Chronic drug abuse and mental health disorders are closely related. Individuals who have psychiatric disorders, such as PTSD, bipolar disorder, or depression, may be more likely to abuse substances, and people who abuse substances may be more likely to have mental health disorders.1 Having at least one mental health disorder in the presence of at least one substance use disorder is known as a co-occurring disorder. Since drug abuse and mental health issues can share common risk factors and influence the course of each other, it’s important to treat both disorders at the same time.1
Dealing with a co-occurring disorder can be challenging and can seriously impact your life. Rehab for co-occurring disorders, also known as dual diagnosis treatment, addresses symptoms of both problems to help you regain control and improve your quality of life.2
What is Co-occurring Mental Health and Drug Abuse?
The term co-occurring disorder, also referred to as dual diagnosis, means that a person has a mental health disorder and an addiction at the same time.3 Mental health conditions can impact the way that addiction rehab takes place. Treatment providers should take not only the substance abuse but the mental health symptoms into account to optimize the likelihood of successful long-term recovery.3
The Substance Abuse and Mental Health Services Administration (SAMHSA) advises a comprehensive, individualized, and integrated approach to mental health and drug abuse treatment.3 An integrated approach means treating addiction and the mental health disorder together.
Your treatment plan should incorporate treatment methods that are designed to address both conditions. Providers may need to adapt these methods depending on your unique needs, which can include your symptoms, your housing situation, gender, race, ethnicity, and other concerns.3 Your treatment plan should also take into account continuity of care, which means that treatment can occur in different settings over time as you progress in recovery. This can be inpatient or outpatient care as well as aftercare, which happens once formal treatment is complete.4
What is a Mental Health Condition?
The terms “mental health condition,” “mental illness,” and “mental disorder” are sometimes used interchangeably by different organizations, while other organizations make a distinction. The National Alliance on Mental Illness (NAMI) uses the terms “mental health condition” and “mental illness” interchangeably to refer to conditions that affect your thinking, behavior, and mood.5 The National Institute of Mental Health (NIMH) refers to these conditions as “mental disorders.”6 The American Psychiatric Association (APA) uses the term “mental illness” to refer to all diagnosable mental disorders.7
Mental health conditions include a wide range of disorders. They fall into categories based on symptoms and diagnostic criteria. While there are many mental health conditions, some of the most common disorders seen by those with co-occurring disorders include:8
- Anxiety disorders. This includes conditions such as generalized anxiety disorder, social anxiety disorder, panic disorder, and agoraphobia. The key feature is excessive fear and worry.
- Depressive disorders. This includes major depressive disorder and persistent depressive disorder. These disorders are characterized by low mood, excessive sadness, and cognitive changes that affect the person’s ability to function.
- Bipolar disorder. This includes bipolar I and bipolar II. These disorders are characterized by mood shifts from depressive episodes to varying degrees of mania, which is the opposite of depression and includes symptoms like increased energy, little need for sleep, and impulsivity.
- Post-traumatic stress disorder, or PTSD. This is an exaggerated fear response that can occur when people have been involved in or exposed to traumatic life-threatening events.
- Personality disorders. This includes a range of usually lifelong disorders that affect a person’s inherent sense of self and impacts their ability to form relationships with others. Examples of personality disorders that commonly occur with addiction include borderline personality disorder and antisocial personality disorder.
- Schizophrenia and other psychotic disorders. These disorders cause severe incapacitation in areas of thinking, perception, and emotion and seriously impact a person’s mental and emotional state. They are characterized by symptoms like hallucinations (seeing, hearing, or feeling things that aren’t there) and delusions (believing things that aren’t true).
- Attention-deficit hyperactivity disorder, or ADHD. This is characterized by a chronic inability to pay attention, hyperactivity, or a combination of both.
