What is a double diagnosis

Sibylle Hornung-Knobel
Specialist in psychiatry and psychotherapy in Munich

What is comorbidity? What is dual diagnosis?

The term comorbidity generally describes the simultaneous existence of two or more clinical pictures. In psychiatry, a double diagnosis is referred to as the joint occurrence of a mental illness with substance abuse or dependence (addictive substances of any kind) or vice versa.

A large number of all people with an addiction disorder (e.g. alcohol, cannabis, drugs) also suffer from a mental disorder (e.g. depression, anxiety disorders, schizophrenia).

How does a double diagnosis come about?

The consumption of addictive substances can weaken the symptoms of a mental illness, initially and only superficially, or lead to an improvement in mood. This positive effect of depressant and euphoric addictive substances such as cannabis and alcohol leads to the desire to continue consuming, which can lead to a habituation effect that leads to a steady increase in dose. In addition to a psychiatric illness that has probably not yet been recognized and treated, the person affected has now also developed an addiction disorder.

With a double diagnosis, however, it is often difficult to assess which disease occurred first. Substance abuse can also cause a mental disorder. For example, it is known that excessive and long-term use of cannabis can have serious consequences and lead to psychosis.

What types of double diagnosis are there?

  • Psychosis and addiction
  • Depression and addiction (mood disorder)
  • Post traumatic stress disorder (PTSD) and addiction
  • ADHD and addiction
  • Personality disorder and addiction
  • Anxiety disorder and addiction etc.

Which therapy methods do I offer for double diagnosis?

Those affected by a double diagnosis need quick help, but also a sustainable treatment and therapy concept that is specifically geared to their personal situation and needs. In the case of a double diagnosis, integrative therapy is necessary, which means that both clinical pictures must be viewed and treated together.