Dual Diagnosis Rehab

A dual diagnosis is when a person suffering from a substance use disorder (SUD) is also diagnosed with a mental health or behavioral disorder. These are also called “co-occurring disorders” or “comorbid disorders.”
Evidence Based
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What is Dual Diagnosis Rehab?

According to the 2018 National Survey on Drug Use and Health, approximately 1 in 5 adults with mental health issues had a co-occurring SUD. Half of all adults with a SUD had a co-occurring mental health disorder.

https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf

People with a dual diagnosis need specialized treatment that evaluates and manages their co-occurring disorders, rather than treating them separately. Many rehab centers provide integrated treatment plans that address these interconnected mental health issues.

Dual diagnosis rehab typically takes place at an inpatient rehabilitation facility. Some of them only treat alcohol use disorders (AUD), others focus on drug dependency, and many provide treatment for both.

Inpatient rehab provides the safest environment, structured planning, and a comprehensive combination of health services. These facilities also focus on creating programs tailored to the needs of the individual who has received a dual diagnosis.

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Common Co-Occurring Mental Health Issues and Substance Use Disorders

Research has proven that a person with a mental health disorder is more likely to have a SUD. People with an addiction, on the other hand, are more likely to suffer from a mental illness.

Some mental health disorders frequently occur alongside substance use disorders, and include:

Anxiety Disorders

Over 40 million adults in the U.S. suffer from anxiety disorders, making it the most common mental health disorder in the country. People suffering from anxiety often use alcohol, tobacco, and other drugs to self-medicate. There is also a high risk of addiction with benzodiazepines, which are medications commonly prescribed for anxiety disorders.

Attention Deficit Hyperactive Disorders (ADHD)

Many doctors prescribe stimulants, such as Adderall or Ritalin, to people with ADHD. These are highly addictive medications. People with these types of disorders may also try to manage their symptoms independently using illicit drugs and alcohol.

Bipolar Disorder

Bipolar is considered a “severe” mental health disorder. Nearly half of all people with bipolar disorder also have a substance use disorder. Bipolar individuals often self-medicate with drugs and alcohol to lessen the symptoms of manic episodes.

Borderline Personality Disorder (BPD)

People with borderline personality disorder receive the highest percentage of dual diagnoses. Approximately 2 out of 3 people diagnosed with BPD have a substance use disorder as well.

Depression

Approximately 10 percent of people in the U.S. experience depression during their adult life. Self-medication is very common among people going through depressive episodes.

Eating Disorders

Drugs that suppress appetites, especially stimulants, are extremely addictive and can cause co-occurring disorders.

Post-Traumatic Stress Disorder (PTSD)

People who go through traumatic experiences may develop PTSD. This is especially common in veterans, though it can happen to anyone. People with PTSD are likely to misuse alcohol, prescription medications, and illicit drugs to deal with their issues.

Schizophrenia

Schizophrenia and SUDs share a variety of symptoms. Most people who have schizophrenia develop a dependence on nicotine, and it is common for them to abuse other drugs in an effort to reduce or lessen their symptoms.

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Why Dual Diagnosis Treatment is Necessary

Co-occurring disorders often share similar symptoms and triggers. This means that they feed each other and feed off of each other. Dual diagnosis treatment is necessary because it is the only way to make sure that the proper therapies or medications are used to treat both issues. Only treating one disorder may actually worsen the other.

Research shows that Inpatient rehab facilities are more effective than outpatient programs at treating individuals with a dual diagnosis.

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Types of Therapy

Co-occurring disorders can occur in a variety of combinations and intensities. Therefore, each case requires individualized attention. In nearly all cases of dual diagnosis treatment, the patient will undergo behavioral therapy.

Common behavioral therapy techniques used in the treatment of co-occurring disorders include:

  • Cognitive Behavioral Therapy (CBT) — focuses on changing a patient’s thought patterns to promote healthy behaviors and sobriety.
  • Dialectical Behavioral Therapy (DBT) — uses CBT methods but concentrates on the social aspects of treatment. Patients are encouraged to work through issues they may have with their counselor and peers in new, healthy ways.
  • Individual Psychotherapy — also known as “talk therapy,” involves one-on-one meetings with a counselor that will help a patient work through their problems and progress towards a happy, sober life.
  • Integrated Group Therapy — was created specifically for individuals with bipolar disorder and an SUD. This focuses on treating both disorders simultaneously by teaching symptom recognition and skills to sustain mood stability and relapse prevention.

Treatment plans may also include medications. However, some medicines can intensify certain disorders, so prescriptions must be used with extreme caution, and always only as directed by a doctor.

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Treatment Timeline

The timeline for recovery varies widely, depending on several factors. These include the types of comorbid disorders, the intensity of symptoms, and the physical and mental health status of the patient, among others.

