Dual Diagnosis Rehab: Treating Addiction and Mental Health

A dual diagnosis means a person has both a mental health condition and a substance use disorder. Though far from rare, these cases can be more challenging to treat. Addressing both conditions tends to produce better outcomes for the patient, however.

When a person has a dual diagnosis, that means they have both a mental disorder and a substance use disorder. Also referred to as co-occurring disorders, they’re far from rare, and outcomes tend to be better if they are treated together.

Dual Diagnosis Defined

A substance use disorder is when a person continues to use alcohol and/or drugs despite the resulting negative effects to their health, their work, their home, or social life. 

Mental disorders affect the way a person thinks, their moods, and how they behave. They can vary from mild to severe and include anxiety, depression, post-traumatic stress disorder, schizophrenia, and more.

Addiction is viewed as a mental illness because of how it affects the brain. Drug or alcohol use changes the parts of the brain that oversee impulse control, decision-making, and rewards. 

Around half the people with a mental disorder will also have a SUD at some point in their lives. The opposite is true, too. 

Often one disorder can make the other worse or more intense. One may also generate the other. For example, a person abusing drugs for some time may develop bipolar disorder as a result. Or a person with bipolar disorder may use drugs to cope with the symptoms the mental illness produces.

7.7
Million Americans

have a co-occurring mental health disorder and substance abuse disorder

52.5%
of Dual Diagnosis Individuals

never receive mental health care nor substance use treatment

23.8%
of Dual Diagnosis Individuals

said they did not know where to go for treatment.

Risk Factors

There are some overlaps among co-occurring disorders. It’s not quite clear why mental and substance use disorders sometimes co-occur, but researchers suggest three potential links:

  • Shared risk factors: Stress, genetics, trauma, or environment often can be found at the root of both disorders. Genetics can make a person more prone to mental illness, but genes can also determine how a person reacts to a certain drug. Trauma or stress, either passed from one generation to another or events personally experienced by an individual, can contribute to SUDs or mental illness.
  • Mental disorders. These can increase the likelihood of SUDs. A person with a mental illness may resort to drugs or drinking to get some temporary relief — commonly referred to as self-medicating. Mental disorders also alter the brain, making a person more vulnerable to addiction.
  • Substance use and addiction. These can factor into the onset of mental disorders. Drug and alcohol use, especially over time, can change the way the brain is wired, affecting impulse control, pleasure receptors, and decision-making. It also can raise the odds of developing mental illness.

Younger people also tend to be more vulnerable for a number of reasons. Many individuals first experiment with drugs or try alcohol during adolescence. Using at a younger age has been linked to the later development of SUDs. (It’s not a foregone conclusion, however.) Those years leading into young adulthood are also when mental illness symptoms often begin to manifest. 

Common Mental Disorders Linked with Addiction

Around half of the people who have a mental illness also develop SUDs. The reverse is true, too. People can have more than one mental disorder along with an addiction to drugs or alcohol. It’s not just one or the other, or one and the other.

Mental disorders that have high comorbidity along with SUDs include:

  • Generalized anxiety disorders
  • Panic disorders
  • Post-traumatic stress disorder
  • Depression
  • Bipolar disorder
  • Schizophrenia
  • Attention-deficit hyperactivity disorder
  • Psychotic illness
  • Borderline personality disorder
  • Antisocial personality disorder

Serious mental illnesses like major depression, schizophrenia, or bipolar disorder — when they cause considerable impairment — tend to overlap more with SUDs. An estimated one in four people with serious mental illness also have substance use disorders. Because young brains continue to develop into one’s early to mid-twenties, particularly the areas governing impulse control, rewards, and decision making, they’re at higher risk.

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Dual Diagnosis Symptoms

The lingering stigma surrounding drug use and mental illness can make it harder for some people to open up about their struggles. 

Also, because some symptoms overlap it can be difficult to diagnose. 

Genes are thought to contribute to half of a person’s likelihood of developing a SUD. As a result, a person with a psychiatric disorder should be screened for substance abuse, and vice versa. It can still be challenging to diagnose both conditions, but frequently patients with co-occurring disorders tend to have more severe and lingering symptoms. They also tend to be more resistant to treatment. 

Polysubstance use is a factor in some co-morbid cases, too.  More than a third of people with a heroin use disorder also have prescription opioid use disorder, for example.

Dual Diagnosis Treatments

Treating both conditions is the best approach for treating dual diagnosis patients. Alcohol or drug abuse must be stopped. Behavioral therapies and medications may be prescribed to manage the mental disorder as well as the SUD. Frequently used behavioral therapies include:

  • Cognitive-behavioral therapy (CBT). This can help shift harmful thinking and behaviors.
  • Dialectical behavioral therapy (DBT). This focuses on reducing self-harming behaviors.
  • Therapeutic communities (TC). These are long-term living situations that prepare the patient for re-entering society.
  • Contingency management (CT). Rewards are given for healthy behaviors, such as passing a drug test or attending therapy regularly.

Exposure therapy may help with some anxiety disorders, especially trauma or phobias. 

Integrated group therapy often includes CBT and medication, and can help the patient better understand the links between mental illness and substance use disorders.

Support groups and family therapy can also provide help. Peers can offer emotional and social connections as well as share tips and advice. 

What to Expect at Dual Diagnosis Rehab

There is no one-size-fits-all approach to recovery, but when a patient checks into an inpatient facility they can expect the following:

  • Intake and evaluation. The patient’s history will be collected, and they will be examined for pressing medical issues and underlying co-occurring conditions. That knowledge will help shape the treatment plan.
  • Detox. This is the first major step of rehab. Here the patient will have around-the-clock medical oversight as their body rids itself of toxins. Depending on the substance in question, medications may be prescribed to make the process more comfortable safe. (This is highly important since withdrawal can be painful and sometimes dangerous if a person goes cold turkey.)
  • Inpatient addiction treatment. The patient may begin CBT to help them learn new coping strategies and develop healthier attitudes and reactions to stress and triggers. Other mental health therapies — both group and individual — may be used as well.

Aftercare. This begins during the stay, and the staff helps the patient craft a plan for long-term sobriety. They’ll learn better ways to cope, healthier alternatives, have contacts and schedules for outpatient treatment, counseling, and/or support groups closer to their home. In cases of dual diagnosis that may include regular appointments with a mental health professional to ensure the treatment is helping.

Medical disclaimer:

Lincoln Recovery strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.

Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.

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