Dual Diagnosis
Signs | Symptoms | Treatments

Table of Contents

  1. Overview of Dual Diagnosis
  2. Common Mental Health Disorders
  3. Signs and Symptoms
  4. Treatments
  5. Detoxification
  6. Medication
  7. Psychotherapy
  8. Group Therapy
  9. Inpatient Rehab
  10. Outpatient Rehab
  11. Self-Help Groups
  12. Resources

What is a Dual Diagnosis/Co-Occurring Disorder?

“Dual diagnosis” refers to someone who has both a substance use disorder (alcohol or drug-related) and a mental health disorder at the same time. For instance, an individual with alcohol use disorder and major depressive disorder at the same time has a dual diagnosis. Having a dual diagnosis may also be referred to as having “co-occurring disorders,” or “comorbid disorders.” It is common for people with a substance use disorder to also have a co-occurring mental disorder, and vice versa. Having a dual diagnosis can make diagnosis and treatment more difficult. Many symptoms of substance use disorders and mental disorders overlap, and one disorder can worsen the symptoms of the other. Additionally, both disorders must be effectively treated, otherwise one’s recovery may be jeopardized.

Common Mental Health Disorders and Addiction

Substance use disorders can co-occur with any type of mental health disorder. Research indicates that mental disorders typically onset before substance use disorders do. Common mental health disorders that co-occur with substance use disorders are listed and described below:

Attention-Deficit/Hyperactivity Disorder (ADHD)

ADHD begins in childhood and can continue into adulthood. It is characterized by inattentiveness and/or hyperactivity and impulsivity. Symptoms of inattention include difficulty with paying attention and staying focused, making careless mistakes, difficulty with following instructions or finishing work, being easily distracted, and often losing items or forgetting to do things. Symptoms of hyperactivity and impulsivity include difficulty sitting still and staying seated, difficulty engaging in activities quietly, acting as if “driven by a motor,” talking excessively, blurting out answers, and interrupting others. An individual with ADHD may have predominantly inattentive symptoms, predominantly hyperactive/impulsive symptoms, or a combination of both. People with ADHD typically also experience irritability, mood swings, and a low frustration tolerance. According to the National Comorbidity Survey Replication, 15.2% of people with ADHD also met criteria for a substance use disorder. 3

Antisocial Personality Disorder

People with antisocial personality disorder have a behavioral pattern of disregarding and violating the rights of other people. They exploit, manipulate, and deceive others, without any remorse. Additionally, they often break the law, lack empathy, and behave violently, impulsively, and irresponsibly. They lack regard for the safety of themselves and of others. In order to be diagnosed with antisocial personality disorder, the individual must have shown a similar behavioral pattern of violating major norms, rules, or the rights of others before the age of 15. Antisocial personality disorder is most prevalent among males with substance use disorders and males who are in prisons.

Bipolar Disorder

Bipolar disorder is characterized by experiencing extremely high and low moods. More specifically, people with bipolar disorder experience episodes of mania and depression. Manic episodes consist of an extreme elevation in one’s mood, energy, and activity levels. During a manic episode, people typically experience feelings of euphoria, an inflated self-esteem, are extremely talkative, have a flight of ideas, and have a decreased need for sleep. They often feel restless and excessively driven to engage in multiple projects or activities, including ones that can lead to harmful consequences, such as spending sprees or sexual promiscuity. During depressive episodes, people typically feel intense sadness, lack of interest in previously enjoyed activities, loss of energy, feelings of hopelessness or worthlessness, and thoughts of death. People with bipolar disorder are about seven times as likely as others to have a co-occurring substance use disorder. In terms of lifetime prevalence, about 56% of people with bipolar disorder have a co-occurring substance use disorder. 4

Borderline Personality Disorder

People with borderline personality disorder demonstrate a pattern of unstable relationships, sudden mood swings, and issues with self-image. They also have intense fear of abandonment, which leads them to have extreme difficulties with being alone. In their interpersonal relationships, they may alternate between idealizing others and then suddenly devaluing them. Additionally, they often experience rapid and extreme changes in their mood, and have difficulty controlling their anger. Moreover, as their sense of self is unstable, they may rapidly and repeatedly change their self-image, goals, opinions, wants, and needs. People with borderline personality disorder typically engage in impulsive behaviors that lead to self-destructive consequences. For instance, they may abuse substances, drive recklessly, or have unsafe sex. They may also engage in self-mutilation or suicidal behavior. About 50% of people with borderline personality disorder have a co-occurring substance use disorder, which is most commonly alcohol use disorder.5

