Dual Diagnosis, Integrated Treatment or Co-occurring: What’s the Difference?
By Kathryn Millán, MA, LPC/MHSP
Neuroscience and psychology are rapidly changing fields. Every day, new research helps us understand more about the processes and biology behind mental health and addiction, so it is only natural that the terms we use to diagnose and treat them evolve as well. “Dual diagnosis” and “co-occurring disorder” are two terms that are relatively new to the world of addiction treatment.
Doctors began identifying dual diagnosis in patients more clearly in the 1980s, and the term became more popular throughout the nineties.1 Today, clinicians now prefer the newer term, “co-occurring disorder,” although both terms describe a similar condition.2
What is a Dual Diagnosis?
A dual diagnosis occurs when a person suffers from two disorders at once. This diagnosis typically includes a substance use disorder and a mental health condition that occur at the same time. For instance, a person may struggle with both alcohol use disorder (alcoholism) and bipolar disorder at the same time. There are many possible combinations of dual diagnoses.
It is actually quite common to see a mental health disorder and a substance use disorder occur at the same time. The National Alliance on Mental Illness (NAMI) found that as many as 50 percent of people who have diagnosed mental health conditions also struggle with addiction. They have even found that nearly 29 percent of all people with a mental health diagnosis eventually abuse drugs or alcohol, possibly as an attempt to cope with their condition.3 Similarly, six out of 10 people with a substance use disorder also have a mental health disorder.4
What is a Co-occurring Disorder?
The term “dual diagnosis” can be limiting. Often, people don’t just have two neatly diagnosable ailments at once. It is very possible to have multiple conditions at the same time. For instance, post-traumatic stress disorder could complicate the recovery of a person who has both substance use disorder and anxiety. It is very common to have more than one psychiatric condition at the same time. In fact, newer studies show that up to 45 percent of people with mental health diagnoses actually have two or more conditions.5
The addition of a third, or even fourth, diagnosis can change the treatment needs of any patient. The presence of more than one condition can make recovery more challenging, as one condition often aggravates the others. Co-occurring disorders are more difficult to treat than single diagnoses, and people with multiple conditions are at higher risk of relapse.2 Without proper treatment, a person may experience worsening symptoms over time.
The Substance Abuse and Mental Health Services Administration (SAMHSA) found that an estimated 7.9 million adults in the US have co-occurring disorders, which affect people of every background and geographic setting.6 These disorders are often misdiagnosed because they can be quite complex and appear unique to each patient.2 Therefore, it is very important to seek treatment with a reputable provider that has extensive experience in recognizing and treating co-occurring disorders.
Integrated Treatment for Co-Occurring Disorders
In the past, people struggled to find both addiction treatment and mental health treatment in one safe, supportive environment. Often, patients were pushed from substance use treatment centers to psychiatric wards, where they were treated for only one ailment at a time. This highly ineffective process delayed healing and often left patients feeling misunderstood, disempowered or still in the trap of a dangerous illness. Leaving one or more conditions untreated often has a negative effect on the other disorders and can worsen the entire quality of life for the addicted person. Integrated treatment was developed to help patients manage all conditions in real-life situations on a daily basis.
These specialty programs understand that it is common for mental health issues and substance use disorders to occur at once. Modern, evidence-based treatment providers understand that co-occurring disorders require more in-depth treatment that will address all issues and prevent relapse through aftercare, ongoing support and targeted treatment for all symptoms.7
This type of treatment for co-occurring disorders integrates, or joins, several types of treatment into one comprehensive wellness plan. It looks at all co-occurring diagnoses and aims to treat each problem under the same roof. This may include a combination of talk therapies, medical management of symptoms, specialized trauma treatment and/or case management.
Integrated treatment is effective because co-occurring disorders often react with or trigger each other. If one condition is left untreated, other conditions may become worse. Often, multiple disorders are woven together through time and experience, and any patient can benefit from the treatment of all disorders simultaneously.
It also often involves a full interdisciplinary treatment team of doctors, counselors, case managers, support staff, coaches and certified peer recovery specialists. These specialists are trained to understand and treat addiction and mental illnesses that often operate in a cycle. This team approach is designed to offer wellness planning and support for every area of life, so that each person can successfully navigate the stresses and challenges of everyday life, even after treatment is complete.
Integrated treatment is an effective method for recovery from co-occurring disorders. It is important to ask your chosen treatment program more about these conditions and ways to heal from both addiction and mental illness. We can help you find the right treatment fit. Just call our confidential helpline seven days a week, 24 hours a day. Trained professionals are on hand to answer any questions you have about treatment.
1 Gorman, C. “Bad Trips for the Doubly Troubled.” TIME Magazine. 3 August 1987. Accessed 2 Aug 2017.
2 Substance Abuse and Mental Health Services Administration. Co-occurring Disorders. Mar 2016. Accessed 2 Aug 2017.
3 White, D. Living with Co-occurring Mental & Substance Abuse Disorders. October 2013. Psych Central. Accessed 2 Aug 2017.
4 Volkow, N. Addiction and Co-occurring Mental Disorders. National Institute on Drug Abuse. 2007. Accessed 2 Aug 2017.
5 Kelly, Thomas M., and Dennis C. Daley. Integrated Treatment of Substance Use and Psychiatric Disorders. Social Work in Public Health. 2013: 388–406. PMC. Web. Accessed 2 Aug 2017.
6 Somers, J., Moniruzzaman, A., Rezansoff, S., Brink, J. The Prevalence and Geographic Distribution of Complex Co-occurring Disorders: a Population Study. Epidemiology and Psychiatric Sciences, Volume 25, Issue 3 June 2016, pp. 267-277. Accessed 2 Aug 2017.
7 Pettinati, H., O’Brien, C., Ph.D. Dundon, W. Current Status of Co-occurring Mood and Substance Use Disorders: A New Therapeutic Target. The American Journal of Psychiatry. Vol 170, Issue 1, Jan 2013, pp. 23-30. Accessed 2 Aug 2017.Contact Us