Treatment For Dual Diagnosis

How Is A Dual Diagnosis Treated?

Having both a substance use disorder (SUD) and a mental health disorder, known as dual diagnosis or co-occurring disorder, can be challenging to treat. Treating one while neglecting the other is ineffective and can lead to a high risk of relapse. For treatment of both an addiction and a mental health disorder to be effective, it must address both illnesses simultaneously.

Integrative care is the gold standard of treatment for dual diagnosis. It uses the same team of mental health and addiction treatment providers to work together and treat both disorders simultaneously in the same clinical setting. Treatment medications and psychotherapy approaches are both used in this integrative treatment approach.

Integrative treatment addresses the underlying triggers and pathology of both disorders, as they are often closely interconnected. People with mental health disorders may be more biologically sensitive to the effects of mood-altering substances. They may use alcohol or other drugs to cope with mental health symptoms or to counter social anxiety.

Substance misuse and addiction can change brain chemistry and alter neural circuits, increasing a person’s vulnerability to mental health disorders. Genetic predisposition, chronic stress, and traumatic experiences also raise the risk for both mental health conditions and addiction. Integrative treatment helps identify and address these underlying factors, offering a more comprehensive approach to dual diagnosis care.

How Is Dual Diagnosis Treatment Different?

The difference between an addiction treatment program and dual diagnosis treatment is the short-term goal. Addiction treatment’s primary goal is to treat the acute SUD, while dual diagnosis treatment focuses on the larger goal of treating any underlying causes that contribute to the mental health and substance use disorders.

Addiction treatment programs help people stop drinking or using drugs by providing a detox program where patients can safely withdraw using medically assisted treatment, followed by a formalized treatment program. The addiction treatment program enforces rules and expectations by providing therapy techniques so patients can learn positive coping skills to help resist urges and maintain sobriety. Addiction treatment programs are tailored for people with a primary substance use disorder, and once these people detox and stop using, the symptoms of depression or anxiety related to their SUD will subside.

Comparatively, dual diagnosis treatment focuses on treating the addiction through detox and medically assisted treatment while also utilizing psychotherapy and medications to treat the co-occurring mental health disorder. The goal of dual diagnosis treatment is not only detox and sobriety but also treating the symptoms of the mental health disorder by incorporating antidepressant or anti-anxiety medications as well as cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) to improve overall mood and mental health.

This dual diagnosis approach is beneficial because if individuals with a dual diagnosis are solely treated for their substance use disorder without treating their mental health disorder, their mental health symptoms will progressively worsen once the individual stops drinking or using drugs.

This is because many people who have a dual diagnosis often start misusing drugs to self-medicate their mental health disorder, so when they go into sobriety, their mental health disorder is exposed, uninhibited, and untreated, with symptoms in full effect. Because of this, they have a very high risk of relapse.

In dual diagnosis treatment, the substance use disorder is treated as a part of a larger picture associated with unhealthy thoughts, emotions, mood, and behaviors that are seen in the mental health disorder.

Why Is Dual Diagnosis Treatment Important?

Dual diagnosis treatment is important because it addresses the interconnectedness of both the substance abuse and the mental health disorder from a whole-person approach, with the potential for the best outcomes and reduced relapse risk.

Dual diagnosis can be difficult to diagnose because a SUD, such as cocaine abuse, can mask symptoms of a mental health disorder. Conversely, a person may experience heightened levels of anxiety symptoms but fail to connect them to their cocaine use. As a result, only one disorder is often diagnosed and treated.

Misdiagnosis can lead to incorrect treatment and also worsen underlying symptoms, increasing the risk of relapse and overdose. Misdiagnosis can happen because certain drugs can mimic mental health disorders, and some people may be embarrassed to admit their drug use due to the stigma associated with addiction.

An individual needs to develop a healthy, trusting relationship with their healthcare provider to ensure an accurate diagnosis. Both the substance use disorder and the mental health disorder must be treated simultaneously to address underlying triggers, prevent symptom re-emergence, and reduce the risk of relapse.

Elements Of Dual Diagnosis Treatment

When dual diagnosis is present, receiving treatment for only one disorder often leads to incomplete recovery. Therefore, dual diagnosis treatment uses an integrative approach combining medication and psychotherapy.

Medication-assisted therapy (MAT) is an important piece for integrative treatment for dual diagnosis. Medications are also commonly used to treat mental health disorders, so it may be common to use different medications simultaneously.

Psychotherapy approaches address underlying triggers, negative thought patterns, and unhealthy behaviors that affect a person’s mental health. They help teach patients healthy coping and interpersonal skills to succeed in recovery. Therapy addresses the psychological aspects of both the SUD and the mental health disorder, and usually both group therapy and individual counseling are used in dual diagnosis treatment.

For example, suppose someone with an opioid use disorder (OUD) also has co-occurring depression. In that case, a dual diagnosis treatment provider may use methadone or Suboxone to treat the OUD while also starting a selective serotonin reuptake inhibitor (SSRI), a common class of antidepressants, to treat the depression. A common psychotherapy approach that is used to treat depression as well as addiction includes CBT, so this could be added to these medications as part of the integrative treatment approach.

Different medications and therapy approaches are used depending on the specific addiction and mental health disorder. Still, psychotherapies can overlap as they can treat both the addiction and the mental health disorder. For example, a person diagnosed with an anxiety disorder and an alcohol use disorder with a history of trauma may benefit from trauma-informed therapy and motivational interviewing, or cognitive behavioral therapy and trauma-informed therapy, in addition to medications.

