For most of my life, nobody was treating both. Mostly because nobody knew there was a "both." There were the drugs. There was depression. Then, at 50, autism, which nobody saw at all. They all lived in the same head, and they all talked to each other.
That's dual diagnosis. In Canada the official term is concurrent disorders: a substance use problem and a mental health condition at the same time. CAMH puts it simply. If you have a mental health problem, your risk of an addiction problem goes up, and the reverse is true too. And people do best with integrated treatment, where both are dealt with at the same time, in a coordinated way.
That last part is the whole post, really. Both. At the same time.
What does dual diagnosis actually mean?
The term describes a situation more than one illness. You have one thing (a substance use disorder) and another thing (depression, anxiety, PTSD, bipolar disorder, ADHD, whatever it is), and they're tangled.
The tangle is the problem. Depression makes using feel like relief. Using makes depression worse the next day. Anxiety makes a drink or a line feel like the only thing that turns the volume down. Then the comedown cranks the anxiety up. Round and round, and after a while you can't tell which one is driving.
In Québec you'll hear troubles concomitants. Same thing.
Which came first, the drugs or the depression?
People love this question. Doctors ask it, family asks it, you ask it at 3 a.m. Honestly? For a lot of us it doesn't matter as much as it seems.
I can't draw you a clean timeline of my own life. The depression was there before, during and after the drugs, as far as I can tell. I didn't call it self-medicating back then. I didn't call it anything. I just knew that for a while, using made the noise stop, and then it made the noise worse.
What matters is that both are here now, and both need attention. Chasing the origin story can turn into another way of not starting.
Why can't I just get clean first and deal with the rest later?
You'll hear this. "Get sober, then we'll look at your mental health." Sometimes it's said with good intentions. Sometimes it's because the system is split in two, with addiction services in one building and mental health in another.
Here's the problem with it. If you quit and the depression is still there, untreated, it's sitting right next to you, and it has a very short memory for why you quit. That's what I'd tell anybody. The thing you were using to cope with doesn't disappear when the drug does. It gets louder.
And the other way works too. Treating someone's anxiety while they're still using heavily is like bailing a boat with a hole in it.
That's why CAMH and others push integrated care: one plan, people who talk to each other, attention to the basics like housing and sleep and money, and a plan for relapse. In real life you might have to build some of that yourself, by telling every professional you see about the other half. Don't let anyone treat just the part that's in their job description.
What about autism?
This one's personal. I was only diagnosed with Autism Spectrum Disorder (ASD) at 50. Looking back, a lot of things look different. A Cambridge study of over 2,000 people found autistic adults were, overall, less likely than others to drink regularly or binge, but among people who gave a reason for using drugs, autistic people were far more likely to say they used to manage their behaviour or their mental health symptoms (Weir, Allison and Baron-Cohen, 2021). Self-medicating, in other words.
I go deeper into that in was I self-medicating undiagnosed autism?. The short version: if you're in recovery and you've always felt wired differently, it might be worth asking about an assessment. Not because a label fixes anything. Because treatment that doesn't know who you are tends to miss.
Where do I start in Québec?
You don't need to figure out which door is the "right" one. Any door can get you moving.
- Call Info-Social 811, option 2. It's free and runs around the clock, and they can refer you to services in the public network.
- Walk into your CLSC. Québec says plainly that all public health and social services establishments offer mental health care and services free of charge.
- Call Drogue : aide et référence at 1 800 265-2626, 24/7, free and confidential. They know the addiction side of the map.
- See your family doctor or GMF if you have one, and tell them about both halves.
The public network also runs addiction rehabilitation centres. Out here in the Petite-Nation there's one in Saint-André-Avellin. Ask 811 which one covers you.
If you're physically dependent on opioids, alcohol or benzos, don't stop on your own. Withdrawal can be dangerous. Get medical help. I wrote about that in getting through opioid withdrawal safely.
And outside Québec, Health Canada keeps a page of provincial and national substance use help lines.
What actually helps, from where I sit
A professional who asks about both. A group that respects the rest of your treatment, including anything your doctor prescribed. If a room tells you to drop your meds or your therapist, that's a room to leave. Therapy that gives you tools for the hard moments, which I get into in CBT, DBT and ACT in plain words.
And patience with the order of things. Some weeks the addiction needs the attention. Some weeks the depression does. You're not doing it wrong if it doesn't move in a straight line.