What is Dual Diagnosis?
The concept of a dual diagnosis—alternatively referred to as co-occurring or comorbid disorders—is a clinical term that refers to the presence of both a substance use disorder and a mental or behavioral health condition.
Someone who struggles with a substance addiction and a co-occurring mental health condition, such as depression or anxiety, is said to have a dual diagnosis. Dual diagnoses require integrated and comprehensive care to fully address and rectify both conditions. Only treating one issue may put the person at an increased risk of relapse.
Sometimes one condition might contribute to or worsen the other. For example, someone with a mental illness might use drugs or alcohol to cope with their symptoms. In other cases, substance abuse may uncover a mental illness or exacerbate related symptoms.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly 8 million adults struggled with both a substance use disorder and a mental disorder in 2014. However, only a fraction of people with substance abuse problems and/or mental illnesses seek professional help to get the treatment they need.
There is no specific explanation for why drug and alcohol addiction and psychiatric illness co-occur so frequently. People who suffer from both a substance disorder and mental illness often exhibit symptoms that are more persistent, severe, and resistant to treatment compared with people who suffer from only one disorder.
Why Mental Illness Goes Untreated
Dual diagnosis typically applies to people who suffer from a severe, persistent mental illness coupled with a substance abuse disorder. Historically, there has been a split in the U.S. between mental health services and addiction treatment. A group that has fallen through the cracks of this divide is people who’ve been given a dual diagnosis.
Because each system of treatment has existed in isolation, it has been extremely difficult for people who have a dual diagnosis to get the care they need in either traditional mental health or addiction treatment programs. Until integrated dual diagnosis programs became available, it was more difficult for people with co-occurring disorders to receive effective help because they generally participated in separate treatment programs that didn’t address their unique needs.
Individuals with dual diagnosis disorders require a treatment program grounded in expertise in both areas. Fortunately, increasing numbers of substance use disorder treatment programs are becoming equipped to treat co-occurring disorders.
Dual Diagnosis Assessment
During clinical assessment for dual diagnosis, health professionals consider a number of factors. Generally they will look at whether the individual:
- Meets the criteria for a psychiatric disorder.
- Has a history of substance use that has had a negative impact on their psychiatric health, relationships, work, and leisure activities.
- Might be a danger to themselves or others, has a history of violence, or has experienced suicidal thoughts.
- Has a support system and resources available.
- Is motivated to undergo rehabilitation (rehab) and has the level of support needed for treatment to succeed.
Signs of Related Conditions
Mental health disorders and substance use disorders frequently occur together, but many of the symptoms are quite distinct. Although symptoms will naturally differ based on the specific mental health condition in question, some commonly encountered signs of co occurring disorders include:
- Feelings of hopelessness, worthlessness, guilt, fear, or panic.
- Lack of interest in daily endeavors.
- Change in appetite, weight, or sleep patterns.
- Lack of energy.
- Racing thoughts and trouble concentrating.
- Increased irritability.
- Risky behavior.
- Suicidal thoughts.
- An inability to control use of the substance or a tendency to use more of the substance than planned.
- Cravings for the substance.
- Developing a tolerance for the substance, or needing more of it to achieve the same effect.
- Feeling symptoms of withdrawal after discontinuing use of the substance.
- Spending a great deal of time on the substance, including time used to acquire it, use it, and recover from use.
- Failing to meet work, home, or school obligations because of use.
- Using the substance at the expense of relationships, regular activities, and personal safety.
Types of Dual Diagnosis Rehab Programs
Treatment for dual diagnosis will be different based on the individual’s needs and preferences. Treatment may take place on an inpatient or outpatient basis.
Inpatient Dual Diagnosis Treatment
Depending on the severity of the illness, a person with a dual diagnosis might require or benefit from inpatient care. A common form of inpatient treatment is “residential” rehab, in which participants live at the rehab center during treatment. Depending on the facility’s rules, residents may be permitted to leave the treatment center or have regular visitors.