Eating Disorders

About 50% of people with eating disorders also abuse alcohol or drugs 6 . Two types of eating disorders that are commonly associated with substance use disorders are anorexia nervosa and bulimia nervosa. People with anorexia nervosa have an unrealistic body image and an intense fear of gaining weight. They severely restrict their food intake, despite being significantly underweight. People with bulimia nervosa engage in periods of binge eating, in which they consume excessively large amounts of food and feel like they have a loss of control once they start eating. In order to prevent weight gain, they engage in inappropriate purging behaviors, such as vomiting, fasting, misusing laxatives, or exercising excessively. In both anorexia nervosa and bulimia nervosa, people may abuse substances, such as stimulants, as a way to suppress their appetite. However, overall, research suggests that there is a stronger connection between bulimia nervosa (rather than anorexia nervosa) and drug and alcohol abuse.

Generalized Anxiety Disorder

People with generalized anxiety disorder (GAD) experience persistent, excessive anxiety and constantly worry about numerous different things. Their constant worrying and nervousness interferes with their daily functioning and their ability to concentrate and relax. GAD is highly linked to co-occurring substance use disorders. It is likely that individuals with GAD self-medicate with substances to relieve anxiety symptoms. One study found that in comparison to individuals with GAD alone, those with GAD and a co-occurring substance use disorder are more likely to be male and have a family history of substance use disorders.7

Major Depressive Disorder

Major depressive disorder is characterized by persistent feelings of sadness and lack of interest or pleasure in things that were once enjoyed. People with major depressive disorder may also have decreased energy, difficulty concentrating or making decisions, feelings of worthlessness or hopelessness, and suicidal ideation. Moreover, they may experience changes in their appetite (either increased or decreased) and in their sleep (insomnia or oversleeping). People with major depressive disorder are about two times as likely as others to have a co-occurring substance use disorder. In terms of lifetime prevalence, about 16.5% of people with major depressive disorder also have co-occurring alcohol use disorder, and about 18% have a co-occurring drug use disorder.8

Obsessive-Compulsive Disorder (OCD)

People with obsessive-compulsive disorder (OCD) experience recurring unwanted, distressing thoughts (obsessions) and perform repetitive mental acts or behaviors (compulsions) in response to them. Common obsessions include germs or contamination and taboo or aggressive thoughts. Common compulsions include excessive washing, checking, or counting. OCD is time-consuming and causes significant psychological distress and impairment in one’s functioning. About 38.6% of people with OCD also have a co-occurring substance use disorder.9

Panic Disorder

Panic disorder is a type of anxiety disorder in which individuals experience repeated, unexpected panic attacks, without any apparent cause. Panic attacks are sudden surges of extreme fear, accompanied by physical symptoms of anxiety, such as pounding heart, trembling, shortness of breath, chest pain, sweating, dizziness, and choking sensations. People with panic disorder constantly worry about having more panic attacks, which can severely impair their functioning and quality of life. Panic disorder is highly associated with co-occurring substance use disorders, particularly with alcohol use disorder.10  It is possible that people with panic disorder may abuse alcohol in attempt to decrease panic attack symptoms.

Posttraumatic Stress Disorder (PTSD)

Posttraumatic stress disorder (PTSD) can develop after someone is exposed to a traumatic event. People with PTSD continuously re-experience the traumatic event, such as through bad dreams or flashbacks, and they avoid anything that reminds them of the traumatic event. Additionally, they experience negative changes in their thinking and mood that are related to the traumatic event. Moreover, they become easily aroused and reactive, wherein they may be excessively irritable, hypervigilant, startled easily, and have problems sleeping. Research has consistently demonstrated that PTSD and substance use disorders frequently co-occur. One study found that 34.4% of people with PTSD had a co-occurring substance use disorder, which was most commonly alcohol use disorder.11

Schizophrenia

Schizophrenia is a serious mental disorder that causes difficulties in perceiving reality accurately, thinking and speaking, and interacting with others. People with schizophrenia experience hallucinations (perceiving something that is not there) and/or delusions (false beliefs). Additionally, they may experience disorganized thinking and speech and exhibit abnormal behavior. They may also have negative symptoms, which include flat affect, social withdrawal, inability to feel pleasure, and lack of interest and motivation. In terms of lifetime prevalence, it is estimated that about 47 to 59 percent of people with schizophrenia have a co-occurring substance use disorder.12

