I. The Basics of Dual Diagnosis Treatment

Unlike standard substance abuse rehab, dual diagnosis treatment must address two major issues at once. Because of the complications and environmental triggers surrounding a co-occurring substance abuse and mental illness, dual diagnosis rehab is most successful in a controlled, inpatient setting that treats both issues at once.

Attempting to treat the problems without supervision can be a dangerous road that leads to self-medication, an unresolved mental issue, or a relapse. Proper dual diagnosis treatment should be administered in tandem by both addiction and mental health professionals.

Steps of Rehabilitation

The steps of rehabilitation for dual diagnosis are similar to the typical rehab process:

  • Assessment: While the assessment process for dual diagnosis is similar to a standard assessment, more time is spent on screening for mental health issues. Additional assessments may be needed to determine the extent of the mental health issues.
  • Detoxification: The process of clearing out the toxins from your body is a critical first step in any rehabilitation, but especially so for dual-diagnosis patients because the effects of detoxing from the substances can be destabilizing for those with mental health issues. For people with co-occurring disorders, inpatient detoxification is often the best choice since they can be carefully monitored by mental health professionals, 24 hours a day.
  • Therapy: Psychotherapy is a critical part of treating a psychiatric disorder in any case and particularly in the case of a co-occurring substance abuse problem. By changing harmful behaviors and ways of thinking, therapy can lower the risk of relapse. For dual diagnosis treatment, medications may be used in conjunction with counseling to help stabilize the patient’s mental condition.
  • Aftercare: As is the case for patients just dealing with substance abuse issues, aftercare is critical to continue the recovery process for patients with co-occurring disorders. Ongoing outpatient counseling sessions, mutual support groups, and halfway houses are all examples of aftercare for dual-diagnosis patients.

If you’d like a more detailed explanation of the steps of rehab, read our guide on the rehabilitation process

Disorders Diagnosed

Mentalhealth.gov breaks down mental health problems into the following categories:

  • Anxiety Disorders: The level of stress that’s commonly associated with these disorders can severely alter the lifestyle of those afflicted. Typical examples include General Anxiety, Social Anxiety Disorder, and Post-Traumatic Stress Disorder (PTSD).
  • Behavioral Disorders: These types of problems are diagnosed after a pattern of disruptive behavior, often in children and teens, for at least six months. ADHD is a common disorder that falls in this group.
  • Eating Disorder: A type of disorder characterized by extreme and unhealthy views towards food and weight. Some examples include Anorexia Nervosa, Binge Eating Disorder, and Bulimia Nervosa.
  • Mood Disorders: These disorders involve major, and occasionally rapid, changes in mood. The most common examples include Major Depression, Bipolar Disorder, and Seasonal Affective Disorder (SAD).
  • Obsessive-Compulsive Disorder (OCD): OCD is often characterized by repeated, upsetting thoughts that lead to actions (called “compulsions”) to make those thoughts go away.
  • Personality Disorders: These disorders cause unhealthy thinking, functioning, and behavior. They include Antisocial Personality Disorder, Borderline Personality Disorder, Narcissistic Personality Disorder, Paranoid Personality Disorder, and Schizophrenia.
  • Psychotic Disorders: Hallucinations and delusions are common symptoms of psychotic disorders, such as schizophrenia.
  • Suicidal Behavior: Often caused by other mental disorders (such as depression) suicidal behavior can start with thoughts of taking your own life, and lead to multiple attempts or plans to carry out the action.
  • Trauma and Stress-Related Disorders: The most common type of disorder in this group is Post-Traumatic Stress Disorder (PTSD). PTSD is common in those who’ve served in the military and those who’ve been through other traumatic events such as rape, physical abuse, or a bad automobile accident.

