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Finding the Best Dual Diagnosis Recovery Programs

Treating Mental Health and Substance Disorders

People suffering from a mental health issue will often use drugs or alcohol to deal with the symptoms of their condition. On the flip side, people who have been abusing substances for a long period of time will often develop symptoms of a mental health disorder.

This condition in which someone has an alcohol or drug addiction as well as a mental health disorder is known as “dual diagnosis,” and it requires a special kind of treatment. Read on to find out more information about dual diagnosis and how it’s treated.

What Is Dual Diagnosis?

Dual diagnosis is also commonly referred to as co-occurring disorders or comorbidity. All of these terms can be used to describe situations where someone suffers from a drug or alcohol addiction as well as a behavioral or mental health disorder.

Dual diagnosis is quite common. In fact, estimates from community samples have suggested that nearly 4 million Americans over the age of 18 suffer from a serious mental health condition along with comorbid drug or alcohol dependency. Studies have also consistently shown that being diagnosed with either a substance abuse disorder or a psychiatric condition places an individual at a greater risk for developing problems with the other.1-3

Very few individuals with dual diagnosis actually seek treatment, however. It has been estimated that only 16% of individuals suffering from both a mental health condition and drug or alcohol dependence seek help.5

Rates of dual diagnosis are even higher among clinical samples. More specifically, estimates suggest that between 36% and 40% of adults seeking treatment for a serious mental health condition also suffer from alcohol or drug dependence.4

Mental Health Conditions Commonly Found With Substance Abuse

It is not uncommon for people to seek out substances, such as alcohol, in order to cope with life stressors such as a mental health disorder.

In many cases, the use of substances can allow the individual to escape from their problems and feel a sense of relaxation.

However, this is only temporary. As the individual continues to use substances as a way to cope, they do not learn important coping skills or address the underlying problem causing their symptoms.

Watch the story of Antonio, who used drugs to cope with undiagnosed bipolar disorder.

Credit: The New York Times

Symptoms of Mental Health Disorders

Some common symptoms of mental health conditions include:

  • Feelings of hopelessness or helplessness.
  • Loss of interest in daily activities.
  • Changes in appetite or weight.
  • Changes in sleep habits.
  • Increases in irritability or anger.
  • Loss of energy.
  • Excessive feelings of worthlessness or guilt.
  • Feelings of fear, worry, nervousness, panic or uneasiness.
  • Difficulty relaxing or sitting still.
  • Racing thoughts or the feeling like you cannot control your worries.
  • Difficulty concentrating.
  • Reckless behavior.
  • Thoughts of suicide.

How Is It Treated?

In most cases, treatment programs need to address both the individual’s substance abuse difficulties and symptoms of behavior or mental health disorders through an integrated treatment approach. Sometimes the symptoms of one disorder are so severe that the individual requires a higher level

of care, which prevents the treatment of the other condition. This is generally the case for people who require inpatient hospitalization or residential care. These facilities are more restrictive and provide people with around-the-clock supervision from a specialized, multidisciplinary team.

What’s the Difference Between a Dual Diagnosis Program and Regular Rehab?

Dual diagnosis programs are very similar to regular rehabs. The main difference is that centers that offer dual diagnosis treatment will treat both the addiction and the mental health disorder concurrently. They will screen for both conditions at intake and develop a comprehensive treatment plan to address them.

These programs are set up to deal with mental health and substance abuse disorders. They have staff trained to manage symptoms of both conditions and have experience helping people work through and manage them. They know which medications can be used together and which therapies work best with which disorders.


Detoxification is an important first step to successful treatment for substance abuse and addiction. During this process, specialists assist the person with detoxification by treating the immediate physiological effects of stopping substance use and removing toxins from the body. Some programs offer medically supervised detoxification that safely and systematically withdraws the person from the substance or substances with medication.

Before you begin treatment at a dual diagnosis program, ask whether it offers specialized detoxification assistance as part of the treatment plan.