Treatment plans differ depending on the specific substance that is being abused and the specific mental health disorder. Other factors to consider include the specific training and experience therapists have with different psychotherapy modalities, as well as which modalities and medications work best for each patient. A patient may need to try different combinations and approaches before seeing improvement.

Therapy In Dual Diagnosis Treatment

Therapy plays a significant role in dual diagnosis treatment, including:

• Cognitive Behavioral Therapy (CBT): CBT helps individuals identify negative thought patterns and behaviors that contribute to both mental illness and substance abuse, and changes these thoughts and actions into healthy coping strategies. CBT is used to treat both addiction and mental health disorders.
• Dialectical Behavior Therapy (DBT): Derived from CBT, DBT emphasizes mindfulness and emotional regulation, as well as improving interpersonal relationships and managing distress. DBT is known to be effective for both addiction and mental health disorders.
• Trauma-Focused Therapy: Trauma-focused therapy is Important for individuals who have underlying trauma associated with their dual diagnosis. Common types of trauma therapy include EMDR, exposure therapy, and trauma-focused CBT.
• Motivational Interviewing (MI): MI is a therapeutic technique used to help treat addiction in patients by strengthening their motivation and commitment to their sobriety. When people feel they are in control of their recovery, it encourages them to continue setting goals and remain self-motivated.
• Contingency Management (CM): CM leverages the principles of “operant conditioning,” which is essentially the idea that individuals can be trained to act in certain ways if they are rewarded or punished following either compliant or aberrant behavior. CM focuses on rewarding individuals to positively reinforce the progress they make during their addiction recovery journey. This often entails giving tangible rewards for urine drug tests. Common rewards include gift cards, cash, and movie vouchers.

Medications For Dual Diagnosis Treatment

Medications are primarily used to alter neurotransmitters in the brain to treat mental health disorders and manage detox and maintenance treatment for SUDs. Common medications include:

• Antidepressants for mood and anxiety: Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are the most common medications to treat depression and anxiety disorders. They work by increasing levels of serotonin and/or norepinephrine, which are neurotransmitters that play a major role in mood regulation.
• Antipsychotics for bipolar disorder and schizophrenia: Common antipsychotics that are used to treat bipolar disorder and schizophrenia include quetiapine, aripiprazole, risperidone, and olanzapine.
• Benzodiazepines: Benzodiazepines are used to treat benzodiazepine and alcohol dependency, specifically in the detox phase, as they help alleviate uncomfortable and dangerous withdrawal symptoms associated with alcohol and benzodiazepine dependence. Benzodiazepines are also prescribed short-term to treat certain anxiety disorders, particularly for acute panic attacks, severe social anxiety, or intense anxiety symptoms. They are often used as a temporary “bridge” while waiting for antidepressants or other long-term treatments to take effect.
• Naltrexone: Naltrexone is an opioid antagonist that is FDA-approved by prescription for long-term management of OUD and alcohol use disorder (AUD). It works by blocking the euphoric effects of opioids on the brain.
• Buprenorphine: Buprenorphine is a partial opioid agonist drug effective in providing comfort during medically supervised opioid withdrawal, and as a maintenance treatment for OUD. It has a ceiling effect (the higher the dosage, the desired effects will max out), meaning it has a low potential for overdose and addiction, which makes it a generally safe and effective treatment medication for OUD.
• Suboxone: Suboxone is a combination of buprenorphine and naloxone used to treat OUD and can also help in opioid detoxification, once acute withdrawal symptoms have already started. Naloxone is an opioid antagonist and reverses the dangerous symptoms of opioid overdose. The inclusion of naloxone with buprenorphine is to assist with long-term recovery goals by making it difficult to abuse buprenorphine.
• Methadone: Methadone is a long-acting opioid that is used in OUD treatment and opioid detox to help ease withdrawal effects and reduce relapse.
• Disulfiram: Disulfiram is FDA-approved to treat alcohol use disorder. It works by interfering with the body’s digestion and absorption of alcohol, triggering a series of highly unpleasant reactions. When an individual who is taking disulfiram consumes alcohol, they will begin to experience hangover-like side effects.
• Acamprosate: Acamprosate is FDA-approved to help treat alcohol use disorder. It is associated with a reduction in alcohol cravings and an increased rate of abstinence because it impacts the glutamate and gamma-aminobutyric acid (GABA) systems in the brain.

Ongoing Dual Diagnosis Support

Support groups provide significant benefits and opportunities for those in recovery when used as an adjunct to dual diagnosis treatment. These include common communities such as

• Alcoholics Anonymous (AA)
• Narcotics Anonymous (NA)
• Double Trouble in Recovery (DTR)

Double Trouble in Recovery is an organization designed specifically for those suffering under the weight of a dual diagnosis, recognizing the unique challenges those with comorbid illnesses face. Based on the 12-step method, DTR emphasizes the importance of community and the strength of a unit in supporting each other as they overcome the obstacles of battling two illnesses. Building connections with others who have shared similar experiences can be immensely healing.

How Do I Choose A Dual Diagnosis Treatment Center?

When looking into dual diagnosis treatment, a person can ask the center questions like:

• Are individualized treatment plans available?
• Is therapy structured to treat a dual diagnosis?
• Are the disorders considered interconnected health issues, or are they seen as separate illnesses?
• How is relapse handled?
• Do they offer aftercare referral services?

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Find Dual Diagnosis Treatment

When dealing with dual diagnosis, it’s important to remember that you are not alone, and help is available for both your mental health and substance abuse struggles. Contact a treatment provider or visit our rehab directory today to explore your treatment options.