a lot of shame associated with mental health and substance use disorders. People who have both have double the amount of shame, and sometimes that is a hindrance to getting care.”

To get help or connect someone you know with behavioral health services, call 216-778-4428.

Getting Treatment

The first step to getting treatment for yourself or a loved one suffering from dual diagnosis is talking with your primary care physician about a mental health evaluation.

“The initial assessment is extremely thorough for mental health diagnoses as well as all substance use disorders,” Dr. Gupta said. “That will guide the treatment plan for that patient.”

Treatment may include hospitalization, or it could be intensive outpatient sessions several times per week with education, relapse prevention and coping skills. It also would include behavioral health counseling and substance use disorder counseling, medication management, as well as psychiatric management for a mental health condition. The level of care depends on the patient’s needs.

The new MetroHealth Cleveland Heights Behavioral Health Hospital offers all levels of care for patients with both substance use and mental health issues, including inpatient stabilization and progressively less intensive care as they improve.

“Having a system that can do a step-down program is the ideal scenario,” Dr. Gupta said. “The fact that we now will have that ability that will provide help for patients in the most need will be helpful for the community.”

Dr. Gupta noted the Behavioral Health Hospital includes a dedicated pediatric/adolescent unit.

“That’s a population that’s very vulnerable to these disorders,” she said. “It’s important that we also are able to offer treatment and support for the adolescent population, and in doing so, intervene at an earlier stage so they don’t go on to develop the more chronic issues of mental and substance use disorders.”


Neera Gupta, MD