This month is the Mental Health America nonprofit’s 70th annual Mental Health Awareness Month.

Not to high-jack this special month, but it may as well be substance use disorder (SUD) awareness month as well because SUD is a mental illness and because SUD and other mental illnesses co-occur so frequently that there is a name for it: dual diagnosis.

A 2014 survey affected an estimated 7.9 million people have both a “serious mental illness” (SMI) – such as bipolar disorder, major depression, schizophrenia – and SUD. Other statistics indicate that around 25 percent of persons with a SMI also have a SUD and about 10 percent of persons with a SUD also have a SMI. 

When you consider the subset of people with a SUD who are receiving “treatment for nonmedical use of prescription painkillers”, 43 percent seem to have a mental health disorder such as depression or anxiety.

Anecdotal evidence and the perception of professionals in the field is even higher. One master’s student in the Co-occurring Disorders Recovery Counseling program at Minnesota’s Metropolitan State University said, “I believe it’s the norm rather than the exception.” And a staffer at a California addiction rehab center, said pretty much all of its clients had a dual diagnosis.

Despite that high occurrence, dual diagnosis is not always diagnosed because:

• It can be hard to distinguish between SUD and SMI; the symptoms can be similar.
• SUD can begin as an attempt to self-medicate for a SMI, which may disguise the symptoms of SMI.
• Some SUD can induce SMI or cause SMI-like symptoms but not actual SMI.
• SUD is more obvious; it has physical evidence.
• Not all counselors at all substance use rehab centers are trained to recognize a dual diagnosis.

Even when both disorders are recognized, for a long time it was thought that it was best to treat the two disorders separately and sequentially, not simultaneously. The best science now believes that integrated treatment – treating both disorders at the same time and if possible by the same treatment team – is most effective.

Unfortunately, even in science-based fields, practitioners sometimes remain stuck in the past, clinging to the methods and practices they were taught in medical school. Some also resist the use of medication-assisted treatment for SUD – prescribing methadone or buprenorphine (Suboxone) to control cravings and prevent withdrawal – out of the belief that this is “substituting one addiction for another”. 

The counselors at the best SUD rehab centers will check for mental health problems during the detox phase. To not do so is tantamount to malpractice.