The Relationship Between Mental Health and Drug Abuse
Many Americans are affected by mental illness and addiction. The 2020 National Survey on Drug Use and Health provides mental health and drug abuse statistics that report that 52.9 million people aged 18 or older had a past year mental illness, and 17 million of these people had a co-occurring substance use disorder.9 NAMI reports that 1 in 5 American adults have a mental illness, and 4% of American adults have a dual diagnosis.10
Mental illness and drug and alcohol addiction are often closely linked. People with mental illnesses can self-medicate with substances, but certain substances can also induce mental illness. A wide range of factors can play a role in the development of both disorders.1, 11
How to Identify a Co-occurring Mental Health and Drug Abuse Problem
Co-occurring disorders can occur for a number of reasons, such as:1, 3, 11
- Common risk factors. Certain factors, such as genetics or environmental issues like stress and trauma, can play a role in the development of addiction and mental health disorders.
- Mental disorders can impact addiction. As mentioned above, people who have mental illnesses may rely on substances to self-medicate, or ease, their symptoms. Brain changes that occur in certain mental illnesses may increase the rewarding feelings associated with substance use.
- Substance use and addiction can impact mental disorders. People who abuse substances can suffer from brain changes that may increase their chances of developing a mental disorder.
- Biological factors. Underlying medical problems or certain chemical imbalances in the brain can affect the development of addiction or mental illness.
Addiction isn’t always easy to spot, but there are certain behavioral, physical, and social changes that can indicate the presence of a problem. Signs of substance abuse can vary by substance and the individual. Common signs and symptoms can include:12
- Frequently missing work or school.
- Frequent fights, accidents, or problems with the law or other authorities.
- Secretive or strange behaviors.
- Appetite or sleep changes.
- Mood swings, irritability, or angry outbursts.
- Low motivation.
- Seeming paranoid for no reason.
- Bloodshot eyes.
- Abnormally large pupils.
- Tremors, a lack of coordination, or slurred speech.
- Sudden changes in social circle.
- Sudden financial problems.
- Ongoing substance use despite the problems it causes.
All mental illnesses have their own set of symptoms and diagnostic criteria. Signs and symptoms can vary by individual and condition. However, some of the more common signs and symptoms that could indicate a possible mental illness can include:13
- Excessive worry or fear.
- Low mood.
- Confusion or unclear thinking.
- Rapid or extreme mood swings.
- Unusual irritability or anger.
- Appetite or sleep changes.
- Social isolation.
- Being unable to relate to others.
- Problems perceiving reality, such as hallucinations or delusions.
- Substance abuse.
- Suicidal thoughts or behaviors.
- Unexplained bodily aches and pains.
- Inability to handle daily life stresses.
If you or someone you care about is struggling with a mental illness or addiction or both, it’s advisable to consult a doctor or another qualified professional to discuss your treatment options.
How to Treat a Mental Health and Drug Abuse Problem
Treatment for co-occurring disorders begins with a comprehensive intake and evaluation by a medical professional to assess the problem, your overall health, social factors, living situation, and any other concerns. Depending on the substance you abuse, you might start with detox, which is a set of interventions designed to help your body cleanse from substances and address symptoms of withdrawal.14 Detox prepares you for further treatment.14 While detox can take place on an in- or outpatient basis, inpatient detox tends to be more effective for helping people obtain initial sobriety and stabilization, according to NAMI.15
Co-occurring disorders are mainly treated with medication and behavioral therapies.1 Different types of dual diagnosis rehab services are available for individuals seeking co-occurring disorder treatment. The proper treatment facility for you can vary depending on your needs, and different settings can work better for different people. Treatment settings include:3, 14, 16
The time frame for treatment can vary. Treatment should be personalized based on individual factors, such as the level of addiction and your physical and mental health. Generally speaking, inpatient stays range from 28–30 days to 90 days or longer. Outpatient treatment might last 2 months to one year.3, 14
NAMI explains that people with co-occurring disorders can benefit from the high level of support and care offered by inpatient rehabs.15 Inpatient care involves living onsite and receiving treatments as well as medication, if necessary, and 24/7 monitoring.