00:15 good evening my name is April Puli and 00:18 I’m a PhD candidate in the msu 00:20 neuroscience program I research the 00:22 effects of traumatic stress on the brain 00:24 and I started on this path in October of 00:27 2011 when I did the most important 00:30 internet search of my life the internet 00:33 what some people think is the antithesis 00:35 of human connection actually brought me 00:37 back to humanity when I googled for 00:40 letters PTSD post-traumatic stress 00:43 disorder I was in my first semester as a 00:46 doctoral student when I did this search 00:48 and I had heard about PTSD and veterans 00:50 but I didn’t really understand what it 00:52 was or why it was such a big deal and 00:55 when I learned that it could be caused 00:58 by a variety of experiences not related 01:00 to military combat I was intrigued 01:02 things like car accidents domestic 01:04 violence and rape I thought it was a war 01:06 disorder and when I read the list of 01:09 PTSD symptoms that day I was floored 01:11 because they read like a definition of 01:14 my own life 01:15 nightmares hyper vigilance startling at 01:18 sudden noises or movements sleep 01:20 problems irritability and the most 01:22 jarring one to me intrusive recollection 01:25 or reenactment of the event in memories 01:27 daytime imagery or dreams now I’d heard 01:31 the word flashback before but I always 01:33 thought of it as someone falling to the 01:34 ground during a thunderstorm or 01:35 fireworks but this description of a 01:38 flashback really hit home intrusive 01:41 recollection of the event in daytime 01:43 imagery every single morning for the 01:46 eight years leading up to this moment I 01:49 stood in my bathroom for hours sometimes 01:52 3-4 hours going over and over the events 01:55 of the night I was raped at a fraternity 01:57 house when I was 17 years old it was 02:00 like I was staring into the mirror 02:01 watching a movie of that night in slow 02:03 motion just trying to figure out what 02:05 happened and why I would get up at 6:00 02:07 a.m. just to maybe be able to make it to 02:10 my 10:00 a.m. class because I knew that 02:12 every morning I would have to go through 02:13 watching that movie and answering this 02:16 list of questions like I was being 02:17 interrogated 02:18 why did my friends leave me there what 02:21 happened in the 16 hours I 02:22 remember why was i paralyzed when I woke 02:25 up is this just what happens when you 02:27 drink should I call the police should I 02:28 go to the hospital was I really raped 02:30 when my friends still be friends with me 02:33 if I hadn’t told them what happened 02:35 every morning for eight years I was 02:38 staring into what I just learned was a 02:41 vortex of flashbacks and now I was 02:43 staring at what would soon become my 02:45 official psychiatric diagnosis PTSD I 02:49 felt so comforted by the fact that all 02:52 of my problems could be explained by 02:53 this four letter acronym and that maybe 02:55 I wasn’t really just a crazy mess the 02:59 feeling that something horrible was 03:00 gonna happen any minute like I was 03:01 holding a live grenade that was PTSD my 03:05 jumps and screams at the phone ringing 03:07 the doorbell chiming a postman putting 03:09 letters into the mail slot my heart 03:12 pounding up into my neck for hours at a 03:13 time 03:14 waking up every 20 minutes at night to 03:16 check my surroundings that was PTSD and 03:19 up until this revelation I thought I had 03:22 just been dwelling in the past and 03:24 feeling sorry for myself because I just 03:25 couldn’t get over it 03:27 I thought I was just a worthless 03:29 alcoholic because the only way I could 03:31 get out of the bathroom in the morning 03:32 or attempt to sleep at night or to be 03:35 alone or to be with people was to drink 03:37 and I was very drunk when I did this 03:40 search for PTSD in fact it had been over 03:43 five years since I had gone a single day 03:46 without being drunk but the hope and 03:49 comfort that I felt it finally figuring 03:51 out what was wrong with me didn’t really 03:52 last long because at the end of the 03:54 search I learned that there really isn’t 03:56 a very good effective treatment for PTSD 03:59 that symptoms can persist and continue 04:01 to worsen over the course of a lifetime 04:03 and that suicide rates and PTSD patients 04:06 are among the highest of any demographic 04:09 group the only hope really seemed to be 04:11 counseling and I wasn’t about to go 04:13 around telling a bunch of strangers all 04:15 of the bad things that had happened to 04:16 me it was like I had just been given