Co-Occurring Disorder and Dual Diagnosis Treatment Guide
A range of individualized treatment options that are both flexible and affordable are available to people struggling with co-occurring disorders, many of which we will outline for you below. Treatment options are tailored to address a person’s unique diagnoses through behavioral therapies and medication.1,2
Integrated treatment, which addresses SUDs and mental illnesses together, is the suggested course of care for people suffering from comorbidity.4 This guide is will provide you an overview of co-occurring mental health disorders, dual diagnosis treatment, and how to find treatment for co-occurring disorders.
In 2019, 9.5 million American adults between the ages of 18 to 25 were diagnosed with at least one co-occurring disorders alongside a substance use disorder. Among this group, only 742,000 people (7.8%) received treatment for both a substance use disorder and mental health disorders simultaneously.4
What is a Co-Occurring Disorder?
A co-occurring disorder refers to when one person has two or more mental health disorders or medical illnesses. These co-occurring disorders may overlap and begin at the same time, or one may appear before or after the other.5
There is a strong link between SUDs and other mental health disorders. In fact, about half of people with one disorder will eventually develop at least one more co-occurring mental health condition in their lifetime.5 Co-occurring disorders can also worsen each other’s level of severity.5 Researchers have identified 3 possible mechanisms that may explain why co-occurring disorders are so prevalent:6
- Overlapping Risk Factors: Common risk factors for SUDs and other mental health conditions often overlap. These may include genetics as well as environmental factors, such as exposure to trauma, that can make a person more likely to develop these issues.
- Self-Medicating: Mental illness can lead to substance abuse as a way of coping with symptoms. This concept is often casually termed, “self-medicating,” however that label may be misleading because while substance use can mask symptoms they may also at the same time exacerbate symptoms in both the short and long terms.
- Drug-Induced Brain Changes: Substance use can cause changes in areas of the brain disrupted by mental health disorders, which can increase someone’s likelihood of developing symptoms of a mental disorder that affects that brain. The areas of the brain affected by substance use seem to be correlated with areas also associated with impulse-control, mood, and anxiety disorders, as well as schizophrenia.
Researchers have studied rates of co-occurring disorders for decades. They have identified that certain mental health disorders have been linked to substance use disorders more often than others.3,6 Mental health conditions that are most likely to occur alongside SUDs include, but are not limited to:
- Anxiety disorders. Approximately 18% of the general population also have a co-occurring anxiety disorder of some type.3 Social anxiety disorders have an especially strong link to marijuana use problems.7 Generalized anxiety disorder, social anxiety disorder, , and panic disorder are all associated with an increased risk of co-occurring disorders.6,7
- Mood disorders. About 20% of the general population with a SUD also have one or more mood disorders, such as bipolar disorder or depression.3
- Personality disorders. In the normal population approximately 10-15% have a personality disorder, compared to a prevalence rate of about 35-73% in patients treated for addiction. The personality disorders most commonly found in those with SUD include antisocial, borderline, avoidant, and paranoid.
- Post-traumatic stress disorder (PTSD). According to one national survey, people with PTSD were, relative to those without PTSD, as much as 4 times more likely to also meet criteria for a substance use disorder.
- Attention Deficit/Hyperactivity Disorder. ADHD is associated with an earlier age at onset of substance use and a higher likelihood of use of a variety of substances. Brook et al20 reported that the diagnosis of ADHD poses an increased risk of SUD into adulthood; meeting criteria for a diagnosis of ADHD in adolescence is associated with developing SUDs in a subject’s 20s and 30s. Among individuals with ADHD, the number of inattention and hyperactivity and impulsivity symptoms exhibited is positively correlated with risk of substance use.8
Increased severity of mental illness is associated with an increased risk of co-occurring disorders, with about 25% of people with severe mental illness developing co-occurring disorders.6
Symptoms of Co-Occurring Disorders
It can be difficult to tell the difference between addiction and mental illness at times, considering there can be significant overlap between their symptoms.3,9,10 To avoid confusion, a mental health diagnosis should be made while a person is abstinent and there are no drugs in their system.3
While each mental health disorder has different symptoms, there are some general signs that point to the possibility of mental illness.9 These include:9, 10
- Changes in eating and sleeping habits.
