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Dual Diagnosis (Co-occurring)

Dual Diagnosis (Co-occurring)

Dual Diagnosis treatment is a relatively new innovation in the field of addiction recovery. Until the 1990s, people who were experiencing symptoms of a mental health disorder — anxiety attacks, depressive episodes, delusional behavior or mood swings — were treated separately from those who sought help for drug or alcohol abuse. When these conditions overlapped, clients were often denied treatment for a mental illness until they got clean and sober. Unfortunately, because substance abuse is often driven by an underlying psychiatric disorder, this meant that many people with a Dual Diagnosis of addiction and a mental disorder never got the help they needed.

What’s Different About Dual Diagnosis Treatment?

In the 21st century, Dual Diagnosis recovery blends the most successful aspects of mental health care and substance abuse treatment.

Instead of drawing a hard line between psychiatric health and addiction, these areas are treated as part of a continuum. Clinicians who work in addiction treatment can now receive training and credentials in the treatment of co-occurring mental health disorders. Dedicated rehab facilities offer recovery services that are personalized for clients with a Dual Diagnosis.

The Office of Applied Studies, a division of the U.S. Department of Health and Human Services, reports that in 2002, only 12 percent of the 4 million American adults who suffered from a Dual Diagnosis received treatment for both conditions.

If you meet the diagnostic criteria for a mental health disorder (depression, bipolar disorder, anxiety disorders, schizophrenia, a personality disorder, etc.) and for an addictive disorder (alcoholism, drug addiction, gambling addiction, sex addiction or another behavioral addiction), you may be classified as a Dual Diagnosis client when you enter treatment. Effective treatment for a Dual Diagnosis involves considering both your addiction and your mental illness as you go through the recovery process.

To increase your chances of achieving a full recovery, your care should include:

  • Parallel treatment of your mental health and substance use disorders by the members of a highly trained treatment team
  • Acknowledgement of the importance of psychotherapeutic medications, such as antidepressants or anti-anxiety meds, in the treatment of co-occurring disorders
  • A supportive approach to therapy that reinforces self-esteem and builds self-confidence instead of confronting the client with negative, aggressive statements
  • An inclusive treatment strategy that brings partners, spouses, children and other household members into therapy for individual counseling, group meetings or education

“Sequential treatment” was the norm before the 1990s, when clinicians believed that there should be a division between mental health treatment and addiction rehabilitation, note the authors of the text Integrated Treatment for Dual Disorders: A Guide to Effective Practice. In the sequential approach, clients with a Dual Diagnosis were excluded from one area of treatment until they were considered stable in the other. For instance, a depressed person with active alcoholism might not be able to receive therapy for depression until she had been through detox and rehab. Sequential treatment became less popular as research showed that it led to a higher rate of relapse.

Getting a Dual Diagnosis

To receive a Dual Diagnosis, you must meet the criteria for a mental health disorder as defined by the current version of The Diagnostic and Statistical Manual of Mental Disorders. Published by the American Psychiatric Association, the DSM is a guideline for mental health professionals who are diagnosing and treating patients in a variety of clinical settings.

A qualified psychiatrist, physician, psychologist, counselor or therapist can give you a Dual Diagnosis if you have a mental health disorder and an addiction to drugs, alcohol, or a behavior like sex or gambling. Getting a Dual Diagnosis may come as a huge relief if you’ve lived with an undiagnosed mental illness for a long time. If you’ve put up with severe mood swings, episodes of hopelessness and sadness, suicidal thoughts, hallucinations or flashbacks to traumatic events for years, putting a name to your condition may give you a sense of hope. After all, if your condition can be named, it can be treated.

Signs and Symptoms

To get an official Dual Diagnosis, you must be evaluated by a mental health professional or addiction specialist. But you don’t have to be a psychologist or a primary care doctor to know that something’s not right with you or someone you care about.

  • These red flags may indicate that someone in your life has a problem with addiction:
    • Abandoning friends or family in favor of new activities or a new crowd
    • Struggling to keep up with school or work
    • Lying or stealing in order to continue an addictive behavior
    • Staying up late at night and sleeping during the day
    • Trying to quit using drugs, drinking, gambling or having unsafe sex, but relapsing repeatedly
    • Expressing feelings of guilt or regret about a compulsive behavior
    • Seeking out larger doses of drugs, more alcoholic beverages or more extreme high-risk behavior in order to get the same high
    • Experiencing withdrawal symptoms after trying to quit a harmful substance or cutting down the dose
  • The symptoms of mental illness vary greatly, but you might suspect that a loved one has a psychiatric disorder if he or she:
    • Deliberately withdraws from others, refusing offers of friendship or support
    • Believes things that aren’t true (delusions) or has sensory experiences that aren’t shared by others (hallucinations)
    • Expresses feelings of despair, hopelessness or worthlessness for two or more weeks in a row
    • Feels compelled to follow complicated rituals and maintain high standards of order in order to relieve internal anxiety
    • Has trouble holding a job, keeping an apartment or maintaining friendships because of behavioral issues or mood swings
    • Has dramatic changes in mood and energy levels
    • Uses drugs, alcohol or compulsive behaviors to manage moods or cope with stress