Because of the complicated nature of co-occurring disorders, many people with a dual diagnosis will require the additional services, ongoing support, and on-site professionals from multidisciplinary backgrounds that may be found in inpatient centers. These programs allow those suffering from complex issues surrounding a dual diagnosis to receive the intensive treatment needed to get a solid start on the path to recovery from both disorders.
Inpatient dual diagnosis rehab programs are more intensive because participants:
- Receive regular education about mental health issues as well as substance abuse and addiction.
- Receive daily therapy.
- Have the opportunity to attend support groups every day.
- Are immersed in a community of people who are learning to live without drugs or alcohol.
Outpatient Dual Diagnosis Treatment
Outpatient treatment for dual diagnosis is more flexible than inpatient treatment. Outpatient programs can vary in intensity and time commitment. For some people, participating in intensive outpatient treatment, where they spend 30 hours or more per week at the rehab center, is sufficient initial treatment.
If inpatient dual diagnosis treatment is initially required, participants may then graduate to an intensive outpatient program that supports their desire to live in the community more independently while they continue their recovery efforts. Participants may receive a variety of services in such a program, including:
- Medication management.
- Involvement in peer support groups or 12-step programs.
- Individual and family therapy.
- Support in living independently.
Co-Occurring Disorders and Behavioral Therapies
There is evidence that with help, people with a dual diagnosis can stabilize and recover. A large part of the treatment for dual diagnosis involves behavioral interventions. Types of behavioral therapy commonly used in dual diagnosis treatment include:
- Dialectic behavioral therapy, which has the goal of reducing self-harming behaviors that often accompany mental health conditions and substance use disorders.
- Integrated group therapy, which seeks to treat the symptoms of both substance use disorders and mental health illnesses all at once.
- Cognitive behavioral therapy, which works to minimize problematic beliefs and behaviors and develop healthier thinking and behavioral patterns to sustain sobriety.
- Individual psychotherapy, which treats behaviors related to substance abuse and/or particular behavioral or mental health problems.
Dual diagnosis treatment programs sometimes utilize behavioral therapies in combination with medication. Medicines will vary according to the individual and the diagnosis. Some of the more commonly used medications include lithium and anticonvulsants, which are often prescribed as mood stabilizers, selective serotonin reuptake inhibitors (SSRIs) and other antidepressants, and anti-anxiety drugs such as buspirone (BuSpar).
What to Know About Dual Diagnosis Treatment Programs
When choosing the best dual diagnosis program for you, it’s important to understand some basics about treatment. This includes your privacy in rehab, where to find and attend treatment, and how to pay for a program.
Rehab center staff members know that confidentiality is paramount to client safety. A common concern among people looking for or entering dual diagnosis treatment is their privacy and confidentiality. Rest assured that all dual diagnosis rehab programs are mandated by law to protect patient privacy.
Rehab center staff members know that confidentiality is paramount to client safety. As part of admission into the program, staff will review the facility’s policies and answer any questions to help you feel as safe and comfortable as possible.
Treatment Location Options
Individual paths to recovery differ, and treatment services for mental health and substance use disorders should be tailored to fit a person’s needs. SAMHSA supports an individualized, integrative approach for treatment of dual diagnosis.
Depending on their individual situation and specific requirements, a person in need of dual diagnosis treatment may benefit in receiving a variety of therapeutic interventions from a number of treatment settings. These may include:
- Specialty community behavioral health centers.
- Substance use disorder rehab programs.
- Independent providers, such as therapists and counselors in private practice.
- Hospital-based treatment programs or access to hospital services.
- Community health centers.
- Mutual support groups and peer-run organizations.
- Community-based organizations, such as churches.
- Criminal justice programs, such as counseling services within a prison system.
- Tele-behavioral or home-based services that provide treatment in the home.
- Inpatient service providers.
- Primary care programs that offer behavioral health services.
Paying for Dual Diagnosis Rehab
The costs of treatment will vary by dual diagnosis program and may be influenced by differing levels of insurance coverage. If you have insurance, check with your carrier to find out:
- Whether your plan covers dual diagnosis treatment.
