In treatment centers around the country, addiction professionals support people diagnosed with a wide variety of substance use and mental health disorders. To help clients take the first, critical steps on the road to long-term, sustainable recovery, the most reputable, highest quality treatment centers apply a time-tested, research-proven clinical approach that yields results. It’s called the integrated model of treatment. Integrated treatment is complex. It involves clinicians with training and experience in multiple mental health disciplines and diverse treatment protocols.
Only clinicians with extensive experience treating people with substance use disorders – whether they occur alone or in conjunction with a mental health disorder – are qualified to offer comprehensive, integrated treatment.
The key to successfully supporting anyone who seeks help for a substance use disorder or a mental health disorder is starting the treatment process with a comprehensive mental health and substance use evaluation. It’s essential that these evaluations are performed by licensed and credentialed professionals.
In a high-quality integrated treatment center, clinicians should spend time learning everything they can about you. They need to listen, observe, and develop a real sense of what’s important to each individual. This helps them understand their goals for the future. When they have an idea about what might resonate with a patient – based on what they learn and their clinical experience – they design an integrated treatment plan that focuses on strengths and addresses areas of difficulty. High-quality treatment centers combine the most effective modes of therapy to help every individual achieve their personal vision of recovery.
While almost all treatment programs begin with a core approach that revolves around individual and group psychotherapy and counseling, there’s more to treatment than those modalities. People in treatment may also engage in complementary therapies like yoga and mindfulness. They may attend traditional peer support group like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). Some will engage in simple recreational activities like exercise classes, walking, or hiking. Many treatment centers also offer expressive therapies like music, visual art, and writing.
One thing the most reputable treatment centers have in common is this: if it’s based in evidence published in respected peer review journals, and it works, they use it. New or old, if an approach is evidence-based, it becomes one option among many.
Substance Use Disorder and Co-Occurring Mental Health Disorders: The Essentials
The science is in.
The disordered use of substances – what we used to call addiction – is now recognized as a chronic medical condition. The old, common stereotypes related to addiction we grew accustomed to seeing in movies and television – the executive abusing cocaine to keep pace with a demanding career, the criminal drug dealer getting high on their own supply, the homeless crack addict stealing to buy one more hit – are misleading, harmful, and contribute to the cultural stigma associated with individuals struggling to overcome alcohol, substance use, and other mental health disorders.
Those stereotypes don’t show us something we all need to know. Substance use disorder (SUD) is a treatable mental health condition. It’s often accompanied by other treatable mental health conditions. When an individual is diagnosed with two or more mental illnesses at the same time, mental health professionals call them co-occurring disorders. This phenomenon is also called dual diagnosis or co-morbidity.
There are several mental health disorders that commonly co-occur alongside substance use disorders. These include, but are not limited to:
- Trauma related disorders, such as post-traumatic stress disorder (PTSD)
- Depressive disorders, including major depressive disorder (MDD) and bipolar disorder (BD)
- Anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder (PD), and obsessive-compulsive disorder (OCD)
- Eating disorders
In many cases, substance use and mental health disorders are treated separately. Unfortunately, this reduces the chance of successful recovery from both. Finding a treatment center capable of treating substance use and mental health disorders simultaneously – meaning a treatment center that offers integrated treatment for co-occurring disorders – is the first step on the road to real, sustainable recovery.
Co-Occurring Disorders: The Diagnosis Challenge
Which comes first, the substance use disorder or the mental health disorder?
Some drugs of misuse and disordered use can mimic symptoms of a mental health disorder or even lead to the development of a separate mental health disorder. The reverse is also true. Some mental health disorders may cause individuals to self-medicate with alcohol or drugs. This can result in an alcohol or substance use disorder in addition to their original mental health condition. Determining precisely where and when the cycle started can be very difficult.
Does a person drink too much because they’re clinically depressed, or do they become clinically depressed because they drink too much? Does a person develop a psychosis because they smoke too much cannabis, or do they smoke cannabis to relieve the symptoms of psychosis? Is a person riddled with anxiety because they use amphetamines, or do they use amphetamines to alleviate their pre-existing anxiety?
Those questions illustrate the diagnostic challenges associated with co-occurring disorders.
When a person enters treatment for a substance use disorder, getting to the bottom of the questions we list above is an important priority. To untangle the puzzle of co-occurrence, most treatment professionals agree that first, the individual in treatment needs time without any alcohol or substances in their system. The combination of withdrawal and the lingering effects of substances of misuse can complicate any attempt at diagnosis. In some cases, it can lead to a misdiagnosis. Next, the individual in treatment needs experienced clinicians, trained to understand the complex dynamics of co-occurring disorders.