There are five commonly referenced stages that all patients must go through for dual diagnosis treatment, including:

  1. Evaluation — The first thing a patient will undergo is a screening and clinical assessment. This includes an interview and urine test. The evaluation will determine the patient’s treatment plan.
  2. Detoxification — The next step is to detox the body and allow it to get used to working without alcohol or drugs. Depending on the severity of the addiction, this may require medical supervision.
  3. Psychological and Medical Treatment — Therapy, medical treatments, and counseling will follow.
  4. Transition — Patients will then take what they’ve learned during treatment and begin to practice their new behavior and skills in real-world situations.
  5. Maintenance —Aftercare helps people maintain a sober life. This may last for years or continue for the rest of a person’s life.
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How to Prepare for Dual Diagnosis Rehab

Deciding to enlist in a recovery program can be daunting. After all, you’ll be making big life changes. However, it is a courageous and admirable choice.

Below are three tips that will help you prepare for your recovery:

Take care of your obligations

Tying up loose ends at work, setting your bills to autopay, and communicating with your family will help calm your nerves and increase your chances of success. Speaking about your decision may be uncomfortable at first, but gaining the encouragement from friends and family will only make your support system stronger.

Pack the essentials

You will only need the essentials for your treatment. These include:

  • Current medications and prescription cards
  • Government issued ID
  • Emergency contact information
  • Medical insurance card
  • Comfortable clothing and shoes
  • Personal hygiene products
  • Credit or debit card

It is advisable to pack a few comfort items that will give you strength and hope while you recover. These may include photographs, books, or an mp3 player. Keep in mind that most facilities don’t allow cell phones, tablets, or computers.

Prepare your mind

The best thing you can do before you check-in is to relax. Try to do an activity that brings you joy and a feeling of calmness. While you’re doing this, adjust your mindset so that you resolve not to quit, no matter how challenging the path may be.

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Costs & Insurance Coverage

Dual diagnosis rehab costs vary greatly depending on the facility, length of stay, and your insurance coverage. The average cost is approximately $6,000 for a 30-day program. Payment options include insurance, financial aid, and monthly financing options.

If you have medical insurance, your plan may cover many treatments. The cost will depend on your insurer, your plan, and the healthcare provider. Most facilities accept:

  • Medicaid
  • Medicare
  • Private insurance
  • State-financed health insurance
  • Military insurance

Going into debt or spending a lot of money on treatment can be scary for some people. However, it helps to look at your recovery as an investment. Addiction costs you both money and your health. People who can remain healthy and sober are in a much better position to take care of their finances.

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How To Find a Good Dual Diagnosis Treatment Center

Finding a dual diagnosis treatment center that provides the services you need, along with personalized care is crucial to making a full recovery.

Here are some questions you should ask to make an informed decision:

  • Does the treatment center have resources to treat co-occurring disorders?
  • Does each patient receive an individualized treatment plan?
  • Do all of the clinicians have proper and current credentials and licenses?
  • Do they provide comprehensive aftercare?

If you or someone you know is struggling with co-occurring disorders, it’s time to get help. Dual diagnosis treatment will provide them with the proper medical care, therapy, and aftercare to help them regain control of their life and future.

Resources

“Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health: Detailed Tables.” Results from the 2018 National Survey on Drug Use and Health, SAMHSA, Aug. 2019, www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf.

NIDA. "Common Comorbidities with Substance Use Disorders." National Institute on Drug Abuse, 27 Feb. 2018, https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders.

Mericle, Amy A et al. “Prevalence, patterns, and correlates of co-occurring substance use and mental disorders in the United States: variations by race/ethnicity.” Comprehensive psychiatry vol. 53,6 (2012): 657-65. doi:10.1016/j.comppsych.2011.10.002

NIDA. "Severe mental illness tied to higher rates of substance use." National Institute on Drug Abuse, 3 Jan. 2014, https://archives.drugabuse.gov/news-events/news-releases/2014/01/severe-mental-illness-tied-to-higher-rates-substance-use.

Drake, Robert E., et al. “A Systematic Review of Psychosocial Research on Psychosocial Interventions for People with Co-Occurring Severe Mental and Substance Use Disorders.” Journal of Substance Abuse Treatment, vol. 34, no. 1, 2008, pp. 123–138., doi:10.1016/j.jsat.2007.01.011.

NIDA. "Common Comorbidities with Substance Use Disorders." National Institute on Drug Abuse, 27 Feb. 2018, https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders.

Brunette, Mary, et al. “A Review of Research on Residential Programs for People with Severe Mental Illness and Co-Occurring Substance Use Disorders.” Drug and Alcohol Review, vol. 23, no. 4, Jan. 2004, pp. 471–481., doi:10.1080/09595230412331324590.

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Updated on: June 24, 2020
Author
Michael Bayba
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Medically Reviewed: March 10, 2020
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Annamarie Coy

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