Co-Occurring Disorder Treatment Centers Near Me
When a person meets the criteria for a substance use disorder (SUD), a medical condition defined by uncontrollable use of substances despite the negative consequences, and they are also diagnosed with one or more additional mental disorders, this is called having co-occurring disorders or a dual diagnosis.1-3
SUDs often co-occur with other mental disorders, however, this does not mean that one caused the other. It’s often difficult for clinicians to establish which came first, or even why both disorders occur in the first place. However, research shows that one disorder can influence and, in some instances, cause the other. They also can have a bidirectional relationship, meaning they can each influence or worsen the course of the other. 1
The Substance Abuse and Mental Health Services Administration suggests that an integrated treatment approach which addresses SUDs and other mental disorders concurrently can improve outcomes and quality of life for people with co-occurring disorders.4 Treatment is typically tailored to address a person’s unique diagnoses through behavioral therapies and medication.1,2 This guide provides information on the prevalence of co-occurring mental disorders, how they are treated, and how to find treatment for substance use disorders that occur alongside other mental disorders.
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Co-Occurring Mental Health Disorder Statistics & Prevalence
SUDs and other mental disorders frequently occur together.1
- Of the 20.3 million adults diagnosed with SUDs, more than a third of them also suffer from mental illness.
- Almost 20% of the 42.1 million people diagnosed with a mental health condition also have a SUD.
- Unfortunately, more than 50% of those diagnosed with co-occurring disorders never receive treatment for either condition.
- Cost tends to be the primary barrier to treatment for more than half of those who are diagnosed but do not receive treatment.
Dual Diagnosis vs. Comorbidity vs. Co-Occurring Disorder
The distinctions are somewhat academic, though for most purposes, these concepts are used somewhat interchangeably. Dual diagnosis is increasingly becoming replaced by the concept of co-occurring disorders, though both terms describe a situation wherein a person has both a SUD and another mental health issue. In such a situation, each condition could be described as a comorbidity of the other, though the phrase comorbidity is also widely used outside of the mental health/behavioral health field to describe the co-existence of multiple medical issues.
Furthermore, dual diagnosis is a psychiatric term that describes an individual who experiences two or more psychiatric conditions simultaneously, each as a distinct diagnosis.5 First introduced in the 1980s, the term “dual diagnosis” originally referred to individuals with coexisting severe mental illness and a SUD. Since the early 2000s, the Substance Abuse and Mental Health Services Administration (SAMHSA) uses the term “co-occurring disorders” to refer to the presence of two or more conditions.6 It’s important to note, however, that Dual Diagnosis Anonymous, which began in 1996, exists as an international organization of support groups for those trying to live a substance-free, healthy life.
Thus, now, co-occurring disorders is typically used when referring to a person who has a SUD and another mental disorder, although it can sometimes be used when referring to a person who has two or more mental health disorders, such as comorbid depression and schizophrenia, for instance. People with SUDs commonly have one or more co-occurring mental disorders, with about half of people who have one also have the other. Co-occurring disorders often overlap, and they may begin at the same time, or one may appear before or after the other.7
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 & Signs of Co-Occurring Disorders
It can be difficult to tell the difference between addiction and mental illness, considering there can be significant overlap between the symptoms of each.3,11,12 To avoid confusion, a mental health diagnosis is ideally 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.13 These warning signs include:13
- 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.
Having a SUD and a co-occurring disorder can result in additional problems or compound problems arising from one or both disorders.1,4 Difficulty maintaining employment and housing, relationship problems, 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.1,4,9
Assessment of Co-Occurring Mental Disorders
Assessing co-occurring mental disorders and SUDs is complicated because of the similarities of risk factors as well as overlapping symptoms, such as those that may occur from withdrawal of a drug and those of a potential mental illness.14 As a result, people who seek treatment for a mental health disorder should be screened for SUDs and vice versa. Additional assessment may take place after a period of abstinence to accurately distinguish between symptoms of intoxication or withdrawal of a substance and symptoms of a mental health disorder.8
Additionally, genetic and environmental factors that may impact an individual’s mental health and/or substance use should be assessed in those suspected of have co-occurring disorders.8 Thus, an assessment might include:15
- The establishment of a clinical diagnosis of SUDs and mental illness. This includes a detailed compilation of the consequences of each on the individual’s life, relationships, work, other activities, and health.
- A motivation to change. Treatment is effective if the individual is committed to stopping or decreasing their substance use during treatment so that the psychosocial interventions improve the individual’s mental health.