Then, once a person has a period of sobriety – or total abstinence – behind them, they need to additional evaluations to confirm or exclude the presence of a co-occurring disorder. This step is absolutely essential. Once the symptoms of withdrawal and/or addiction recede, clinicians can ensure they arrive at an accurate diagnosis. With an accurate diagnosis, they can get to work creating a treatment plan that offers the best possible chance of success.
Research shows the type of plan that consistently leads to positive outcomes for people with co-occurring disorders follows the model we mention at the beginning of this article: the integrated treatment model. And if an individual has a serious substance use and/or mental health disorder, treatment at the inpatient or residential level of care increases their chances of success.
Integrated, Inpatient-Residential Treatment for Mental Health, Substance Use, and Co-Occurring Disorders
Data from the National Institute on Drug Abuse indicates that one of the most effective ways to treat serious and disruptive alcohol, substance use, and/or co-occurring disorders is an inpatient or residential treatment program. These programs can be short-term or long-term. Short-term programs typically last several weeks to a month. Long-term programs can last six months or longer. Benefits of receiving treatment away from the home environment include:
- Round-the-clock emotional, physical, and psychological support provided by licensed, trained, professional staff
- Relief from the pressures and responsibilities of work, friends, and family
- A full range of traditional and complementary therapies, including but not limited to individual therapy, group therapy, family therapy, mindfulness techniques, meditation, yoga, and exercise
- Educational classes on the science of addiction and recovery
- An environment conducive to reflection, learning, and growth
- A positive staff and peer community, all focused on one thing: recovery.
- Total immersion in the recovery process
For some individuals, inpatient or residential treatment might not be a viable option. In those cases, intensive outpatient or partial hospitalization programs can offer an extremely high level of care while allowing individuals the time to meet family, educational or vocational responsibilities.
Modes of Treatment for Dual-Diagnosis and Co-Occurring Mental Health Disorders
Treatment for co-occurring disorders may include medication, but almost always includes the following types of psychological/psychiatric therapy:
Cognitive Behavioral Therapy (CBT)
CBT helps people see the world in a new way. It helps them identify counter-productive behaviors and patterns of thought, then replace them with practical life skills, healthy decision-making processes, and healthy coping mechanisms that prevent relapse and promote lifelong recovery.
Dialectical Behavior Therapy (DBT)
DBT helps people with disruptive symptoms characterized by a high level of emotional reactivity. It’s a preferred therapy for people who experience dramatic emotion/mood swings because it focuses on techniques they can use immediately. DBT skills help people effectively manage and process volatile and dangerous thoughts, emotions, and behaviors. A skilled DBT therapist can help people with co-occurring disorders develop the tools they need to change thoughts and behaviors associated with substance use and/ or mental health disorders into productive thoughts and behaviors that promote recovery.
Family Therapy
Family therapy acknowledges that it’s impossible to understand an individual without also understanding the unique dynamics of their current and past family environment and network of relationships. When key family members are on the same page and understand the changes the individual in recovery needs to make, the chance of sustained recovery increases dramatically.
Group Therapy
Group Therapy offers the opportunity for a collection of individuals struggling with similar issues to share stories – both successes and failures – and support one another on their respective recovery journeys. Guided by accredited and licensed professionals, peer group sessions include some of the most honest, real, and practical help and advice in treatment, because it comes from people who’ve experienced recovery firsthand.
Treatment For Co-Occurring Disorders: Putting it all Together
Creating a realistic treatment plan that addresses substance use and mental health disorders is the first step. The second step is applying the plan in a manner that’s fluid, responsive, and adaptive. What works for one person in the first month of treatment might lose meaning as they grow in recovery. And what didn’t work for them in the first month of treatment might help them after six months. These developments are impossible to predict, different for every person, and require the careful attention of experienced clinicians. If something no longer works, good clinicians see it. They consult with the person in treatment and replace it with something that works. A good recovery plan is a template for positive forward growth. People change over time. So do good recovery plans. They change along with the person they support.
For people with co-occurring disorders, an adaptable plan allows therapists to address the interaction between substance use and mental health disorders in a way that helps both and exacerbates neither. That’s the primary challenge with co-occurring disorders. It’s the reason it takes a high-quality treatment center with experienced clinicians to offer a recovery program that helps individuals recover from both their substance use disorder and their mental health disorder. When a plan is in place that addresses both, it dramatically increases the likelihood that an individual will learn to manage both. When that happens, they can live a life not dictated by the symptoms of their disorders but rather guided by their unique vision of a healthy, fulfilling future.