Dual diagnosis: supporting the whole person

What came first, the alcohol problem or the mental health problem?

For many people, it’s an impossible question to answer. Alcohol use is often just one factor in the complex challenges someone faces in their life. Drinking may be a means to cope with mental distress. It can also contribute to experiences of mental health problems such as anxiety, depression and low mood.

What is ‘dual diagnosis’?

‘Dual diagnosis’ is the term that’s often been used to describe the situation when someone is experiencing severe mental health problems and problematic alcohol use. In reality, it’s not always a very helpful term, since the difficulties someone faces don’t have to have been diagnosed by a doctor for them to be having an impact on someone’s life. It’s increasingly common to refer instead to ‘co-occurrence’, which simply means that more than one thing is happening at the same time [1].

How alcohol affects mental health

The relationship between alcohol and mental health is complex. Alcohol has been described as a ‘favourite coping mechanism’ in the UK, and many of us drink to try and help manage stress, anxiety, depression or other mental health problems [2]. This is sometimes called ‘self-medicating’ with alcohol. Although alcohol can bring a short-term escape from mental distress, the effects don’t last, and in the longer-term overuse of alcohol can worsen the symptoms of many mental health problems, particularly anxiety and depression. To find out more, read our factsheet: Alcohol and your mood: the highs and lows of drinking.

Why alcohol services and mental health services need to work together

People’s lives and the challenges they face generally can’t be neatly divided up and dealt with in isolation. Alcohol problems and mental health problems can contribute to each other; and it’s often impossible to overcome one without getting to grips with the other. That’s why it’s so important for services to work together to provide support across boundaries. Across all services, there should be a ‘no wrong door’ policy, where no one is turned away because their needs don’t meet a service’s usual criteria, and all services know how to connect people with the support they need [3]. This means that practitioners in a range of fields – alcohol, mental health, housing, social care, and more – need to build up local connections, so that they know what’s available and where people can turn for help.

Find out more about how one local service is providing support that crosses traditional boundaries between substance misuse and mental health.

More on alcohol and complex needs


[1] Welsh Government (2015) Service Framework for the Treatment of People with a Co-occurring Mental Health and Substance Misuse Problem

[2] Mental Health Foundation (2006). Cheers? Understanding the relationship between alcohol and mental health.

[3] Australian Government (2016) Guidelines on the management of Co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings.