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.
The steps of rehabilitation for dual diagnosis are similar to the typical rehab process:
If you’d like a more detailed explanation of the steps of rehab, read our guide on the rehabilitation process
Mentalhealth.gov breaks down mental health problems into the following categories:
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:
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 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 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.
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.”
|Outpatient||Intensive Outpatient||Residential Inpatient||Medically-Monitored Inpatient||Hospital Inpatient|
|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||✕||✕||✓||✓||✓|
Aside from the typical trials that accompany drug or alcohol rehab, dual diagnosis cases must overcome some if not all of these hurdles:
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.
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:
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.
Common symptoms that are typically associated with mental illness include:
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:
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:
For a more thorough guide to rehab assessment, read over the “Your Level of Addiction” section in our guide to choosing the right rehab.
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.
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.
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”
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?”
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.
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:
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.
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.
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.
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:
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.