Treatment of Dual Diagnoses

Treatment of Dual Diagnoses

It is not uncommon for people to have a mental illness and a substance use disorder (SUD) occurring together. The coexistence of both disorders is called dual diagnosis or co-occurring disorders. People with a mental illness are more likely to experience a SUD than people without a mental illness. Some of the most common co-occurring disorders include depression, anxiety and bipolar disorder. Around 9.2 million Americans experience dual diagnosis. Although the presence of dual diagnoses can make treatment challenging, there is hope and effective treatment is available.

Warning Signs of Mental Illness and SUD

Sometimes it can be difficult to tell if someone is experiencing a mental illness or SUD. However, people with mental illness and SUDs will often exhibit warning signs that indicate problems requiring professional treatment. Symptoms of a mental illness may vary among individuals, but some key warning signs to look for can include:

  • Withdrawal from friends and family
  • Changes in energy levels
  • Loss of interest in hobbies and activities once found pleasurable
  • Significant changes in appetite or sleep
  • Thoughts of suicide or self-harm
  • Loss of touch with reality in the form of delusions or hallucinations
  • Inability to cope with daily life stressors
  • Difficulty understanding and relating to people and situations
  • Changes in sex drive
  • Unexplained aches, pains, and physical complaints

Warning signs of SUD are sometimes subtle, but they can be obvious at other times. They often include:

  • Unexplained financial problems or need for money
  • Legal issues
  • Continuing to use substances despite negative consequences
  • Unusual odors on a person’s clothing, breath or body
  • A decline in grooming and hygiene
  • Abnormal pupil size and or bloodshot eyes
  • A decline in school or work performance
  • Secretive or suspicious behaviors
  • Sudden change in friends

Why Do Mental Illnesses and SUDs Often Occur Together?

While it is true that these disorders can often occur together, it does not mean that one caused the other. It is also not easy to figure out which came first. Researchers believe that these disorders occur together for three reasons:

  • SUDs can contribute to the development of a mental illness. This is because substance use may cause brain changes that make a person more likely to develop a mental illness.
  • Common factors such as stress, genetics and trauma may contribute to both mental illness and SUD.
  • Having a mental illness may contribute to SUDs due to self-medication. Having a mental illness may also cause changes in the brain that make a person more likely to develop a SUD.

No matter what the chain of causality is, it is vital that both disorders are treated simultaneously to achieve the best possible outcomes.

Challenges Facing Patients With Dual Diagnoses

Treating patients with dual diagnoses is challenging because these patients often have multiple complex needs. Unfortunately, patients who have a dual diagnosis are at higher risk for negative outcomes, like:

  • Homelessness
  • Higher rates of severe infections like HIV
  • Violence
  • Higher relapse rates
  • Incarceration

Women, people of color, people who are homeless, individuals who have been incarcerated and those who have dual diagnoses are especially vulnerable to poor outcomes.

Treating Patients With Dual Diagnoses

The tradition of parallel and separate treatment for mental illness and SUDs is unhelpful for people with dual diagnoses. These systems are confusing and difficult to navigate. In addition, care for these patients can be delayed because they cannot receive help from one linear system. They are instructed to return when they have gotten treatment for the other diagnosis.

The idea that a patient must receive treatment for a substance use disorder before seeking treatment for mental illness is outdated and not best practice. According to SAMHSA, the best practice for treating dual diagnoses is using the Integrated Model of Care. With this model, mental illness and SUD treatment are combined into one or even a series of sessions. Techniques can include:

  • Interventions for patients who have a third problem, such as trauma or a serious medical issue, in addition to substance use and mental disorders
  • Assessments and screening
  • Motivational enhancement techniques targeting the mental illness diagnosis and the SUD
  • Medications for both conditions
  • Talk therapy
  • Support groups

Integrated care can be provided in a variety of settings and at different levels of care. When patients receive integrated care, their mental illness and SUD are treated, and they learn to live with and manage two severe conditions while living healthier, happier lives. In spite of the increased complexity in caring for patients with dual diagnoses, it is important that care is made accessible to all.

It is common for people to experience a mental illness and a substance use disorder (SUD) at the same time. Although a dual diagnosis can make treatment more challenging, help is available at Casa Palmera. Call Casa Palmera at (855) 508-0473 to find out how we can help.


This blog is for informational purposes only and should not be a substitute for medical advice. We understand that everyone’s situation is unique, and this content is to provide an overall understanding of substance use disorders. These disorders are very complex, and this post does not take into account the unique circumstances for every individual. For specific questions about your health needs or that of a loved one, seek the help of a healthcare professional.