The only way to know for certain if a Dual Diagnosis exists is to consult an addiction treatment specialist with a background in psychiatric care. At Dual Diagnosis rehabilitation facilities, intake counselors and evaluation specialists will review your psychiatric history and evaluate your substance use patterns before helping you develop an individualized treatment plan. Reaching out for help may be the hardest part of getting the support you need to begin the recovery process.

Treatment Options

There is no single treatment option that works for everyone with a Dual Diagnosis. The range of mental health disorders is broad, and the relationship between your psychiatric condition and your substance abuse is complicated. People who seek treatment for addiction and mental illness may be diagnosed with:

  • A mood disorder, such as major depression or bipolar disorder
  • An anxiety disorder, such as generalized anxiety, post-traumatic stress disorder or obsessive-compulsive disorder
  • A personality disorder, such as borderline personality disorder or antisocial disorder
  • An eating disorder, such as bulimia, binge eating disorder or anorexia

More Treatments +

In order to be effective, your recovery plan must address your specific disorder as well as your personal history of addictive behavior. The level of care you need will be based on the extent of your substance abuse and the severity of your psychiatric condition. Clients who have recently been using drugs or alcohol heavily or who have had severe signs of mental illness, such as psychotic episodes or suicidal thoughts, may benefit from a residential treatment program that provides intensive, round-the-clock monitoring and care.


Clients who are physically and mentally stable may be referred to an outpatient treatment program, where they can continue to live at home, go to work and take care of family members while they go through rehab. In order to reap the benefits of outpatient care, you must be strongly dedicated to your recovery. Without constant supervision, it’s easier to backslide in your treatment program.


Outpatient therapy requires a high level of motivation in order to reap the benefits of minimally supervised care.Pharmacological therapy is a key component of treatment when it comes to Dual Diagnosis rehabilitation. Medications are often prescribed to stabilize moods, reduce anxiety and agitation, prevent flashbacks to traumatic events or prevent hallucinations. Although psychiatric medication was once discouraged in substance abuse treatment programs, Dual Diagnosis care providers understand the importance of continuing pharmacotherapy throughout drug or alcohol rehab.Educating spouses, partners, children and siblings about addiction and mental health is another important part of your recovery.


The more informed your loved ones are about the nature of your condition, the more likely they are to support you in your recovery journey. Family counseling, 12-step meetings and peer support groups are available for friends and loved ones who want to help you meet your recovery goals.

Understanding the Need for Treatment

Denial is a common behavior in people who have a Dual Diagnosis. When your thoughts and perceptions are altered by mental illness, it’s easy to neglect your own care. Depression can make you feel that your life isn’t worth saving, while anxiety may drive you away from contact with others. The symptoms of mental illness can be so disturbing that alcohol or drug abuse may seem like the only way to cope.

Getting your life back on track requires help, hope and trust. We understand how difficult it is to extend your trust to others, but relying on the members of your treatment team will make rehabilitation easier and more rewarding.

Dualdiagnosis.org (na).Dual Diagnosis TreatmentRetrieved February 22, 2018, from https://www.dualdiagnosis.org/dual-diagnosis-treatment/

 

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Mental Health Stats

  • Approximately 1 in 5 adults in the U.S.—43.8 million, or 18.5%—experiences mental illness in a given year.
  • 1.1% of adults in the U.S. live with schizophrenia.
  • 2.6% of adults in the U.S. live with bipolar disorder.
  • 6.9% of adults in the U.S.—16 million—had at least one major depressive episode in the past year.
  • 18.1% of adults in the U.S. experienced an anxiety disorder such as posttraumatic stress disorder, obsessive-compulsive disorder and specific phobias.
  • Among the 20.2 million adults in the U.S. who experienced a substance use disorder, 50.5%—10.2 million adults—had a co-occurring mental illness.
  • More than 90% of children who die by suicide have a mental health condition.
  • Each day an estimated 18-22 veterans die by suicide.
  • Only 41% of adults in the U.S. with a mental health condition received mental health services in the past year.
  • Just over half (50.6%) of children aged 8-15 received mental health services in the previous year.

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