Behavioral Therapy

Either used alone or with medication, behavioral therapies can be one of the most effective methods for ensuring a positive outcome for individuals suffering from dual diagnosis. In many instances, people with co-occurring disorders may prefer behavioral therapy because they may be uncomfortable taking medication given their history of substance abuse.

There are several types of behavioral therapies available.

Dialectical Behavior Therapy

The goal of dialectical behavior therapy is to reduce self-harming behaviors. For example, this approach might focus on drug abuse and suicidal thoughts or urges from depression.

Integrated Group Therapy

Integrated group therapy is designed for individuals with bipolar disorder and substance abuse problems. It uses a group setting to target the symptoms of both disorders simultaneously.

Cognitive Behavioral Therapy

The goal of cognitive behavioral therapy is to change an individual’s faulty beliefs and unhelpful behaviors. CBT has received empirical support for treating substance abuse.

Individual Psychotherapy

Psychotherapy addresses both addictive behaviors as well as behavioral or mental health condition. It is important to make sure that your therapist is appropriately licensed and trained.

Other approaches to treating dual diagnosis have begun to emerge. While these programs have not received much research, they may be beneficial for some patients. These programs include art therapy, equine therapy, yoga, and acupuncture.

Medication Therapy

In some cases, medication may be necessary to treat co-occurring substance abuse and psychiatric conditions.

LithiumLithium (whose brand names include: Eskalith, Lithobid), for instance, is a medication commonly prescribed as a mood stabilizer for individuals suffering from symptoms of bipolar disorder. This medication has also received some limited support for its use in treating co-occurring alcohol and cannabis use.
Anti-ConvulsantsSimilarly, anti-convulsants, which are another class of medications prescribed for their mood-stabilizing effects, have received some support for their beneficial effects in treating co-occurring symptoms of substance abuse.
Selective Serotonin Reuptake InhibitorsSelective serotonin reuptake inhibitors (SSRIs) have received support for their role in treating dually diagnosed anxiety and alcohol abuse. For instance, both paroxetine (brand name: Paxil) and sertraline (brand name: Zoloft) have been explored among samples of individuals who diagnosed with alcohol abuse and anxiety.5
BuspironeAdditionally, buspirone (brand name: BuSpar), an anti-anxiety medication, may be used to treat both alcohol abuse and symptoms of anxiety6 and the anti-convulsant medication topiramate (brand name: Topamax) has demonstrated potentially positive results in treating individuals with cocaine dependence and symptoms of anxiety.7

How Much Does Treatment Cost?

The cost of dual diagnosis treatment can vary widely from program to program, and individual insurance plans will differ in terms of available coverage.

How Effective Is Dual Diagnosis Treatment?

Dual diagnosis is more challenging to treat than substance abuse alone. In the past, many facilities were ill-equipped to treat it.

Fortunately, though, an increasing number of alcohol and drug treatment programs have been designed or modified to address dual diagnosis. With the care and attention of psychiatric clinical staff, they are now able to offer specialized treatment designs that best address the intricacies of both substance abuse and co-occurring behavioral or mental health conditions.

How Do I Find a Facility?

If you believe you or a loved one might have a mental health disorder and an addiction, search our online directory for dual diagnosis programs in your area.

[1]. Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62(6):593-602.

[2]. Grant BF, Stinson FS, Dawson DA, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders. Arch Gen Psychiatry 2004; 61:807-816.

[3]. Robins LN, Locke BZ, Regier DA. An overview of psychiatric disorders in America. In: Robins LN, Regier DA, editors. Psychiatric disorders in America: the Epidemiologic Catchment Area study. New York: Free Press; 1991. pp. 328-366.

[4]. Regier DA, Farmer ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) Study. JAMA. 1990;264(19):2511-2518.

[5]. Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 2007;64(7):830-842.

[6]. Kranzler HR, Burleson JA, Del Boca FK, et al. Buspirone treatment of anxious alcoholics. A placebo-controlled trial. Arch Gen Psychiatry 1994;51(9):720-731.

[7]. Johnson BA, Ait-Daoud N, Bowden CL, et al. Oral topiramate for treatment of alcohol dependence: a randomised controlled trial. Lancet 2003;361(9370):1677-1685.