Therapy Options

In both inpatient and outpatient dual diagnosis cases, the patient will work with a professional psychiatrist, psychologist, or therapist. Here are a few of the many therapy options typically employed by those in the mental health field to help address both the substance abuse and the mental illness:

  • Pharmacological Therapy: A type of therapy that uses antidepressants and other pharmaceuticals in the hopes of stabilizing moods and reducing anxiety, flashbacks, and hallucinations in the patient. Once the mental illness is stabilized, work can begin to treat the underlying issues.
  • Cognitive Behavioral Therapy: A common therapy method that helps the patient become more aware of negative thinking so they can look at challenging situations in a new way. This is most commonly used in the treatment of depression, Post-Traumatic Stress Disorder, and eating disorders.
  • Dialectic Behavioral Therapy: This type of cognitive-behavioral therapy method emphasizes the psychosocial side of therapy. The end goal in dual diagnosis cases is to reduce harmful behaviors that are associated with both mental illness and substance abuse. Specifically, it’s been found to be successful in treating people with Borderline Personality Disorder.
  • Interpersonal Psychotherapy: A time-limited therapy that hones in on interpersonal issues and conflicts, working to derive the origin of the mental issue and address it. It has been clinically proven to work on psychiatric disorders such as Bipolar Disorder, depression, and Bulimia Nervosa.

Inpatient vs. Outpatient Treatment

The right setting for each patient depends on the severity of both the mental health issue and the substance abuse addiction. Overall, moderate to severe addictions and mental health issues are best treated in an inpatient setting, and slight to moderate addictions and mental health issues may be treated in an outpatient setting.

Outpatient treatment allows patients to continue living at home

Outpatient treatment refers to when the patient receives care from a clinic or rehabilitation center but continues to live at home and carry on most of their everyday life. This treatment can range from once a week visits to an intensive daily regimen with your therapists, which would include both addiction and mental health specialists in a dual diagnosis case.

Inpatient treatment removes patients from the triggers and stress of everyday life

Inpatient treatment refers to when the patient moves into a rehabilitation or treatment center full time for the duration of the rehab process. This treatment setting reduces environmental triggers and utilizes in-house care to address both the mental health and substance abuse problems. For this reason, inpatient care is recommended for those struggling with a moderate to severe addiction, as well as most patients with co-occurring disorders.

Treatment Settings by Level of Addiction
Treatment Setting Level of Addiction
Outpatient Support Groups Low
Counseling (Regular Outpatient) Low – Moderate
Intensive Day Treatment (Intensive Outpatient) Moderate
Inpatient Short-Term Residential Inpatient Moderate
Long-Term Residential Inpatient Moderate – Severe

Integrated care is the best way to successfully rehabilitate in cases of dual diagnosis

Regardless of inpatient or outpatient care, integrated and simultaneous care for both the mental illness and the addiction is the best way to ensure a successful rehabilitation. While integrated care from multiple sources is possible in the outpatient setting, it’s much easier to manage in a residential environment. We’ll go into greater detail on choosing between inpatient or outpatient care in the section titled “Choosing the Right Care.”

Overview of Service Settings
Outpatient Intensive Outpatient Residential Inpatient Medically-Monitored Inpatient Hospital Inpatient
Moderate addictions
Severe addictions
Patients needing medical treatments
Substances with severe physical withdrawal symptoms
Substances with potential medical complications
Patients with co-occurring medical conditions
Patients with co-occurring psychological conditions
Patients with limited social support

Challenges to Overcome

Aside from the typical trials that accompany drug or alcohol rehab, dual diagnosis cases must overcome some if not all of these hurdles:

  • Increased severity: Due to the increased severity and complexity of dual diagnosis cases, treatment of the problems tends to require longer and more involved rehabilitation.
  • Limitation on medication: While pharmaceuticals can be useful in dual diagnosis rehab, some drugs that treat mental illness can share properties with potentially abusive substances. Since the patient already has a propensity towards substance addiction, the range and dosage of medications are limited.
  • More environmental triggers: With dual diagnosis, patients have to be wary of environmental triggers for both the substance abuse as well as the psychiatric issues being treated. This is one of the main reasons that inpatient care is recommended for those with co-occurring disorders.

II. Is Dual Diagnosis Rehab Right For Me?

Dual Diagnosis treatment is for individuals with a co-occurring mental health issue and a substance use disorder. The first step is determining whether or not you meet the criteria for both substance abuse and mental health problems, and then you can look at the pros and cons of dealing with the issues concurrently in dual diagnosis treatment or one at a time.