- Tests to confirm the presence of substances and identify the level of damage.
What is Integrated Treatment for Co-Occurring Disorders?
Integrated treatment programs screen, assess, and treat patients with both SUDs as well as other mental disorders.
Integrated treatment programs, like many drug rehab facilities, may also provide additional support services to address other areas of need, including housing, employment, and socialization.17
In an integrated treatment program, individuals receive both medical and therapeutic intervention and care for both disorders concurrently. This allows the team of physicians, therapists, psychologists, counselors, and other clinicians to better assess and manage the symptoms of a mental health disorder without the influence of drugs and alcohol potentially worsening those symptoms. Comprehensive integrated care that begins during detox and continues through aftercare treatment and support can lead to positive outcomes for patients looking to build a new life recovering from substance abuse as well as other mental disorders.
Benefits of Integrated Treatment
The integrated care treatment model is considered the standard of care by the Substance Abuse and Mental Health Services Administration when treating individuals with co-occurring substance misuse and mental health disorders.5 This treatment approach has been linked to many positive outcomes.5 Patients are more likely to stay engaged and participate in treatment when care is integrated and comprehensive.5
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 with co-occurring disorders learn how to maintain sobriety or significantly reduce their substance use as well as manage the symptoms of their mental illness.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 use disorders, such as:5,7,12
- 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 provides small incentives for clients who exhibit desirable and positive behaviors such as passing a drug test 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 to people with co-occurring disorders, such as Dual Diagnosis Anonymous or Narcotics Anonymous, which offer meetings for people with co-occurring disorders.
Integrated treatment can occur along the continuum of care for SUDs, including:5,12
- Detox, or Withdrawal Management: 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 clears the body of drugs and alcohol.
- Inpatient Care or Residential Treatment: Inpatient or residential care has individuals residing at a rehab facility 24/7 for the duration of treatment. Medical and mental health staff are always present or on call to provide support, medication, and more while individuals learn to manage their substance use and symptoms of any 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 patients are afforded the freedom to live at home while still receiving care for co-occurring disorders.
Do All Rehab Facilities Provide Integrated Treatment for Mental Illness?
No, but 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
How to Find Treatment for Co-Occurring Disorders
Integrated treatment is the standard of care for treating co-occurring disorders. A provider or treatment facility that offers treatment for co-occurring disorders is equipped to assess for both and to treat them concurrently or in stages, whichever is most appropriate for the individual.17 An integrated approach to treatment—as opposed to fragmented and uncoordinated care—ensures that services and therapies meet the needs and conditions of the individual.17 This typically means that treatment happens in the same place without division between mental health and substance misuse.17 There is, however, no one-size-fits-all approach to treatment for co-occurring disorders.5
Things to look for when deciding on a treatment facility to treat co-occurring disorders include:17
- Specific services for co-occurring mental health disorders and SUDs. Does the facility employ physicians, therapists, counselors, psychologists, and other clinicians experienced in evaluating, assessing, and treating various mental health conditions as well as SUD?
- A variety of therapy modalities. Research indicates that counseling, behavioral therapies, motivational interventions, and ongoing support can be effective in treating certain mental illnesses and SUDs simultaneously.
- Various options for inpatient and outpatient treatment. Though rehab length varies for each individual, you want to know that there are different programs, such as 30-, 60-, and 90-day programs, and the one that’s best for you depends on multiple factors, including the severity of the disorder, symptoms of withdrawal, and more.
- Aftercare support. Does the facility offer ongoing services and social support to help manage both disorders beyond treatment? Connecting people with social support after they leave a structured treatment program is vital to long-term success. Staying engaged in treatment and developing positive relationships are important factors in sustained recovery.
- Multicultural or population-specific programming (if desired). Does the treatment facility have specialized programs for a specific population you belong to, such as women, veterans, first responders, or members of the LGBTQ community, for instance?
- Insurance coverage. Check with your insurance provider to find out the specifics on coverage for treatment of co-occurring disorders. You can also verify your insurance for an American Addiction Centers facility by filling in the form below.
Co-Occurring Disorder Treatment Centers Near Me
American Addiction Centers is the country’s top provider of addiction treatment and many of our facilities offer treatment for co-occurring disorders. Each person’s treatment plan is uniquely tailored to the individual.
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 Co-Occurring Disorder 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.18 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.18
It can be difficult and frustrating to live with 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.