Inpatient or residential care may be well-suited for those who require a higher level of care and support. This can include individuals with co-occurring medical or mental health disorders, as well as those with a prior history of relapse or withdrawal seizures, people who need medical supervision, those without supportive home environments, and people who require withdrawal management. Inpatient care removes the distractions of daily life so you can focus on recovery.14, 15, 16, 17
Outpatient treatment means you live at home but travel to a treatment facility one to several times per week. Treatment may begin at a high level of intensity and transition to less supportive levels of care. High-intensity programs offer treatment for several hours per day, most days of the week, while others may offer fewer services and lower levels of intensity.16 Some of the settings where outpatient care takes place include:3, 18
- Partial hospitalization. This is highly supportive and usually involves attending treatment 4 to 6 hours per day, most days of the week.
- Intensive outpatient. This involves attending treatment more than twice a week for at least 3 hours per day.
- Standard outpatient. This can involve attending treatment sessions at a rehab 1 to 2 times per week.
- Outpatient visits with counselor/therapist/clinician. This may be helpful as a form of aftercare for individuals who have completed a treatment program or can be useful as a brief intervention to receive referrals to other forms of care.
Behavioral therapy typically takes place in groups or on an individual basis.19 Some of the behavioral therapies you may receive include:1, 6, 19, 20
- Cognitive-behavioral therapy (CBT), which helps you address unhelpful thoughts and behaviors related to the addiction and mental illness.
- Dialectical behavior therapy (DBT), which helps you develop mindfulness and acceptance of the situation and your emotions. It teaches you skills such as self-regulation and stress management and helps prevent self-harm.
- Assertive community treatment (ACT), which focuses on outreach, long-term support, and an individualized treatment approach.
- Mindfulness-based cognitive therapy, which combines elements of CBT and mindfulness (such as meditation).
Medication-assisted therapy, or pharmacotherapy, may be a part of your treatment plan.3 You may receive different medications based on your diagnosis and unique needs. Common mental health medications include:21
- Antidepressants. These medications treat depression. This can include selective-serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), or bupropion.
- Anti-anxiety medication. This helps reduce anxiety symptoms. The most common anxiety medications are benzodiazepines.
- Stimulants. These are primarily used to treat ADHD.
- Antipsychotics. These are used to manage psychosis, such as in cases of schizophrenia or bipolar disorder.
- Mood stabilizers. These can help stabilize your mood and are mainly used to treat bipolar disorder or other conditions that cause mood swings.
What Happens After Treatment?
Recovery is a lifelong process that continues after treatment has been completed. Aftercare involves ongoing support or treatment that helps prevent relapse and increases your chances of long-term recovery success.22
Aftercare can be any form of relapse prevention support that works for your needs. This can include options like:3, 15, 23, 24
- Mutual support groups, like Alcoholics Anonymous or Narcotics Anonymous.
- Sober living homes, which provide a supportive, substance-free environment for people in recovery.
- Individual therapy, where you have weekly sessions with a therapist to obtain recovery support.
- Group therapy, where you meet in a group, led by a therapist, with others who are also in recovery.
- Mindfulness-based relapse prevention, which combines self-care and relaxation strategies with relapse prevention techniques.
Additional Resources on Health Insurance Providers and Coverage Levels
Visit the links below to find out more about your health insurance coverage levels, how to get your insurance company to pay for drug and alcohol rehab, and how to pay if you don’t have insurance.
- Blue Cross Blue Shield
- Kaiser Permanente
- Rehab Insurance Coverage
- Rehab Without Insurance
The only way to determine which treatment options are best for you is to talk with your medical or mental health provider. You can speak with them about which program will be best considering your priorities and goals. Start your path to recovery today by verifying your insurance to see what and how much will be covered.
Additional Resources on Drug and Alcohol Rehabilitation
Whether you’re looking for a specific type of rehab treatment, substance related information, or additional guides, here are a few recommended resources:
- How to Help a Drug Addict
- Detox Centers Near Me
- Free Drug Rehab Centers
- State-Funded Rehab Centers
- Drug Addiction Hotline Numbers
- Alcohol Addiction Hotline Numbers