- Dropping hobbies or activities that were once important.
- Experiencing extreme emotional highs and/or lows.
- Frequently feeling afraid without cause.
- Having difficulty focusing or thinking clearly.
- Inability to see these changes in one’s behavior or personality.
- Increased irritability.
- Increased or decreased libido.
- Isolating from friends and family.
- Lack of attention to personal hygiene.
- Loss of touch with reality, such as hallucinations, paranoia, or delusions.
- Participating in risky behaviors such as substance use or promiscuousness.
- Suffering from physical complaints with no cause.
- Thoughts of suicide or suicide attempts.
The symptoms of SUDs can also differ depending on the substance used, but general symptoms can indicate that an individual may have an issue with substances.11 These warning signs include:10, 11
- Difficulty or inability to stop using drugs even when they want to.
- Experiencing withdrawal when substance use is stopped.
- Having difficulty functioning or coping with stress without alcohol or drugs.
- Having trouble completing tasks at home, school, or work because of substance use.
- Inability to stop using even after it has caused or worsened physical or mental health conditions or interpersonal relationships.
- Isolating from family and friends or spending time with different friends.
- Frequently tardy or absent from school or work.
- Not appearing intoxicated after ingesting large amounts of a substance (increased tolerance).
- Participating in risky behaviors such as driving under the influence.
- Spending a lot of time getting, using, or recovering from the effects of a substance.
Co-occurring disorders can result in additional problems or compound problems arising from one or both disorders.1, 4 Difficulty maintaining employment and housing, relationship difficulties, health issues, and increased risk of arrest and suicide can be found in people with co-occurring disorders, especially as the disorders increase in severity.3,4 Additionally, each disorder can make the other worse, making it harder to recover.1,4,7
What is Integrated Treatment?
Integrated treatment programs screen and assess patients for substance use disorders as well as other mental health disorders.
Integrated treatment programs may also provide additional support services to address other areas of need, including housing, employment, and socialization.12
For the purposes of treatment, it is recommended that clients receive intensive medical and therapeutic intervention and care for both disorders at the same time. This allows them to manage the symptoms caused by the mental health disorder without abusing drugs and alcohol and worsening those symptoms — or allowing an untreated mental health disorder to increase the urge to drink or get high. Comprehensive care that begins during detox and continues through aftercare treatment and support is the best way to build a new life in recovery from co-occurring disorders.
Benefits of Integrated Treatment
The integrated care treatment model is considered by the Substance Abuse and Mental Health Services Administration a best practice when treating individuals with co-occurring substance abuse and mental health disorders. 12 Patients are more likely to stay engaged and participate in treatment when care is integrated and comprehensive.12
Integrated treatment plans are tailored to meet the individual needs of each patient.7 The treatment approach has been linked to many positive outcomes.12 Research has shown that people who participate in integrated treatment are more likely to stay sober, see a significant reduction of their symptoms, visit the hospital less often, live independently, maintain steady employment, and report feeling happier with their lives.12
What Does an Integrated Treatment Plan Look Like?
The goal of integrated treatment is to help people learn how to maintain sobriety or significantly reduce their substance use and manage the symptoms of their mental illness at the same time. 3 This is accomplished through the use of effective counseling and behavioral therapy interventions and, sometimes, with medications.1,3 Integrated treatment may utilize multiple therapeutic techniques proven effective in the use of mental health disorders as well as substance abuse issues, such as:5, 10, 12
- Cognitive behavioral therapy, or CBT, which explores a person’s thoughts and beliefs to change their behaviors.
- Dialectical behavioral therapy, or DBT, which is used to treat borderline personality disorder by reducing negative actions such as self-harm, substance use, and suicidal behavior.
- Contingency management, which provides small incentives for clients who exhibit desirable and positive behaviors such as staying sober or avoiding self-harm.
- Motivational enhancement, which can help people increase their motivation to make positive changes in the treatment process.
- Mutual-support groups tailored towards people with co-occurring disorders. Narcotics Anonymous also offers meetings for people with co-occurring disorders.
