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People everywhere are struggling to manage the drug epidemic that has invaded our communities. On a daily basis, families are confronted with the devastating effects that addiction has on their loved ones. Many people feel hopeless about how to best help those family members and friends who are struggling with this disease. When treating patients with substance use disorder, behavioral health providers should consider the possibility of an underlying mental illness. This occurrence is referred to as having a dual diagnosis, and it encompasses all patients with a co-occurring mental illness and problematic drug and/or alcohol use. Both conditions are categorized as brain disorders, and it is this consideration that contributes to the complexity involved with differential diagnosis and treatment. What comes to mind when we think about dual diagnosis concerns the age old question of, "What came first, the chicken or the egg?" Did mental illness contribute to addiction or did addiction contribute to mental illness? Both scenarios are possible. This is a complex question, but one that is worthy of analysis in order to get to the root of the problem for each individual patient. The point is that there could exist a causal relationship or interplay between substance use disorders and mental illnesses. For example, a newly divorced woman may self-medicate her depression with alcohol in order to feel better, but eventually may find herself addicted. A war veteran suffering from Post-Traumatic Stress Disorder (PTSD) may use opioids to do the same. Conversely, substance abuse and addiction may trigger or exacerbate a predisposition to a mental illness, such as a college student becoming psychotic after using certain drugs. Depending on the severity of the mental illness, some addicted individuals have even attempted or committed suicide while using substances. These people may have undiagnosed mental illnesses and/or trauma histories that have contributed to their substance abuse. Furthermore, the high-risk lifestyle of some addicted individuals can result in severe trauma related to homelessness, abuse, health problems and loss of family support. The psychosocial stressors related to this harsh lifestyle can lead to serious psychiatric issues, such as PTSD and depression. In addition, chronic substance abuse negatively impacts the brain, further complicating the diagnostic picture. According to the National Institute on Drug Abuse, a person who is addicted to drugs or alcohol is twice as likely to suffer from a mood and anxiety disorder as someone who is not 30 b y R i c h a r d C u r c u r u , C E O o f G o s n o l d , p h o t o g r a p h y b y M i n d i S o k o l o s k i C o n s i d e r i n g D u a l D i a g n o s i s i n t h e Tr e a t m e n t o f A d d i c t i o n According to the National Institute on Drug Abuse, a person who is addicted to drugs or alcohol is twice as likely to suffer from a mood and anxiety disorder as someone who is not addicted.