a 04:19 death sentence 04:20 so I finished the rest of the whiskey 04:22 and my bottle and I walked down the 04:23 street to the quality dairy to get 04:25 another but being the scientist that I 04:28 just happened to be I could not give up 04:30 there I had to look for my own answers 04:32 as to what PTSD really was and how maybe 04:35 could be treated I thought maybe I could 04:37 be part of some new experimental group 04:40 so I read hundreds of journal articles 04:42 examining the effects of atypical 04:44 antipsychotics benzodiazepines SSRIs and 04:47 even cancer medications on PTSD some of 04:51 which showed promise in animal studies 04:53 but more than half of PTSD patients 04:56 failed to respond to these current 04:58 standard treatments but the most 05:00 striking thing I noticed in this 05:02 research was that almost all of these 05:04 studies were only looking at human men 05:06 or male rat nobody was looking at how 05:09 these treatments work in women or if 05:10 PTSD is even the same in women and maybe 05:13 I was just looking for something 05:15 specific to women because I couldn’t 05:16 understand how what happened to me as a 05:18 teenager could be the same as what 05:20 happened to men in Vietnam as many as 05:23 one in ten women suffer with PTSD but 05:26 this seemed to be overlooked by 05:28 everybody 05:28 I certainly had never heard of it as a 05:30 rape disorder medical research is 05:34 historically notorious for predominantly 05:36 studying men some scientists say that 05:39 the difference is between men and women 05:40 really only matter with regard to 05:42 reproduction and some say that it’s 05:44 impossible to really scientifically 05:46 study women because there’s just too 05:48 much going on with their periods and all 05:50 those hormones seriously so I just kept 05:54 doing my own research reading every 05:57 article on PTSD I could find and this 05:59 went on for about a year during which 06:01 time I did end up finding a really good 06:03 therapist but even with going to therapy 06:06 two sometimes three times a week and 06:08 commitment to sobriety I was still 06:11 suicidal 06:12 I was relapsing all the time I wasn’t 06:14 sleeping I wasn’t eating long story 06:17 short I wasn’t getting much better so I 06:19 just kept thinking if only the right 06:22 research had been done research on women 06:24 research on the actual brain mechanisms 06:26 of PTSD there would be a cure for me and 06:29 I wouldn’t be failing at my recovery 06:30 right now I wanted to see more data 06:33 mechanisms of action and have a 06:34 step-by-step plan for how to get rid of 06:37 my PTSD in my alcoholism once and for 06:39 all I was a very stubborn scientist but 06:42 I’m also very impatient and science was 06:45 moving a little too slowly for me 06:47 so I finally realized that my life is 06:51 not a textbook and recovery is not an 06:54 experiment at the beginning and an end 06:55 and I acknowledged that I really had no 06:58 idea what I was doing that I finally 07:01 began to find some relief I started 07:03 working with my therapist doing 07:05 breathing exercises journaling exercises 07:08 letting myself scream at the top of my 07:10 lungs I did EMDR therapy where I 07:13 followed this little light back and 07:14 forth while I thought about traumatic 07:16 memories all of these things I 07:18 considered to be pseudoscience but my 07:20 nightmares and flashbacks actually 07:22 started to go away I began to start a 07:24 less easily but my real healing came 07:28 when I started connecting with other 07:29 people there were so many people out 07:32 there so many women who like me had been 07:34 raped or abused and had no idea that the 07:37 reason they couldn’t just get over it 07:38 was because they were suffering from 07:40 PTSD I had to tell them I thought I had 07:43 this big secret that if all these 07:45 traumatized people knew they had PTSD 07:48 they would be okay but it wasn’t sharing 07:52 my scientific knowledge of PTSD that 07:54 helped people it was sharing my story 07:57 which is exactly the opposite of what I 07:59 wanted to do I wanted to show people 08:02 diagrams of the brain and bar graphs of 08:04 stress hormones this is your no I’m 08:08 missing a slide this is your brain on 08:09 trauma but as the people I was talking 08:13 to started sharing their stories I 08:15 started sharing mine not my personal 08:18 story but not my science story but my 08:20 personal story of rape of abuse of 08:23 addiction all of the darkness within me 08:25 of which I was so ashamed but once it 08:28 was out there with everybody else’s 08:30 