An integrated treatment approach can be provided at all levels of care, including:10, 12
- Detox: A medically managed detox typically consists of 24/7 medical care. Staff are on-site 24/7 and physicians may prescribe medications as needed to ensure safety as one detoxes from drugs.
- Inpatient Care: There are multiple levels of inpatient care, all of which tend to involve patients residing at an addiction facility 24/7 for the duration of treatment. Medical and mental health staff are present at all times to provide support, medication, and more while patients learn to manage their co-occurring disorders.
- Outpatient care: Outpatient treatment provides patients the opportunity to receive similar (if not identical) services as they did in inpatient care, but on a less intensive basis. This level of care allows patients the freedom to attend school or work and participate in regular activities at home while still receiving care for co-occurring disorders.
What Types of Mental Illnesses Can be Treated at an Integrated Treatment Center?
According to a 2019 survey of 15,961 treatment centers in the United States, 53% of them offered treatment programs for people with co-occurring disorders.13 American Addiction Centers’ integrated treatment starts from the very beginning thorough psychiatric screening and evaluation that includes understanding the extent of substance use as well as the presence of additional mental health disorders.14 This gives you the opportunity to discuss any mental health symptoms you’re experiencing and anything you’ve been diagnosed with and you’ll work with a psychiatrist to develop an individual treatment plan that may include medications, if needed.14
Finding Treatment for Co-Occurring Disorders
American Addiction Centers is the country’s top provider of addiction treatment and many of our facilities offer treatment for co-occurring disorders.15 Each treatment program is uniquely tailored to each individual client.14, 15
For assistance in finding a facility that offers integrated treatment for co-occurring disorders, the Substance Abuse and Mental Health Services Administration offers a behavioral health treatment service locator that can be found here. You can search by location and filter the search according to factors like the type of treatment setting, special programs offered, and payment types that are accepted.
Does Insurance Pay for Dual Diagnosis Treatment?
The Affordable Care Act and the Mental Health Parity and Addiction Equity Act changed how insurance plans cover treatment for SUDs and other mental health disorders.16 The Affordable Care Act (ACA) ensures that treatment for SUDs and mental health disorders is considered an essential health benefit, requiring coverage by the majority of health insurance plans.16 Most health insurance plans are required to offer similar coverage for mental health and SUDs as they do for physical health disorders.16 This federal law also ensures that restrictions for mental and behavioral health conditions aren’t more restrictive than they would be for physical health conditions.16
It can be difficult and frustrating to live with one or multiple co-occurring disorders, but it is possible to learn to manage your mental health conditions and achieve your goals to reduce your substance use. AAC’s integrated treatment approach for co-occurring disorders can help you to learn how to effectively manage these potentially debilitating and life-threatening conditions to live a happy, healthy, and productive life.
- National Institute on Drug Abuse. (2018). Comorbidity: Substance use and other mental disorders.
- Substance Abuse and Mental Health Services Administration. (2020). Mental health and substance use disorders.
- Flynn, P.M., & Brown, B.S. (2008). Co-occurring disorders in substance abuse treatment: Issues and prospects. Journal of Substance Abuse Treatment, 34(1), 36-47.
- Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality.
- National Institute on Drug Abuse. (2018). Comorbidity: Substance use disorders and other mental illnesses.
- National Institute on Drug Abuse. (2020). Common comorbidities with substance use disorders.
- Kelly, T.M., & Daley, D.C. (2013). Integrated treatment of substance use and psychiatric disorders. Social Work in Public Health, 28(3-4), 388-406.
- Official Journal of the American Academy of Pediatrics. (2014). Attention-Deficit/Hyperactivity Disorder and Substance Abuse.
- National Alliance on Mental Illness. Warning signs and symptoms.
- National Alliance on Mental Illness. Substance use disorders.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment for people with co-occurring disorders.
- Substance Abuse and Mental Health Services Administration. (2020). National survey of substance abuse treatment services (N-SSATS): 2019. Rockville, MD: Substance Abuse and Mental Health Services Administration.
- American Addiction Centers. (2020).
- Centers for Medicare and Medicaid Services. The Mental Health Parity and Addiction Equity Act (MHPAEA).