Dual Diagnosis Treatment and Rehab Programs
Someone who struggles with drug or alcohol addiction and a co-occurring mental health condition, such as depression or anxiety, is said to have a dual diagnosis. In this article we will provide an overview on dual diagnosis, how one is assessed for a dual diagnosis, signs of mental health and substance misuse, treatments for dual diagnosis, and how to find and pay for treatment.
What Is Dual Diagnosis?
The concept of a dual diagnosis treatment—alternatively referred to as co-occurring or co-morbid disorders—is a clinical term that refers to the presence of both a substance use disorder and a mental or behavioral health condition.
Dual diagnosis treatment centers take an integrated and comprehensive care approach to fully address and rectify both the drug or alcohol addiction and co-occurring mental health condition. Only treating one issue may put the person at an increased risk of relapse.
Sometimes one condition might contribute to or worsen the other. For example, someone with a mental illness might use drugs or alcohol to cope with their symptoms. In other cases, substance abuse may uncover a mental illness or worsen related symptoms. Some examples of what could be considered a dual diagnosis disorder is having a substance misuse problem along with any of the following:
- Post-traumatic stress disorder (PTSD)
- Attention-deficit hyperactive disorder (ADHD)
- Bipolar disorder
- Anxiety disorder
Why Is a Dual Diagnosis Treatment Program Important?
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 17.0 million adults struggled with both a substance use disorder and mental illness in 2020.1 However, only a fraction of people with substance abuse problems and/or mental illnesses seek professional help to get the treatment they need.1
There is no specific explanation for why drug and alcohol addiction and psychiatric illness co-occur so frequently.2 People who suffer from both a substance disorder and mental illness often exhibit symptoms that are more persistent, severe, and resistant to treatment compared with people who suffer from only one disorder.3
History of Dual Diagnosis
Dual diagnosis typically applies to people who suffer from a severe, persistent mental illness coupled with a substance use disorder. Historically, there has been a split in the U.S. between mental health and addiction services.3 Because each system of treatment has existed in isolation, it has been difficult for people who have a dual diagnosis to get the care they need in either traditional mental health or addiction treatment programs.
Until integrated dual diagnosis programs became available, it was more difficult for people with co-occurring disorders to receive effective help because they generally participated in separate treatment programs that didn’t address their unique needs.3
Individuals with dual diagnosis disorders require a treatment program grounded in expertise in both areas. Fortunately, increasing numbers of substance use disorder treatment programs are becoming equipped to treat co-occurring disorders.
Dual Diagnosis Assessment at Drug and Alcohol Rehab
During clinical assessment for dual diagnosis, health professionals consider a number of factors. Generally, they will look at whether the individual:4
- Meets the criteria for a psychiatric disorder.
- Has a history of substance use that has had a negative impact on their psychiatric health, relationships, work, and leisure activities.
- Might be a danger to themselves or others, has a history of violence, or has experienced suicidal thoughts.
- Has a support system and resources available.
- Is motivated to undergo rehabilitation and has the level of support needed for treatment to succeed.
Signs of a Mental Health Disorder
Mental health disorders and substance use disorders frequently occur together, but many of the symptoms are quite distinct. Although symptoms will naturally differ based on the specific mental health condition in question, some commonly encountered signs of a mental health disorder include:5
- Feelings of hopelessness, worthlessness, guilt, fear, or panic.
- Lack of interest in daily endeavors.
- Change in appetite, weight, or sleep patterns.
- Lack of energy.
- Racing thoughts and trouble concentrating.
- Increased irritability.
- Risky behavior.
- Suicidal thoughts.
Signs of a Substance Use Disorder
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is used by clinicians to diagnose and classify substance use disorders. The DSM-5 includes 11 criteria; a few of these criteria are:6
- An inability to control use of the substance or a tendency to use more of the substance than planned.
- Cravings for the substance.
- Developing a tolerance for the substance, or needing more of it to achieve the same effect.
- Feeling symptoms of withdrawal after discontinuing use of the substance.