- How much your plan will pay.
- Which rehabs programs are covered in your plan.
Many people who have low incomes qualify for Medicaid. If you have Medicaid, you’ll need to check with your county to find a covered rehab.
If you don’t have sufficient insurance to cover your dual diagnosis rehab program, you may be able to obtain financing from the rehab facility. This financing is usually based on financial need. You might receive a reduced rate or be given the option to pay your bill in monthly installments.
Recommendations from people leaving treatment
While dual diagnosis treatment lays the foundation for recovery and long-term sobriety, aftercare helps maintain the progress made during treatment. Ongoing support is essential for anyone in recovery from addiction and is even more important when a mental health disorder is present. A comprehensive, individualized aftercare plan is vital to sobriety and progressive recovery after completion of a dual diagnosis rehab program.
Dual diagnosis treatment centers take extra care to incorporate relapse prevention into the aftercare plan. Prior to leaving a treatment program, the individual will meet with counselors to discuss a plan for aftercare.
Many dual diagnosis rehab facilities offer follow-up programs to assist recovering individuals as they transition back into their everyday lives. These follow-up plans may include:
- Weekend stays at the rehab center. These stays benefit individuals who feel they may be at risk for relapse or those who simply require some additional support.
- Transition to a sober-living facility. While there, recovering individuals may be required to complete chores, work at an outside job, and participate in group therapy sessions. This offers a supportive, transitional time before returning back to “normal” life.
- Regular therapy sessions. These help the individual to continue working through issues and making positive changes to sustain sobriety.
- Scheduled drug testing. This provides a good way to maintain accountability for abstinence after program completion.
- Group therapy. This type of therapy provides a positive method for building a support system at home. Options for group therapy include 12-step support groups, gender-specific or faith-based support groups, and more.
In dual diagnosis aftercare support groups, it is often said that participants get what they give, so they are encouraged to interact with other group members and share their experiences with the group. Once those recovering from dual diagnosis are more established in their sobriety, they may choose to mentor others who are newly recovering as well.
Finding The Best Treatment For Dual Diagnosis
Although dealing with substance abuse and mental illness can seem like an uphill battle, many people with dual diagnosis recover and go on to live happy, healthy lives. But successful recovery takes time and effort. At the start of the process, attempting to choose a dual diagnosis treatment program on your own can be overwhelming.
You can always call a helpline or treatment center’s direct line to speak to a caring admissions consultant about your treatment options. In order to receive guidance concerning your treatment search, it’s important to prepare some information before calling. For instance, if you have insurance, you’ll want to have your insurance card in front of you. That way you can provide the admissions consultant with your policy number and plan name. They will then use this information to verify your benefits. You’ll also want to report the substance or substances being abused, how long the addiction has been going on, the average amount used, the method of administration, and any co-occurring medical or mental health disorders. If you have any special medical concerns, such as pregnancy, then you’ll want to disclose that as well.
- National Alliance for the Mentally Ill. (2016). Dual Diagnosis.
- Mohammed, T-S. (2004). Dual diagnosis: management within a psychosocial context. Advances in Psychiatric Treatment. 10(5): 352-360.
- Goldsmith, RJ, Garlapati, V. (2004). Behavioral interventions for dual-diagnosis patients. The Psychiatric Clinics of North America. 27(4):709-25.
- National Institute of Drug Abuse. (2016). Comorbidity: Addiction and Other Mental Illnesses.
- Substance Abuse and Mental Health Services Administration. (2016). Mental and Substance Abuse Disorders.
- Tirado-Munoz, J., Farre, A., Mestre-Pinto, J., Szerman, N., & Torrens, M. (2018). Dual Diagnosis in Depression: treatment recommendations. Adicciones 30(1), 66-76.
- Vitali, M., Mistretta, M., Alessandrini, G., Coriale, G., Romeo, M., Attilia, F., et al. (2018). Pharmacological treatment for dual diagnosis: a literature update and a proposal of intervention. Rivista di psichiatria, 53(3), 160-169.