What Is Dual Diagnosis? Why Integrated Therapy Is Key

Having a substance use disorder and a mental health disorder simultaneously can interfere with how well you function at work, home, school and socially. However, using integrated dual diagnosis therapy, you can overcome obstacles and achieve long term recovery.

What Is Dual Diagnosis Therapy?

A dual diagnosis is given to someone who has a substance use disorder (SUD) and a mental health disorder at the same time. People with a dual diagnosis often have similar risk factors or circumstances in their lives that make it more likely for them to develop co-occurring disorders.

Examples of these risk factors may include:

Family history of a SUD or mental health disorder
Stressful home or work environment
Post traumatic stress
Chronic illness
Unstable relationships with family, significant others or friends

To receive a dual diagnosis, a licensed professional must conduct an evaluation that includes a thorough personal, psychiatric, family and substance use history, a mental status exam and standardized assessment tools, such as the PHQ-9 or GAD-7.

It may also include a physical examination or diagnostic testing, including blood work.

A person must meet the specific criteria for a substance use disorder and a mental health disorder as established in the Diagnostic and Statistical Manual for Mental Disorders, 5th Edition (DSM-5), for a proper diagnosis.

Criteria for a substance use disorder diagnosis

You take the substance in larger amounts or over more extended periods than was intended.
You want to quit, but your efforts are unsuccessful.
You spend a great deal of time obtaining, using or recovering from substance use.
You have cravings or a strong desire or urge to use a substance.
Your substance use keeps you from fulfilling significant duties at work, home or school.
You continue to use despite having persistent or recurrent social or interpersonal problems.
You give up important social, occupational or recreational activities because of substance use.
You use it in dangerous situations.
You continue to use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
You develop a tolerance to the drug.
You experience withdrawal symptoms when you stop taking it.

According to the DSM-5, meeting one to two criteria indicates a mild SUD, meeting three to five criteria is a moderate SUD and meeting more than six criteria indicates a severe SUD.

Mental Health Disorder Criteria

Common mental health disorders, including depression, anxiety, post-traumatic stress eating disorders, behavioral disorders and neurodevelopmental disorders all have their own unique set of criteria, listed in the DSM-5, that must be met before an individual receives a diagnosis.

Common Pairings

Some substance use and mental health disorders are more commonly diagnosed together.

For example, autism-related disorders are less common than depressive types to have co-occurring substance use disorder. Whereas someone who has anxiety may develop a substance use disorder after attempts to self medicate become problematic.

According to a recent National Survey on Drug Use and Health (NSDUH), 21.5 million Americans have a co-occurring disorder. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports the most common mental health disorders and most commonly misused substances include:

Most Common Mental Health Conditions	Most Commonly Misused Substances
Anxiety and Mood Disorders	Alcohol
Schizophrenia	Tobacco
Bipolar Disorder	Opioids
Major depressive disorder	Stimulants
Conduct disorders	Marijuana
Post traumatic stress disorder	Hallucinogens
Attention deficit hyperactivity disorder	Prescription drugs

How One Affects the Other

A person with a mental health disorder can experience unpleasant and sometimes debilitating symptoms if their illness is left untreated. They may try to cope with those symptoms through self-medication, which means they are misusing alcohol, prescription drugs or illicit drugs to ease their symptoms.

Over time, a person’s brain chemistry changes because of the continued exposure to the substance, leading to a potential intensification of their mental health disorder or the development of a substance use disorder. Thus, starting a cycle where recovery can be difficult.

Integrated Treatment

Integrated treatment is the most effective way to help someone with a dual diagnosis. This means treating both the SUD and the mental illness simultaneously. Integrated treatment may include several types of therapies, including:

Medications

In some cases, the use of medication can help treat one or both conditions. For example, selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are commonly used to treat depression and anxiety disorders.

Individuals with alcohol use disorder often benefit from FDA approved medications, including. acamprosate, disulfiram, and naltrexone. Additionally, individuals with an opioid use disorder may use the FDA approved medications such as buprenorphine, naltrexone and methadone to help sustain their sobriety.

Medication can be a valuable component of an individualized treatment plan; however, its use is not indicated for everyone.

Behavioral Therapies

Behavioral therapies, including cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), contingency management (CM), exposure therapy (ET) or seeking safety (SS), and motivational interviewing (MI), are extremely helpful forms of therapy for a person struggling with a dual diagnosis.

Family-Based Interventions

The family is an essential part of recovery. Multiple types of family therapy interventions exist to educate family members on specific disorders, help them to create a healthy environment for recovery, improve communication and develop healthy coping skills and boundaries.

Examples include multi-system family therapy (MSFT) and functional family therapy (FFT).

Holistic Therapies

To ensure healing occurs in the mind, body and spirit, holistic therapies are often included in an integrative treatment plan. Examples of holistic therapies may include acupressure, yoga, exercise, nutrition, massage, relaxation therapy, art therapy or equine therapy.

Seeking Help Early

The longer a substance use disorder or mental illness goes untreated, the worse the symptoms may become. Therefore, seeking treatment for co-occurring disorders is critical for sustained recovery.

If you have a dual diagnosis or want to learn more about treatment options for co-occurring disorders, help is available. Explore the Therapy.com directory of treatment providers to find a therapist in your area specializing in dual diagnosis care.

Dual Diagnosis Therapy FAQs

Do I Have a Dual Diagnosis?

While only a licensed professional can diagnose, having a dual diagnosis refers to a condition where an individual has both a substance use disorder and a mental health condition at the same time. Seeking professional help can provide you with the appropriate diagnosis.

Why Do People Develop a Dual Diagnosis?

Several risk factors lead to the development of a dual diagnosis. Interestingly, substance use disorder and some mental health disorders have common risk factors, including genetics, brain chemistry, trauma, stress or unstable home environments.

In some cases, a person with a mental health disorder will self medicate their symptoms through the use of alcohol or drugs. Although this may temporarily relieve the symptoms, this can quickly develop into a substance use disorder, creating a cycle where one condition worsens the other.

Can a Dual Diagnosis Be Treated?

Both mental health and addiction are treatable. Integrated dual diagnosis treatment with licensed professionals is the most effective way to combat both conditions. Through an individualized treatment plan utilizing a wide range of therapies, long term recovery is possible.

What Is Dual Diagnosis? Why Integrated Therapy Is Key to Recovery