Dual Diagnosis: What You Need To Know

Last updated: April 2020

Date of Interview: September 27, 2019

Author bio: Senior Psychotherapist Lindsey Kimball received her master’s degree in mental health from Caldwell University. Her clinical background includes the assistance of individuals with a variety of conditions ranging from incarceration to brain injury. She believes in the process of forming a safe space for healing that is unique to the individual, and based on a foundation of trust and collaboration.

If you look at individuals who have an addiction, it is easy to assume that the addiction and substance use and abuse is the sole cause of all their problems. Yet statistics prove that this is rarely the case. Most people with a substance abuse problem have an underlying mental illness that is detrimental in driving their addiction and vice versa. When the two conditions exist simultaneously, it is referred to as dual diagnosis.

The following information is intended to offer counselors a comprehensive overview of dual diagnosis to better serve their clients.

Dual Diagnosis: Why It's Important

Consider the following scenario: A person enters an outpatient program for an addiction to opioids. He or she successfully completes psychotherapy, group therapy and the 12-step recovery program. However, once the individual has eliminated the substance, the patient rediscovers what initially drove him or her to opioids — debilitating depression. It is an unfortunate truth that most people in a similar situation will resume substance use because one problem is completely intrinsic in the other.

If both addiction and the co-occurring disorder are not correctly diagnosed at one time, they are also improperly and ineffectively treated. For instance, an addiction counselor may fail to understand why his or her client is so incapacitated by anxiety and only treat issues relative to the addiction — without tending to the anxiety disorder. The patient would then have a harder time achieving full sobriety because all of his or her needs are not being addressed and met.

The Statistics Behind Dual Diagnosis

There are multiple factors that can make an individual more at risk of having co-existing substance abuse and mental health disorders, such as exposure to drug use in early childhood, traumatic events or even genetics. Regardless of the underlying reason, some people develop both problems, dual diagnosis is more common than what many people really understand.

Different Methods for Treating Dual Diagnosis

When entering a dual diagnosis treatment program, patients must be assessed on an individualized level to determine:

  • What co-existing conditions are present
  • How the two conditions affect each other
  • What methods should be used to address both issues concurrently

There can be multiple levels and types of treatment, and treatment must be individualized to the patient’s unique needs:

  • Detox: Initial detox is the process patients go through as the substances they have been using leave the system. Some treatment centers provide medication to curb withdrawal. This method can be especially effective for dual diagnosis patients who may be more at risk of certain symptoms like irritability or irrational thinking during detox.
  • Inpatient rehab: Inpatient rehab involves living in a treatment facility full time while receiving all of the mental health and medical care necessary. Inpatient rehab is best for those with the most extreme circumstances.
  • Psychotherapy sessions: Psychotherapy is one of the biggest elements in any dual diagnosis treatment plan — whether it is an inpatient or outpatient program. Psychotherapy can involve tools such as cognitive behavioral therapy, which is a form of therapy aimed at evolving poor behavior patterns that can exacerbate mental health or substance abuse issues.
  • Outpatient rehab: Outpatient rehab can be just as effective for patients with dual diagnosis as inpatient, if done properly. Most outpatient centers offer some of the same levels of care, such as psychotherapy and group or family support meetings. Medication-assisted treatment is also a key component in many outpatient dual diagnosis programs.

Outcomes of Dual Diagnosis Treatment

Patients given a dual diagnosis have more trials to face than the average individual with only an addiction. Therefore, treatment can be increasingly challenging, and successful outcomes only occur with the help of a good program and diligence on behalf of the patient. However, most people who meet those two factors do see a positive treatment outcome. They may go on to live sober lives just the same as others who enter treatment with only a substance abuse problem.

The Difference Between Normal Treatment and Dual Diagnosis Addiction Treatment

Anytime there is more than one mental illness present, treatment must be more intensive and broadly designed to tend to multiple issues and types of problems. Not all addiction treatment providers are capable of treating co-occurring conditions.

Some of the primary differences between dual diagnosis and regular treatment include:

  • A more comprehensive treatment program must be created.
  • Dual-diagnosis treatment can be more strenuous on the patient and success requires more patient commitment.
  • Additional facets of treatment may be involved (i.e., medication-assisted treatment or specific types of therapy).

It is critical for patients with co-occurring disorders to seek a qualified dual diagnosis treatment facility if they need help with addiction combined with another mental illness. Treatment for only one problem lowers the chances of seeing complete sobriety. Issues can be so tightly intertwined that it's hard to tell where one condition ends and the other begins. To achieve a healthier, happier life, tending to both problems at once is often necessary.