darkness it didn’t really seem so dark 08:32 after all and that’s when I started 08:35 getting involved in all of these things 08:37 like lobbying for women’s health care 08:38 policy I shared my story at survivor 08:42 gatherings and art shows I started 08:44 getting involved in helping victims of 08:46 sexual assault on campus I started a 08:49 blog about these issues I wrote a book I 08:51 joined activists and advocacy groups and 08:53 I’m telling you this because this is 08:55 when my shame and my guilt when 08:58 shame and guilt are two of the most 09:00 insidious forces that can take over your 09:02 life after trauma and destroy your 09:04 self-worth your ability to form 09:07 relationships with other people and even 09:09 your will to live I was so ashamed I had 09:12 gotten raped I was ashamed I didn’t call 09:14 the police I felt guilty for the years 09:16 that I wasted on drugs and alcohol and I 09:18 felt guilty for the brief moments of 09:20 emotions that I did feel because they 09:22 were filled with anger I don’t think any 09:25 amount of science will ever find a cure 09:27 or a pill for shame and guilt that 09:30 doesn’t involve sharing your story your 09:32 human experience with another human 09:34 being we need to be seen for who we are 09:37 to be heard to be accepted and to be 09:40 believed there’s a human element to 09:42 recovery that we often forget it’s not 09:45 surprising to me that the single 09:47 greatest risk factor for developing PTSD 09:49 after trauma is lack of social support 09:52 more than any contribution made by one’s 09:55 genes other biological characteristics 09:57 of an individual or aspects of the 09:59 trauma itself it’s social support that 10:02 has the largest influence on whether 10:04 someone will develop PTSD socially 10:07 supported people are allowed to talk 10:09 about what happened to them to 10:11 experience and express their emotions 10:13 without judgment or ridicule to cry and 10:16 scream and do whatever their body needs 10:18 to do to discharge all that energy with 10:21 proper social support human connection 10:23 immediately following trauma the 10:25 likelihood of recovery is exponentially 10:28 greater but even though it had been 10:30 almost 10 years since my trauma when I 10:32 found this kind of social support 10:34 I still suddenly found this piece that I 10:37 didn’t even know existed I didn’t even 10:39 know I was looking for it after nearly a 10:42 decade of alcoholism I’ve now been sober 10:44 for two years after a decade of 10:46 loneliness I’m now married to the love 10:48 of my life and after a decade of PTSD I 10:51 can now finally sleep at night so as it 10:54 turned out it wasn’t that there needed 10:56 to be more research in the field of 10:58 traumatic stress to help me I needed to 11:00 find my way back to humanity but with 11:03 that being said even though science and 11:05 medication alone will probably never 11:07 fully cure 11:08 PTSD I am still chipping away at it 11:11 because I do believe there’s value in 11:13 understanding how the world around us 11:15 and within us works maybe we can at 11:17 least make a find a way to make this 11:19 journey a little less painful when I was 11:22 in it as I like to say my life revolves 11:25 solely around my will to survive but 11:29 when I was able to shift my focus on a 11:30 will to help other people I found peace 11:32 sobriety and love and I wouldn’t have 11:35 had the strength to do that if it wasn’t 11:36 for the people in my life who helped me 11:38 first the will to survive is an innate 11:41 human driving force but the will to help 11:44 other people and make the world a better 11:46 place is precisely what makes us human 11:48 and that’s what we should all be 11:50 striving for so despite my attempts to 11:53 avoid connecting with people because I 11:54 was ashamed of who I was and because I 11:56 was scared 11:57 it ended up being humanity the very same 12:00 humanity that I thought had betrayed me 12:02 that ended up saving me and I am so 12:05 grateful for every person who has told 12:07 me that my blog post or my book gave 12:09 them the courage to face another day 12:11 because that’s what this is all about 12:12 using all of the resources we have 12:15 whether it’s the internet or medication 12:17 or counseling or science or art or music 12:20 or yoga to bring the people who have 12:22 been so traumatic Lee severed from 12:24 humanity back to us because each and 12:27 every one of us matters and I have to 12:29 end with a picture of my family because 12:31 without them I would not be here today 12:33 thank you

