When someone has a dual diagnosis of substance use disorder (SUD) and a mental health disorder, this means they have co-occurring disorders that require simultaneous treatment. These patients require integrated treatment for co-occurring disorders to ensure that both their SUD and their mental health disorder are addressed.
For example, someone in treatment for opioid addiction may also be diagnosed PTSD as well as major depressive disorder. Another person who is recovering from alcohol abuse might also have an eating disorder and an anxiety disorder.
It is not fair for individuals who are receiving care for their substance abuse disorder to have their other disorders swept to the side. Co-occurring disorders are often intertwined and affect one another. The individual with the eating disorder may have undergone trauma, which is a major reason why they chose to start drinking, which ends up making the eating disorder symptoms worse. SUDs and mental health disorders are interconnected and they need to be treated as such. Inpatient treatment for co-occurring disorders is available.
The Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5), which is what all psychiatrists have used to diagnose mental illnesses since 2013, gives names, symptoms, and diagnostic features of each disorder.
The DSM-5 covers 11 different criteria to diagnose substance use disorders:
1. Taking the substance in larger amounts or for longer than you’re meant to.
2. Wanting to cut down or stop using the substance but not managing to.
3. Spending a lot of time getting, using, or recovering from the use of the substance.
4. Cravings and urges to use the substance.
5. Not managing to do what you should at work, home, or school because of substance use.
6. Continuing to use, even when it causes problems in relationships.
7. Giving up important social, occupational, or recreational activities because of substance use.
8. Using substances again and again, even when it puts you in danger.
9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
10. Needing more of the substance to get the effect you want (tolerance).
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.
Individuals do not have to meet all 11 criteria. Two or three symptoms indicate a mild substance use disorder; four or five symptoms indicate a moderate substance use disorder, and six or more symptoms indicate a severe substance use disorder.
Did the chicken come before the egg or the other way around?
This question is often asked when working with patients in a co-occurring disorders program. Was there a mental health disorder, such as generalized anxiety disorder, that ultimately led to a SUD? Or did genetics play a role in the onset of a SUD that then consequently developed into mental health disorders as well?
Both can occur.
Multiple national population surveys have found that about half of those who experience a mental illness during their lives will also experience a substance use disorder and vice versa, .
Throughout someone’s lifetime, the mixture of biological factors and environmental factors create who they become. This includes physical and mental disorders that become triggered due to changes in gene expression.
Co-occurrence of a SUD and mental health disorder is not the fault of anyone or anything—they happen for a multitude of reasons.
Mental health disorders that are commonly diagnosed with a substance use disorder include:
That is not to say that other mental health disorders cannot occur in someone with a substance use disorder. Co-occurring disorders and conditions can vary from person to person. No one suffering from addiction is the same as another. Alcoholism and co-occurring disorders along with other substances are commonly seen in treatment facilities.
Co-occurring disorder treatment starts with key integrated screening.
Key integrated screening occurs when a patient is in the pre-admissions and intake processes. To begin treatment at an inpatient facility, psychiatrists and psychologists, and medical physicians will screen and assess for mental health disorders along with determining the severity of the substance use.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA):
Integrated treatment coordinates mental and substance use interventions by linking people to other providers who can deliver individualized and personalized services to treat the physical and emotional aspects of mental and substance use disorders. There are three models for delivering care for co-occurring disorders: coordinated, co-located, and fully integrated. With integrated care, a more complete recovery is possible.
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.
Integrated care is the best option for the most successful outcome in a patient with co-occurring disorders.
Co-occurring disorders treatment centers are all over the country and greatly benefit those who struggle with mental health disorders as well as SUDs. Dual diagnosis recovery is a blessing for many while they get intervention for everything they need to treat.
A dual-integrated treatment plan typically includes multiple therapeutic techniques such as the following:
Dual diagnosis recovery isn’t much different than going through a typical substance abuse program.
What is a co-occurring disorder?+
What are some co-occurring disorders?+
What is co-occurring disorders treatment?+
What does research on co-occurring disorders show us?+