Dual Diagnosis (Co-Occurring Disorders) Treatment Guide
What is Dual Diagnosis?
People with mental health conditions are more likely to have a drug or alcohol addiction than those without one, yet most of them do not get appropriate treatment for both disorders. They tend to seek help for one or the other—often the disorder with the symptoms that present the most acute distress. But finding the right type of treatment, even in the early detox stages of recovery, can make a huge difference.
What’s The Connection Between Drug Addiction and Mental Health?
The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that roughly 43 million Americans have a mental health disorder and nearly 21 million people have a substance abuse disorder.1 Sometimes people have both a mental health and a substance abuse diagnosis, in which case that person is said to have a dual diagnosis or co-occurring disorders. In the United States, approximately 7.9 million adults are dually diagnosed with concurrent mental health and substance abuse issues.2
Several theories have attempted to explain the strong connection between substance abuse and mental health:3
- Drugs and alcohol can sometimes exacerbate the symptoms of existing mental health conditions or produce symptoms that mimic those of certain mental illnesses. For example, people who use cocaine can experience severe anxiety after use.
- Mental illness may lead to substance abuse: Sometimes, people suffering from mental health conditions may misuse substances to relieve their symptoms, known as self-medicating. If they continue to turn to drugs as a coping mechanism, over time addiction may develop.
- Additional factors may lead to both addictions and mental illnesses: Both disorders are the result of many social, biological, and environmental factors that affect people in different ways. Some of these influences could include:
- Genetic tendencies.
- Differences in brain chemistry and brain structure.
- Life experiences, including trauma.
- Excessive stress.
Common Mental Health Disorders
The most common mental health disorders include:4
- Anxiety affects approximately 40 million Americans and is characterized by excessive worry and fear that interfere with daily functioning.
- Depression manifests in sad, hopeless, empty, or irritable moods that last for at least 2 weeks. About 6.6% of all adults have experienced at least 1 episode of major depression in their lives.
- Attention deficit disorder (ADD) affects 2.5% of adults and is characterized by chronic inattention and impulsiveness and, in some cases, hyperactivity.
- Bipolar disorder affects 2.6% of American adults with symptoms that include manic (expansive moods with highly impulsive—and sometimes dangerous—behaviors that impact social functioning) and depressive episodes (hopelessness and sadness). People with bipolar disorder often cycle through these stages of depression and mania, and some experience mixed episodes where both manic and depressive symptoms occur together.
- Post-traumatic stress disorder (PTSD) is generally diagnosed following traumatic experiences, such as being the victim of violent crime, being in a military combat situation, or surviving an accident or natural disaster—about 7.7 million adults suffer from it. PTSD symptoms may include nightmares, flashbacks, hyper-vigilance, and avoidance of situations that trigger those symptoms, and can severely impact a person’s family, social, and occupational relationships.
- Schizophrenia is a mental disorder in which people may experience hallucinations (seeing or hearing things that other people do not see or hear) and delusions (developing paranoid or irrational beliefs that most people do not share). Sometimes delusions make the person believe they possess special abilities or powers. Around 1% of adults have schizophrenia.
- Obsessive compulsive disorder (OCD) affects about 2.2 million American adults and is characterized by unwanted thoughts and overwhelming compulsions that lead a person to engage in repeated, ritualistic behaviors to relieve the stress caused by those thoughts and compulsions.
What Is Dual Diagnosis Treatment?
A dual diagnosis typically requires a specialized treatment program that can effectively treat both the mental disorder and the substance abuse disorder at the same time. Treatment professionals evaluate how long you’ve used a substance, the severity of that use, co-occurring mental health or medical conditions, and other relevant factors to chart a proper detox course for you. There are a few dual diagnosis rehab options:
Inpatient Detox Program
Inpatient mental health and substance abuse programs provide 24/7 oversight and may be the preferred option for substance abuse detox under certain circumstances, such as:5
- Going through benzodiazepine or alcohol withdrawal, which can lead to seizures and other serious medical complications and injuries. Around-the-clock medical supervision and treatment is advisable to reduce the risk of complications.
- Having unsuccessfully gone through substance abuse detox on an outpatient basis more than once.
- Not having a supportive, drug-free environment to live in while undergoing outpatient detox.