Evaluate Your Substance Abuse Problem

The first step in deciding whether you should pursue dual diagnosis treatment is to determine if you have a substance abuse problem. There are many signs that point to abuse, no matter what the substance may be. These signs include:

  • An insatiable craving for the substance
  • A decline in daily motivation and energy
  • Prioritizing substance over family, work, etc.
  • Sudden, frequent, or unusual requests for sums of money
  • Having to increase the dosage for the same effect
  • Intense withdrawal when abstaining from use
  • Endangering self and others when using and/or obtaining the substance

Evaluate Your Mental Health Issues

Your next step should be to have a professional examine your mental health problems to determine if they are separate, diagnosable mental health disorders, or if they are symptoms of your substance abuse.

Many mental health issues share common symptoms

Common symptoms that are typically associated with mental illness include:

  • Lack of energy and motivation
  • Increased apathy
  • Large mood swings
  • Change in eating and sleeping habits
  • Feeling of hopelessness, irrational fear, suicidal thoughts
  • Withdrawing from loved ones
  • Trouble keeping a steady position at work

Dual diagnosis cases can involve any mental illness

While any mental illness can be a problem when paired with substance abuse, a few of the most common and problematic illnesses and disorders include:

  • Depression
  • Post-Traumatic Stress Disorder
  • Schizophrenia
  • Attention-Deficit Hyperactivity Disorder (ADHD)
  • Bipolar Disorder
  • Antisocial Personality Disorder (APD)
  • Anxiety Disorders
  • Eating Disorders

Secure a Professional Assessment

If you or a loved display any of the symptoms above, it’s wise to get a professional assessment, which is the first step in any rehabilitation. The ASAM Criteria are used to perform an evaluation that determines the severity of the addiction, the substances involved, the mental and physical health of the patient, and any other circumstances surrounding the addiction. The assessment will find signs of mental illness that can lead to a more thorough psychiatric evaluation from a professional, if not an immediate diagnosis. The assessment will also determine how the substance abuse and mental illness are interacting, and if dual diagnosis treatment is warranted. In the simplest terms, an assessment allows health professionals to determine whether or not the individual meets these criteria:

  • A history or evidence of substance abuse
  • Signs of a psychiatric disorder
  • Is a threat or danger to either themselves or others around them
  • Has a present support system in the event of rehab
  • Is willing to undergo rehabilitation

For a more thorough guide to rehab assessment, read over the “Your Level of Addiction” section in our guide to choosing the right rehab.

Consider the Benefits and Drawbacks of Dual Diagnosis Treatment

Dual diagnosis treatment is almost always the best choice for anyone with diagnosed mental health problems and substance abuse issues, but there are some drawbacks to consider.

Benefits of Dual Diagnosis Treatment

  • More Successful Outcomes: Patients who just address substance abuse issues without addressing mental health problems may become frustrated with their progress and dropout.
  • Lower Chance of Relapse: Those who complete traditional rehabilitation without addressing mental health concerns may be more likely to return self-medication via substance abuse than those who’ve had both issues treated.

Drawbacks of Dual Diagnosis Treatment

  • Cost: The cost associated with dual-diagnosis treatment tends to be greater since the treatment programs are more intensive. Additional time in rehab may be necessary to treat both problems, which also drives up the cost.
  • Time Commitment: Those who opt for outpatient commitment will have to dedicate more time to recovery if they are receiving treatment for both mental health and substance abuse issues. Additionally, the duration of dual diagnosis programs is often longer than those only treating substance abuse.
  • Limited Selection: Not all rehab facilities accept and treat patients with co-occurring disorders, so it may be harder for patients to find a quality treatment center that fits their needs.

III. Choosing the Right Care

Choosing between inpatient and outpatient care is a critical step in finding the rehab facility that will be the best for your needs. Typically in general rehabilitation, people with slight to moderate addictions that don’t inhibit daily life can benefit from outpatient treatment. For more severe cases, an inpatient environment provides the safest and most effective path to rehabilitation.