- Spending a great deal of time on the substance, including time used to acquire it, use it, and recover from use.
- Failing to meet work, home, or school obligations because of use.
- Using the substance at the expense of relationships, regular activities, and personal safety.
What Is Dual Diagnosis Treatment?
There is evidence that with help, people with a dual diagnosis and co-occurring disorders can stabilize and recover. A large part of the treatment for dual diagnosis involves behavioral interventions. Types of behavioral therapy commonly used in dual diagnosis treatment include:7
- Dialectic behavioral therapy, which has the goal of reducing self-harming behaviors that often accompany mental health conditions and substance use disorders.
- Integrated group therapy, which seeks to treat the symptoms of both substance use disorders and mental health illnesses all at once.
- Cognitive behavioral therapy, which works to minimize problematic beliefs and behaviors and develop healthier thinking and behavioral patterns to sustain sobriety.
- Individual psychotherapy, which treats behaviors related to substance abuse and/or particular behavioral or mental health problems.
Dual diagnosis treatment programs sometimes utilize behavioral therapies in combination with medication. Medicines will vary according to the individual and the diagnosis.
Types of Treatment in Dual Diagnosis Programs
Treatment for substance misuse dual diagnosis will be different based on the individual’s needs and preferences. Treatment may take place on an inpatient or outpatient basis.
Dual Diagnosis Detox
For many, the first step of addiction treatment will be detoxification. The detox process removes drugs and alcohol from the body so that people can then enter treatment. The three key elements of medical detoxification include evaluation, stabilization, and fostering patient readiness for a comprehensive treatment program.8
Since withdrawal symptoms can range from severely unpleasant to dangerous (in cases of alcohol, sedatives, and opioids withdrawal), it is important to undergo detox under the supervision of a physician where medications may be used to help ease withdrawal symptoms and help keep individuals safe and comfortable. Detox typically lasts 3 to 7 days, depending on the individual’s situation and needs.
Inpatient Dual Diagnosis Treatment
Depending on the severity of the illness, a person with a dual diagnosis might require or benefit from inpatient care. A common form of inpatient treatment is “residential” rehab, in which participants live at the rehab center during treatment. Depending on the facility’s rules, residents may be permitted to leave the treatment center or have regular visitors.
Because of the complicated nature of co-occurring disorders, many people with a dual diagnosis will require the additional services, ongoing support, and onsite professionals from multidisciplinary backgrounds that may be found in inpatient centers. These programs allow those suffering from complex issues surrounding a dual diagnosis to receive the intensive treatment needed to get a solid start on the path to recovery from both disorders.
What Happens During Inpatient Dual Diagnosis Treatment?
- Regular education about mental health issues as well as substance misuse and addiction.
- Daily therapy.
- The opportunity to attend support groups every day.
- Immersion in a community of people who are learning to live without drugs or alcohol.
Outpatient Dual Diagnosis Treatment Programs
Outpatient treatment for dual diagnosis is more flexible than inpatient treatment. Outpatient programs can vary in intensity and time commitment. For some people, participating in intensive outpatient treatment (IOP), where they spend 30 hours or more per week at the rehab center, is sufficient initial treatment.
If inpatient dual diagnosis treatment is initially required, participants may then step down to an outpatient program that supports their desire to live in the community more independently while they continue their recovery efforts. Participants may receive a variety of services in such a program, including:
- Medication management.
- Involvement in peer support groups or 12-Step programs.
- Individual and family therapy.
- Support in living independently.
Dual Diagnosis Treatment Aftercare
While dual diagnosis treatment lays the foundation for recovery and long-term sobriety, aftercare helps maintain the progress made during treatment.
Ongoing support is essential for anyone in recovery from addiction and is even more important when a mental health disorder is present. A comprehensive, individualized aftercare program is vital to sobriety and progressive recovery after completion of a dual diagnosis rehab program.
Dual diagnosis treatment centers take extra care to incorporate relapse prevention into the aftercare plan. Prior to leaving a treatment program, the individual will meet with counselors to discuss a plan for aftercare.
