Dual diagnosis: addiction plus mental illness

When substance use and a mental health condition show up together, it can feel like fighting two battles at once. You are not alone, and support that treats both is available.

What it is

Dual diagnosis, sometimes called a co-occurring condition, is when someone experiences a substance use problem alongside a mental health condition such as depression, anxiety, PTSD or bipolar disorder. The two often feed each other. Someone might drink or use a substance to cope with difficult feelings, while the substance use in turn worsens their mood, sleep or anxiety over time. Neither condition simply "causes" the other, and a professional can assess how they interact for you specifically.

Signs to notice

• Using alcohol or other substances specifically to numb sadness, anxiety, anger or trauma memories
• Mood, anxiety or sleep problems that do not improve, or get worse, even when substance use stays the same
• Substance use that escalates during periods of stress, low mood or crisis
• Difficulty telling which came first, the low mood or the drinking or drug use
• Withdrawal from relationships, work or activities alongside changes in substance use

What helps

• Seek an assessment that looks at both concerns together, rather than treating them separately or one at a time
• Be honest with your counsellor or doctor about both your mood and your substance use, even if it feels uncomfortable
• Build a daily routine with regular sleep, meals and movement, which supports both mental health and recovery
• Identify your triggers, situations, emotions or people that make you want to use, and plan ahead for them
• Connect with a support group where both experiences are understood, rather than judged
• Involve a trusted family member or friend so you are not managing this alone

When to reach out for help

Reach out if substance use is affecting your health, relationships, work or safety, or if you notice your mental health symptoms are not improving. If you ever feel unable to keep yourself safe, or thoughts of self-harm arise, this is urgent and needs immediate support.

Getting help in South Africa

Cleared Mind's EAP counsellors can help you find an assessment and appropriate treatment pathway, in confidence. SADAG's Mental Health Line (011 234 4837) offers support and referrals.

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If you or someone else is in immediate danger, reach out now. SADAG Suicide Crisis Helpline (24h): 0800 567 567 or SMS 31393. SAPS 10111, ambulance 10177, GBV Command Centre 0800 428 428.