- Having physical dependence on multiple substances, a long history of addiction, or a history of severe substance use.
- Having a co-occurring medical disorder, such as diabetes or a heart condition that needs monitoring. Detox from substances can sometimes disrupt or aggravate these conditions.
- Having a co-occurring mental health disorder. For example, if you need to detox from stimulants and also have a history of major depressive disorder, the substance withdrawal symptoms can worsen depression and sometimes result in suicidal urges.
- Having self-medicated with a benzodiazepine, such as Valium. This could make you become paranoid, highly agitated, or increasingly delusional while going through detox.
Outpatient Detox Program
Outpatient detox is an option for many people; a substance abuse professional can assess if it is a good fit for you based on numerous factors, such as severity of drug addiction and the presence of other medical issues. Outpatient dual diagnosis rehab programs vary in intensity and frequency of services. Some programs meet several hours a day as many as 7 days per week, while other outpatient programs meet 2 to 3 hours a day, 2 or 3 times a week.
Medication-assisted detox is a form of detox in which you are prescribed medication to help you stop using the drug you’ve abused, such as opioid painkillers or alcohol. The most common types of medication used in detox are:6,7
- Methadone, which is prescribed only under strict medical supervision to help you stop using heroin or other opioids without the acute symptoms of opioid withdrawal. Only a federally licensed clinic or medical hospital can administer methadone.
- Buprenorphine is a partial opioid agonist medication that attaches to the same opioid receptors in the brain as other opioids, such as oxycodone or heroin, and helps prevent acute withdrawal symptoms during detox. Suboxone is a form of buprenorphine that also includes naltrexone, a medication that stops opioids from affecting the opioid receptors in the brain and keeps opioids from producing a high in the user.
For general mental health conditions—such as depression, bipolar disorder, anxiety, PTSD, and psychosis—treatment program psychiatrists may prescribe a variety of medications that address the thought and mood symptoms these disorders produce. Substance abuse considerations affect which psychiatric medications you’ll receive, since some (such as benzodiazepine anxiolytics) can be habit-forming themselves, but a reputable dual diagnosis rehab program will effectively manage these issues.
Not all detox programs are ideal for people with mental illness substance abuse problems, so be honest about your dual diagnosis symptoms, your drug use, and your mental health history when finding the best dual diagnosis rehab program for your needs.
Types of Behavioral Therapies
Among the most common evidence-based treatment approaches for mental health and substance abuse disorders are cognitive behavioral therapy (CBT) and family behavior therapy (FBT). Evidence-based means that independent researchers have found that a certain treatment results in measurable improvements in the people who go through it.
CBT helps you recognize faulty thought patterns and replace them with healthier ones. You also learn new coping skills and discover effective ways to avoid substance abuse. CBT has proven effective for treating both substance abuse and mental health disorders.8
FBT addresses issues with family functioning, behavioral patterns, and substance abuse. You and your family members work together to set mutually agreed-upon behavioral goals, and when someone reaches a goal, they receive a reward.9
Regardless of the therapeutic approach you choose, many co-occurring treatment options exist to help you find relief from both your substance abuse and mental health disorders.
Paying for Rehab Treatment
Additional Resources on Drug and Alcohol Detox
- Inpatient Detox
- Outpatient Detox
- Alcohol and Drug Detox Hotlines
- Finding Detox Nationwide
- Alcohol Detox Guide
- Substance Abuse and Mental Health Services Administration. (2019). Behavioral Health Treatments and Services.
- National Institute on Mental Health. (2016). Substance Use and Mental Health.
- National Institute on Drug Abuse. (2010). Comorbidity: Addiction and other mental illnesses.
- U.S. Department of Health & Human Services. (2019). Mental Health and Substance Use Disorders.
- Substance Abuse and Mental Health Services Administration. (2006). TIP 45: Detoxification and Substance Abuse Treatment: Physical Detoxification Services for Withdrawal from Specific Substances.
- Substance Abuse and Mental Health Services Administration. (2020). Methadone.
- Substance Abuse and Mental Health Services Administration. (2019). Buprenorphine.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research Based Guide (Third Edition): Cognitive Behavioral Therapy.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research Based Guide (Third Edition). Family Behavior Therapy.