Many dual diagnosis rehab facilities offer follow-up programs to assist recovering individuals as they transition back into their everyday lives. These follow-up plans may include:
- Weekend stays at the rehab center. Weekend stays benefit individuals who feel they may be at risk for relapse or those who simply require some additional support.
- Transition to a sober-living facility. While there, recovering individuals may be required to complete chores, work at an outside job, and participate in group therapy sessions. This offers a supportive, transitional time.
- Regular therapy sessions. Therapy programs help the individual to continue working through issues and making positive changes to sustain sobriety.
- Scheduled drug testing. This provides a good way to maintain accountability for abstinence after program completion.
- Group therapy. This type of therapy provides a positive method for building a support system at home. Options for group therapy include 12-Step support groups, gender-specific or faith-based support groups, and more.
In dual diagnosis aftercare support groups, it is often said that participants get what they give, so they are encouraged to interact with other group members and share their experiences with the group. Once those recovering from dual diagnosis are more established in their sobriety, they may choose to mentor others who are newly recovering as well.
Things to Consider When Choosing a Dual Diagnosis Rehab
When choosing a dual diagnosis treatment program, it’s important to understand some basics about treatment.
Dual Diagnosis and Co-Occurring Treatment Offerings
Individual paths to recovery differ, and treatment services for mental health and substance use disorders should be tailored to fit a person’s needs. The National Institute on Drug Abuse (NIDA) supports an individualized, integrative approach for treatment of dual diagnosis.7
Depending on their individual situation and specific requirements, a person in need of dual diagnosis treatment may benefit in receiving a variety of therapeutic interventions from a number of treatment settings. These may include:
- Specialty community behavioral health centers.
- Substance use disorder rehab programs.
- Independent providers, such as therapists and counselors in private practice.
- Hospital-based treatment programs or access to hospital services.
- Community health centers.
- Mutual support groups and peer-run organizations.
- Community-based organizations, such as churches.
- Criminal justice programs, such as counseling services within a prison system.
- Tele-behavioral or home-based services that provide treatment in the home.
- Inpatient service providers.
- Primary care programs that offer behavioral health services.
Paying for Dual Diagnosis Rehab
The costs of treatment will vary by program and may be influenced by differing levels of insurance for dual diagnosis treatment. If you have insurance, check with your carrier to find out:
- Whether your plan covers dual diagnosis treatment.
- How much your plan will pay.
- Which rehabs programs are covered in your plan.
Many people who have low incomes qualify for Medicaid. If you have Medicaid, you’ll need to check with your county to find a covered rehab.
If you don’t have sufficient insurance to cover your dual diagnosis rehab program, you may be able to obtain financing from the rehab facility. This financing is usually based on financial need. You might receive a reduced rate or be given the option to pay your bill in monthly installments. For more information on the various payment options available and how to pay for rehab treatment. including free rehab, call .
Find a Dual Diagnosis Addiction Treatment Center
Successful recovery takes time and effort. At the start of the process, attempting to choose a dual diagnosis treatment program on your own can be overwhelming. Aside from considering a dual diagnosis treatment center near you, there are other factors that should be considered to meet your specific needs. You can always call a helpline or treatment center’s direct line to speak with a consultant about your treatment options. In order to receive guidance concerning your treatment search, it’s important to prepare some information before calling.
For instance, if you have insurance, you’ll want to have your insurance card in front of you. They will then use this information to verify your benefits. You’ll also want to report the substance or substances being misused, how long the addiction has been going on, the average amount used, the method of administration, and any co-occurring medical or mental health disorders. If you have any special medical concerns, such as pregnancy, then you’ll want to disclose that as well.
Insurance Coverage for Mental Health and Addiction Treatment Centers
Rehabs.com is a subsidiary of American Addiction Centers (AAC) a leading provider of addiction and dual diagnosis treatment nationwide. AAC is in network with many of the top insurance providers in the United States. Use the form below to find out instantly if your insurance benefits cover some or all of the cost of dual diagnosis treatment.