Editor’s Note: Breaking the stigma around dual diagnosis means seeing the full picture. Learn how truth, empathy, and integrated care lead to real recovery. In this thoughtful article, Pam Reiman discusses the situation when mental health problems and substance use collide.
By Pam Reiman, JD, LCSW, CAADC, CSAC (Executive Director at Bridging the Gaps, Inc.)
The stigma around dual diagnosis shows up in quiet moments. A person with depression who drinks to cope may be told they “just need willpower.” Someone battling addiction might have their panic attacks dismissed as excuses. When the two conditions overlap, one often hides the other. The result is missed signs, unfair judgment, and delayed care.
What Dual Diagnosis Really Means
Dual diagnosis is when mental health problems and substance use collide. It’s not rare. You’ll find it in people who drink to calm racing thoughts, or in those who use drugs to keep sadness at bay. Sometimes the opposite happens. Long-term drinking or drug use stirs up anxiety, depression, or worse. The two sides circle each other, each one making the other harder to manage. Nothing about it is clean or simple.
This overlap makes treatment more difficult. Someone may go into rehab and receive no therapy for their depression. Another might see a therapist for panic attacks while their alcohol use worsens at home. These mismatched approaches don’t work. Effective care sees both parts clearly and treats them together.
The Damage of Misunderstanding
The stigma around dual diagnosis doesn’t begin in the clinic. It starts in everyday conversation. People say, “They’re just an addict,” or “It’s all in their head.” These phrases shrink someone’s story down to a stereotype. They erase complexity. Over time, people internalize those messages. They feel defective. And they hide their symptoms. Ultimately, they avoid seeking help.
Family members and even health professionals sometimes get it wrong. A person might be too high-functioning to be seen as “really sick” or too chaotic to be viewed as “mentally ill.” These judgments are not only wrong—they are dangerous. They delay diagnosis, make treatment harder, and push people away from support, which can worsen both conditions over time. To break this pattern, the root problem must be named. Society must understand the intersection of addiction and mental health. This concept is not abstract. It points to a key truth: recovery fails when one half of the story gets ignored.
Both sides matter. If a person works on sobriety but their depression remains untreated, the risk of relapse grows. Suppose a patient focuses only on therapy but still drinks every day; progress stalls. When people get support for both conditions—at the same time, in one plan—the chance of lasting change grows.
What Ignoring One Side Can Cost
Neglecting one part of a person’s struggle comes with consequences. If addiction is treated in isolation, mental illness may worsen. If only the mental health issue is addressed, substance use can spiral. People may bounce between services, never quite fitting anywhere. One provider sees a client’s drug use and discharges them. Another overlooks signs of trauma. Neither makes progress.
The person in the middle suffers. Their story is reduced to symptoms. Their pain gets filtered through a system that was not designed to see the full picture. This leads to mistrust. It feeds hopelessness. And in many cases, it leads to crisis—overdose, suicide, incarceration, or homelessness.
Integrated care changes that. When services collaborate, when clinicians share information, and when both disorders are treated together, people stay in care longer. Their outcomes improve. They feel seen, not judged. That shift begins not just with new policies, but with new attitudes.
Replacing Blame With Understanding
Language creates culture. Changing words can change minds. Replacing a colloquial term with “person with substance use disorder” does more than soften tone. It moves the focus from blame to healing. Instead of asking, “What’s wrong with them?” people begin to ask, “What happened to them?” That question opens space for care.
Breaking the stigma around dual diagnosis also means questioning our own reactions. Are we more comfortable with one label than another? Do we flinch at the word “psychosis” but overlook daily drinking? Do we call someone a hero for getting sober, but roll our eyes when they talk about anxiety?
These reactions matter for patient safety. They echo through families, schools, workplaces, and clinics. They shape how people see themselves. Undoing that harm means noticing it first. Then changing how we speak, listen, and respond.
What You Can Do
Support someone with a dual diagnosis by staying curious and patient. Don’t rush to assign a cause or a label. To protect patients, let them explain how their symptoms feel. Ask what helps, what doesn’t, and what they want. Offer connection without condition.
If you work in healthcare or social services, look at how your systems handle complexity. Are mental health and addiction services siloed? Are referrals fast and smooth? Do clients get a full picture of their care?
If you are navigating both mental illness and addiction yourself, know that your experience is valid. It is not your fault. Help exists. You deserve care that respects all parts of you—not just the part that others understand more easily.
A Change in Story, A Change in Outcome
The stigma around dual diagnosis tells people they are too much to handle, too complicated to treat, or too far gone to help. That story is false. With the right support, people recover. They rebuild lives, relationships, and a sense of peace. Real change begins with recognition. People must see that mental illness and addiction often walk hand in hand. Neither should be ignored. Both deserve care. By talking honestly, by challenging judgment, and by refusing to simplify what is complex, it’s possible to replace stigma with support. This shift matters—not only for those in treatment, but for everyone connected to them. Change one story, and you change many. When that story includes the full truth of dual diagnosis, healing becomes real.
Pam Reiman, JD, LCSW, CAADC, CSAC
Having experienced a spiritual awakening in the midst of a career as an attorney, Pam made a mid-life course correction and joined BTG’s clinical treatment team. Since beginning her BTG adventure in 2007, Pam has held a variety of positions starting as an intern and culminating in her present position as Executive Director.
From both a personal and professional perspective, Pam believes passionately in the unique integrative and holistic approach to substance abuse treatment offered by BTG. Within the organization, she is responsible for ensuring that each client receives the highest quality of individualized care. Pam’s leadership skills foster a cooperative interdisciplinary team spirit amongst the clinical, medical, and residential staff so as to ensure the provision of a seamless range of comprehensive client services.
Pam brings to her position an exuberance that comes from the joy she receives in working with both the clients and the staff in the fight to overcome the darkness of life in addiction to transformation towards physical, emotional, mental, and spiritual health.