Why do Substance Use Disorders and Mental Disorders Occur Together?

In individuals with a dual diagnosis, it is difficult to determine whether the substance use disorder or mental illness developed first. It is possible that an individual with a mental illness may self-medicate with substances to alleviate his or her symptoms, which could lead to the development of a substance use disorder. It is also possible that abusing substances may lead one to develop a mental disorder, such as by changing brain structure and function. Additionally, abusing substances may also exacerbate symptoms of a preexisting mental disorder. However, even if a substance use disorder or mental disorder developed first, one does not necessarily cause the other. While it remains unclear why so many people have a dual diagnosis, there are various shared risk factors for mental disorders and substance use disorders, including: 

Genetic vulnerability
Environmental factors and influences
Interactions between genetic vulnerability and environmental factors
Brain regions, including circuits that mediate reward, emotions, impulse control, and decision making
Brain chemistry, including neurotransmitter systems
Stress
Trauma
Adverse childhood experiences

Warning Signs and Symptoms of a Dual Diagnosis

It can be difficult to identify when someone has a dual diagnosis, especially since the symptoms can vary greatly depending on the substance use disorder and the mental disorder an individual has. For instance, a person with alcohol use disorder and depression can have very different symptoms than a person with stimulant use disorder and anxiety. However, some common symptoms of a dual diagnosis may include:

Extreme changes in mood or sudden mood swings
Withdrawal from family, friends, and social activities
Concentration problems
Difficulty controlling emotions
Problems with employment or keeping a job
Issues with maintaining relationships
Decreased work or school performance
Financial problems
Legal problems

Treatment for Dual Diagnosis

Having a dual diagnosis complicates treatment and increases the risk for relapse. Additionally, patients with a dual diagnosis are more likely to be noncompliant with treatment or drop out of treatment early. Furthermore, patients who have a substance use disorder and a mental disorder at the same time experience more severe and persistent symptoms than patients who only have one disorder. If a patient receives treatment for only one disorder while the other is left untreated, it could severely negatively affect his or her treatment progress. Therefore, effective treatment for dual diagnosis involves simultaneously treating both the substance use disorder and the mental disorder. This is referred to as integrated treatment, in which multiple interventions are used in order to comprehensively treat both co-occurring disorders in the patient. Integrated treatment may involve combining psychotherapy, medication, education, and other behavioral treatments. Integrated treatment also often involves interdisciplinary teams, wherein multiple clinical providers from different fields collaborate together to best serve each patient. Research has continuously found that using an integrated treatment approach for dual diagnosis patients is more effective than using a single focused treatment approach. Additional treatments for dual diagnosis patients are described below. Each treatment option may be utilized alone, or in combination with others as a part of an integrated treatment plan.

Detoxification

Detoxification, or detox, is often the first step of substance abuse treatment. It involves safely eliminating the drug or alcohol from a patient’s body. Health professionals support patients and help them manage the physical and psychological withdrawal symptoms that are experienced from prolonged substance abuse. In medical detox, medications are prescribed to help ease withdrawal symptoms. Detox programs are offered in either inpatient or outpatient settings, although inpatient detox is most effective since patients can be monitored 24 hours a day. It is recommended that upon completing detox, patients continue to remain in treatment, such as in inpatient or outpatient treatment centers. A study from John Hopkins found that patients completing detox treatment alone have high relapse rates, between 65 to 80 percent. However, patients continuing to receive treatment after completing detox were up to 10 times more likely to stay sober.

Medication

In addition to being used during detoxification to ease withdrawal symptoms, medications may also be used to treat symptoms of mental disorders in dual diagnosis patients. There are several different types of medications for various mental disorders. The medication(s) prescribed to dual diagnosis patients will vary based on each patient’s mental health symptoms. Common types of medications for treating mental disorders in dual diagnosis patients include:

Mood stabilizers

Sedatives/Hypnotics

Beta blockers

Antidepressants

Antipsychotics

Individual Psychotherapy

One-on-one psychotherapy is a vital aspect of treatment for dual diagnosis patients. Behavioral therapies are commonly used to treat these patients. Cognitive behavioral therapy (CBT) in particular is a highly effective type of behavioral therapy for treating substance use disorders and various mental disorders. CBT helps patients understand the relationship between their thoughts, feelings, and behaviors. Additionally, it helps patients identify their negative thinking patterns, emotions, and other triggers that lead to maladaptive behaviors, such as substance abuse and self-medicating. Patients receiving CBT will learn adaptive ways to cope with their negative thoughts, feelings, and mental health symptoms that lead to substance abuse and other undesirable behaviors. Other therapeutic techniques that are used by therapists to effectively treat dual diagnosis patients include:

