If you're struggling with a mental health diagnosis in addition to experiencing substance use disorder, you might consider a dual diagnosis treatment facility, also known as integrated treatment for co-occurring disorders or comorbidity.
From the lens of substance use disorder, dual diagnosis means that a person is not only experiencing substance use disorder (i.e. addiction), but they're also dealing with another mental health disorder, which can be anything ranging from depression, anxiety to bipolar disorder.
In the United States, it's estimated that as many as 7.9 million adults are dually diagnosed with a co-occurring mental health condition while struggling with substance use disorder.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), people diagnosed with a mental health condition are more likely to struggle with substance use disorder. With co-occurring disorders, it can also be difficult to know what the true concern is. A mental health diagnosis can be worsened by substance use disorder, and substance use disorder can be worsened by a mental health diagnosis.
Because of this dynamic, you might not know what the true problem is or what to treat first. That's the benefit of dual diagnosis treatment – both conditions are treated together.
Dual Diagnosis Symptoms
There is a number of mental health conditions people usually experience when dually diagnosed, including:
Obsessive compulsive disorder
Post-traumatic stress disorder (PTSD)
Other behavioral health disorders (eating disorders, gambling addiction, sex addiction, etc.)
If you've been formally diagnosed with a mental health condition and are seeking treatment for substance use disorder, the next step – and often the first step – is making an appointment with a dual diagnosis rehab or alcohol and drug counselor to discuss your recovery goals and mental health history to determine what next step is right for you and your recovery.
How Does Dual Diagnosis Treatment Work?
If you're experiencing substance use disorder and a co-occurring disorder, help is available and recovery is possible. It can be difficult to know what problem to treat first – your mental health condition or substance use disorder. A dual diagnosis program examines both simultaneously.
According to the National Institutes of Health, patients struggling with a co-occurring mental health disorder have better treatment outcomes when involved in a dual diagnosis treatment program.
So what is a dual diagnosis treatment program?
Simply put, when participating in integrated dual diagnosis treatment, you will receive services for your mental health condition along with substance use programming. This could be anything ranging from dual diagnosis therapy to recovery groups, along with family programming, individual counseling, and other therapeutic services.
Elements of Dual Diagnosis Treatment
While participating in a dual diagnosis treatment program, it's common to have different people helping you on your care team. This could be an alcohol and drug counselor, case manager, psychologist, psychiatrist or even a primary care doctor. Each person helping you get better will represent a different discipline, which is another benefit of dual diagnosis treatment: you'll have the people around the table to make sure you're getting better as a whole person.
Here are some common elements of dual diagnosis treatment:
Participation in group therapy, for both substance use disorder and a mental health disorder
Individual counseling with a therapist, alcohol and drug counselor and psychiatrist
Receiving evidence-based therapies like Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) or motivational interviewing
Specialized treatment or therapies if needed, including trauma counseling, gender-specific programming, programming for populations with HIV/AIDS, etc.
Medications to help alleviate the symptoms of a psychiatric diagnosis, and medication monitoring to ensure the dosage is working and being taken properly
What To Expect at a Dual Diagnosis Rehab
Before you can be formally admitted to an appropriate level of care for treatment, you will be referred to a counselor, psychiatrist or therapist for a comprehensive chemical use assessment, as well as a mental health evaluation.
During the chemical use assessment, counselors will ask you questions about your intoxication or withdrawal potential, any physical health concerns you have, history of chemical use, readiness to change, treatment history, recovery environment, social/environmental aspects of life, as well as any mental health symptoms you're experiencing.
If you indicate a formal mental health diagnosis or express mental health concerns, you may be referred to either an in-house psychiatrist or psychologist, or to someone in the community, for a mental health evaluation. If the provider is not an in-house professional, you'll sign a release of information form between the treatment center, mental health provider, or any other counselor or therapist helping you get started in treatment so they can help coordinate your care.
After the chemical use assessment and mental health evaluation have been completed, there are a number of recommendations you may be given:
If you've been actively using right up to the chemical use evaluation, you may need detoxification services to allow your body to come down from any chemicals still in your body. During this process, if you're working with a treatment center and are planning on attending group treatment after you complete detox, you'll often continue coordinating your care with a case manager or group of counselors, therapists and/or social workers to help you complete detox (stays can range between 1-14 days depending on your chemical use history) and transition into a formal treatment program.
If your substance use is severe, you're using substances with a high potential of relapse, or you have a complex history of substance use treatment, you may be referred to dual diagnosis residential treatment. Residential dual diagnosis treatment centers have a number of different programs including mental health treatment groups, individual therapy and group therapy for substance use disorder. Typical residential treatment stays can range anywhere from 30 days to a year or longer.
Dual diagnosis outpatient treatment can be an effective treatment method if your substance use and/or mental health diagnosis is less severe and can be managed through several hours of treatment per week, rather than around the clock care and all-day programming. Outpatient dual diagnosis treatment can also be a recommendation after you complete a residential treatment program to continue providing you with additional support as you care for your mental health, recover from substance use disorder, and re-acclimate to your new life in recovery. Because outpatient treatment centers can range in size, you'll either be recommended to work with an in-house therapist to continue treating your mental health condition, or will be referred to a community therapist to work with.
After you've successfully completed a treatment program, whether it be residential or outpatient, long-term dual diagnosis treatment centers will offer an aftercare plan referring you services ranging from community support groups, ongoing individual counseling services or transitional housing (halfway house, sober living facility or group residential housing). For dually diagnosed patients, ongoing mental health counseling is beneficial and can supplement ongoing recovery support programs you may be involved in. Depending on the type of treatment center you've completed, you may have a case manager or social worker helping facilitate your aftercare treatment or program options.
Specialty Dual Diagnosis Treatment Centers
Even with the help available through traditional dual diagnosis treatment centers, other specialty treatment centers exist for those who feel more comfortable in specific settings, like gender-specific treatment centers for women, or treatment centers for those experiencing trauma or a traumatic brain injury.
Some treatment facilities offer gender-specific treatment groups, creating options for those that align with a male gender identity or a female gender identity. Research supports gender-specific groups, stating it allows group participants to open up, process feelings and discuss treatment concepts in a space that is comfortable and affirming. Studies show women’s dual diagnosis treatment centers are especially popular and effective in helping women with co-occurring disorders.
Patients with post-traumatic stress disorder (PTSD) are five times more likely to struggle with substance use disorder. If you've experienced a traumatic event or have been diagnosed with PTSD, it could be beneficial to your recovery to incorporate trauma-informed treatment into your care. Trauma-informed treatment will help you process the past and move forward, in a way that will allow you to address trauma as it pertains to your substance use alongside trauma-sensitive counselors and programming.
For those who have had a traumatic brain injury (TBI), learning and cognition can be impacted. Recovering from a TBI can be difficult, and often requires tailored techniques to re-train your brain certain concepts. When pursuing recovery, a dual diagnosis or specialty treatment center for those with a TBI can be helpful. You'll be surrounded by counselors and physicians that understand the dynamics of a TBI, while also helping you stay on track and pursue recovery from chemical use.
The verdict? If you have both a mental health condition and are struggling with substance use disorder, consider dual diagnosis treatment. Focusing on both your recovery from addiction and the stability of your mental health will ensure you're receiving all of the help you need to live a successful, resilient life in recovery.