Mental illness complicates the decision, however. Because of the increased potential for relapse due to environmental triggers during the delicate beginning stages of treatment, those dealing with co-occurring disorders of any severity should consider beginning with residential style rehab, before graduating to an outpatient system with regular visits to support groups and therapy.

Since the severity and type of addiction needs to be considered alongside the severity and type of mental health problems, a professional assessment is vital in determining which service setting is best and in developing a treatment plan.

What to Consider when Choosing a Facility

Choosing a facility will greatly depend on the needs of your situation. For instance, some facilities may have psychiatric staff who specialize in behavioral disorders, but not anxiety disorders. Ultimately, the ideal rehab facility will have a staff that covers both your substance abuse and mental health needs. You’ll also want to choose a facility that fits within your insurance coverage or what you can afford on your own, which we’ll discuss below.

For more information on choosing a rehab facility, read our guide Choosing the Right Rehab

How Much Does it Cost?

The cost of dual diagnosis treatment varies from person to person and greatly depends on the type of coverage your insurance provides. If you are insured, speaking to your insurance provider is a good place to start. Most insurance policies are required to provide some type of coverage for diagnosed mental health and substance abuse issues, but not every type of treatment is covered.

If your insurance company doesn’t provide the right coverage, or you don’t have insurance at all, many rehab facilities offer flexible payment arrangements for rehabilitation. “Low-Cost Rehabs” are facilities jointly subsidized by both the state and federal government and can provide a lot of help in paying for rehab in the form of no-interest payments, sliding scale fees, income-based fees, and scholarships.

For more on the cost of rehab, read our guide called “How much does rehab cost?

Finding a Facility

To get started in your search, you can use our directory to find rehab facilities in your area that meet your needs by using the filters to identify dual diagnosis treatment centers. Once you’ve identified a few likely candidates, it’s wise to conduct further research by visiting their website and speaking with representatives over the phone.

Click your state from the list below, then input your zip code to find rehabs near you

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IV. Aftercare and Staying Clean

Aftercare is every bit as important as detoxing and rehab, and so it should be approached with a plan. Support groups, trusted loved ones, and any other positive support are critical in any substance abuse case, but are paramount when also dealing with mental illness. A few of the aftercare options include:

  • Group therapy, 12-step programs, other sobriety programs
  • Regular visits with a psychiatric specialist
  • Overnight or weekend stays at your rehab center
  • Scheduled drug testing
  • Regular and frequent individual therapy sessions

Sober living homes provide a sober environment to foster re-entry into society

If the struggles and environmental triggers of the everyday world are too much, transferring to a sober-living facility is an excellent option for a slower adjustment back to society. Residents at these facilities can still work an outside job and have some freedom, but they have a completely sober home to return to with regularly scheduled therapy and other transitional assistance.

For more information on sober-living facilities, read our guide on the subject.

Support groups are a cheap, effective way to stay accountable and continue your journey towards recovery

One of the most common forms of aftercare is a support group. Many people are familiar with Alcoholics or Narcotics Anonymous, a 12-step faith-based support group. However, many other options also exist. Support groups are an excellent way to stay accountable to your abstinence goals and continue your recovery process. Regularly attending support groups can also benefit by providing a support system for those with a lack of positive relationships from which to draw encouragement.

Click your state listed below to find AA and NA meetings near you

To find Narcotics Anonymous meetings near you, click on your state from the list below. From there you will be able to find the local organization that coordinates the meetings. They will be able to provide the most up-to-date information about the time and location of meetings, as well as the contact information for group leaders.

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V. Take Action

Dual diagnosis treatments are completely unique to your individual situation. Here’s a recap of what you need to know about choosing dual diagnosis treatment:

  • Dual diagnosis treatment is more complicated than other rehabs
  • Diagnosed disorders and substance dependencies will affect the type of care needed
  • Not all psychiatric orders are treated the same
  • Dual diagnosis rehabilitation is typically longer than standard rehab
  • The most successful scenario is an involved inpatient treatment program, graduating to an outpatient program with support

If you or a loved one is struggling with co-occurring disorders, finding the treatment for both of the issues is paramount. The best place to start is to schedule a professional assessment and use our database to find a rehab that offers dual diagnosis treatment.