Mindfulness-based interventions

Guided imagery

Breathing exercises

Progressive muscle relaxation

Relaxation techniques

Group Therapy

Like individual therapy, group therapy is often another major component of treatment for dual diagnosis patients. There are several advantages of group therapy, including:

Allowing patients to feel encouraged and supported by others who have experienced similar difficulties to them
Allowing patients to witness others’ recovery, which can motivate and inspire them in their own recovery
Allowing patients to receive helpful feedback from other group members, especially about distorted beliefs they may have
Helping patients who are new to recovery learn valuable information and gain new insights
Helping patients learn new ways to cope with their difficulties by hearing how others have done so
Giving patients the opportunity to learn and improve social skills and how to effectively interact with others, in a supportive environment

Inpatient Rehab

Inpatient rehabs are residential treatment programs. This means that patients will stay at the treatment center for the duration of treatment, which will typically be from 30-90 days. Here, they will receive ongoing medical and emotional support from a team of professionals, including psychiatrists, therapists, and counselors, 24 hours a day. Inpatient programs are more intensive than outpatient programs. They also provide a controlled and structured environment for patients to recover in, away from outside distractions. Thus, they are ideal for dual diagnosis patients experiencing more severe addictions and mental health symptoms. In inpatient dual diagnosis programs, patients will typically receive daily therapy, attend groups daily, and regularly receive education about both substance use disorders and mental health issues.

Outpatient Rehab

Outpatient rehabs are less intensive and offer more flexibility than inpatient programs. In outpatient rehab programs, patients live at home and come to a treatment center for a certain amount of hours each week. Outpatient programs vary in intensity, but typically 6 to 30 hours of treatment is provided to patients each week. Thus, outpatient programs are ideal for patients who want to continue living with their families and going to work or school while receiving treatment. Many patients finishing treatment at inpatient rehabs choose to continue their recovery at outpatient rehabs. In outpatient dual diagnosis treatment programs, patients will receive individual therapy and attend multiple groups each week. Patients can also meet with psychiatrists for medication, if necessary. Outpatient rehab programs typically last three months to a year, or even longer.

Self-Help Groups

In self-help groups, people who share a common problem come together and provide mutual support to one another. Social support has been shown to enhance mental health and quality of life, including in individuals with substance use disorders and mental disorders. Additionally, it has been found that people participating in dual diagnosis self-help groups reported decreased mental health distress and substance use. Therefore, attending self-help groups can be extremely beneficial for people with a dual diagnosis. Alcoholics Anonymous and Narcotics Anonymous are popular self-help groups for people with substance use disorders.

Some common self-help groups specifically for people with a dual diagnosis are:

Double Trouble in Recovery
Double Trudgers
Dual Recovery Anonymous

Resources

  1. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.pdf
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3327759/
  3. https://www.researchgate.net/publication/7195472_The_Prevalence_and_Correlates_of_Adult_ADHD_in_the_United_States_Results_From_the_National_Comorbidity_Survey_Replication
  4. https://www.ncbi.nlm.nih.gov/pubmed/11448377
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145127/
  6. https://www.centeronaddiction.org/addiction-research/reports/food-thought-substance-abuse-and-eating-disorders
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951633/
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860396/
  9. https://ajp.psychiatryonline.org/doi/full/10.1176/ajp.2006.163.4.652
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851027/
  11. https://cpb-us-w2.wpmucdn.com/web.sas.upenn.edu/dist/3/176/files/2016/07/2010_-_ruscio_et_al.-1qpwqcv.pdf
  12. https://www.uptodate.com/contents/co-occurring-schizophrenia-and-substance-use-disorder-epidemiology-pathogenesis-clinical-manifestations-course-assessment-and-diagnosis
  13. https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/why-there-comorbidity-between-substance-use-disorders-mental-illnesses
  14. https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/what-are-treatments-comorbid-substance-use-disorder-mental-health-conditions
  15. https://www.hopkinsmedicine.org/news/media/releases/drug_free_housing_for_substance_abusers_leaving_detox_linked_to_fewer_relapses
  16. https://www.ncbi.nlm.nih.gov/books/NBK64223/
  17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1868661/

Table of Contents

  1. Overview of Dual Diagnosis
  2. Common Mental Health Disorders
  3. Signs and Symptoms
  4. Treatments
  5. Detoxification
  6. Medication
  7. Psychotherapy
  8. Group Therapy
  9. Inpatient Rehab
  10. Outpatient Rehab
  11. Self-Help Groups
  12. Resources