Seeking treatment for the challenges you face in your life is a difficult step to take. It’s an even harder step when you have multiple issues that need to be addressed, since a lot of sources of treatment tend to focus on one thing at a time.

If you find that no one seems equipped to handle the problems you face, it might be appropriate to seek dual diagnosis treatment. Before you start digging into your options, though, it’s worth talking about what dual diagnosis is, how treatment works, and whether or not it’s right for you.

DISCLAIMER: This article is for informational and educational purposes only and should not be considered medical or psychological advice. The information presented here is not intended to diagnose, treat, cure, or prevent any mental health condition or replace professional therapeutic care. Every individual's experience with trauma and mental health is unique. Please consult with a qualified mental health professional, therapist, or healthcare provider to determine the most appropriate treatment approach for your specific situation. If you are experiencing a mental health crisis or emergency, please contact your local emergency services or crisis hotline immediately.

What is Dual Diagnosis?

If you break down the concepts, it seems straightforward. Dual diagnosis would be two diagnoses, right? So, if you have PTSD and anxiety, you have two diagnoses. Does that mean dual diagnosis treatment is right for you?

Unfortunately (or fortunately), this is not actually what dual diagnosis means. Unfortunately, because we may have just clarified a detail that means it’s not right for you. Fortunately, because having several mental health issues like PTSD, anxiety, and depression is not uncommon, most conventional therapists can handle it just fine.

Dual diagnosis is a specific term in therapy and mental health treatment. It does mean you have two diagnoses, but they’re specifically:

• A mental disorder, such as PTSD, anxiety, or depression
• A substance use disorder, either with alcohol or with drugs

This is where the challenge of seeking treatment comes into play. Many therapists are equipped to handle either substance use disorder or a mental health disorder, but not necessarily both at the same time.

As you likely already know, mental health disorders and substance use disorders often go hand-in-hand. It’s not as clear-cut as one simply causing the other, though. Current research indicates that there are three possible reasons why they tend to be interconnected.

• Risk factors are often similar. Genetics, stress and stressful situations, trauma, and other risk factors that lead to mental health disorders are similar to those that lead to substance use disorder.
• Mental health disorders can often lead to substance use as a coping mechanism or a form of self-medication when legitimate treatment is difficult or unavailable. People with mental health disorders also often have a predisposition towards addiction more easily.
• Substance use disorders can often lead to the development of (or worsening of existing) mental health disorders. Drugs change the way your body works, from biochemistry to mental activity, and that can lead to disordered ways of thinking and reacting to the world around you.

None of this is guaranteed. Millions of people with substance use disorder do not have mental health disorders (at least not at a clinical level), and the same is true in the other direction. It’s estimated that there are around 21 million individuals with substance use disorder in the United States, and only around 8 million of them are dual diagnosis. So, while it’s common, it’s not so common that it’s considered the default.

What Does it Mean to Get a Dual Diagnosis?

A dual diagnosis is not really a specific category, so much as it is an increase in awareness and potential options for treatment.

If you are only diagnosed with PTSD, and you approach an inpatient clinic for substance use treatment, they aren’t likely to be able to help you. Conversely, if you have a substance use disorder and you visit a PTSD specialist, they might not know what to do.

The reality is that anyone within the overall circle of mental health professionals will know at least how to point you in the right direction and give you some basics, but the fact is, you want treatment that fits the disease, not treatment that doesn’t hit the mark.

Even if you do have the second disorder, not having the second diagnosis on paper can mean it’s more difficult to access certain kinds of treatment. In many ways, having that official diagnosis opens up doors.

There isn’t necessarily any official type of account or therapist or back-end insurance code or anything else that specifically flags you as a “dual diagnosis individual,” such as it is. Rather, it just means that anyone you seek treatment with will know that they need to be part of a care team rather than a sole provider.

What Are the Signs You Should Seek a Dual Diagnosis?

It can be difficult to know when you need to take the next step and seek a professional diagnosis or, in this case, a dual diagnosis. To help you make a self-determination, we’ve put together five signs to watch for.

Sign #1: You’re Using Substances to Handle Your Emotions

Think about the common scenarios where you might reach for the substances you use, be it alcohol, cannabis, or other drugs.

• Do you frequently find that you’re anxious if you haven’t had a hit or a drink recently?
• Do you prefer the numbness of alcohol or drugs over the depression you feel without them?
• Do you have trouble leaving the house without using?

The struggle with addictive and mind-altering substances is that they do work, often temporarily and in unhealthy ways. Emotions and feelings that you can’t control in other ways can be numbed or regulated by these substances, and you can feel good using them… until you need more, and more, and more.

Even if you don’t necessarily recognize which emotions are being addressed or what mental health disorder they represent, realizing that you’re using substances to control them is a sign that you should seek dual diagnosis.

Sign #2: You Find Your Moods Vary Wildly

Everyone experiences changes in mood. Sometimes, those mood changes can be rapid. Often, though, there will be some kind of impetus or event that triggers those changes in mood.

When substances are in play, rapid mood changes can be a sign of the highs and lows of those chemicals. When a mental health disorder is also involved, everything gets a lot harder to track. It can be very difficult to tell whether a mood change is due to a substance, due to an imbalance in the brain, due to moods or disorders themselves, or other factors.

Seeking a dual diagnosis in this instance isn’t a bad idea. Even if it turns out you don’t have that second diagnosis, knowing is better than not, and it can be a gateway to the care you need.

Sign #3: Your Mental Health is Noticeably Worse When You’re Sober

As mentioned above, one of the reasons some people turn to substance use in the first place is a form of self-medication to control otherwise untreated mental illness. Substances that either numb you or make you feel good tend to override mental health disorders like anxiety, insomnia, intrusive thoughts, depression, and other issues.

When the substance starts wearing off, and you return to sobriety, those mental health disorder symptoms come back in full force, and sometimes even stronger. Anxiety, self-medicated, ends with panic attacks. Depression, self-medicated, can lead to suicidal ideation.

In some cases, this can be, or can feel like it is, symptoms of withdrawal from the substance. Just as often, though, it’s the underlying mental health disorder coming back in full force. Either way, it drives you further into wanting your next fix, and the next. All the while, tolerance is getting higher, effects are getting lower, and you need more and more of the substance to keep functioning.

This is a sure-fire sign that you have both substance use disorder and an untreated mental health disorder, and seeking a dual diagnosis can be the first step to getting effective treatment for both.

Sign #4: You’ve Tried and Failed with Traditional Treatment

This applies to either side of the coin.

If you’ve sought rehab, even to the extent of attending an inpatient substance use clinic to detox, only to relapse later, there’s a decent chance that it’s not just “weak willpower” or situational factors pushing you to it, but an underlying mental health disorder that was not adequately diagnosed or treated during your sessions.

Conversely, if you’ve sought traditional mental health treatment like cognitive behavioral therapy, group therapy, or EMDR, only to find that you don’t seem to be making any progress, you may have the roadblock of a substance getting in the way. It can be hard to truly address an underlying disorder when you’re muddled or fuzzy from a substance, and are less likely to retain what you learn.

Co-occurring disorders are interrelated in complex ways, and it’s all but impossible to treat one while ignoring the other. Standard-formula treatments for one or the other won’t suit your needs, because your needs are more complex. This is where it’s a good idea to seek dual diagnosis treatment.

Sign #5: You Feel Trapped in a Cycle of Relapse

One of the greatest hallmarks of co-occurring disorders is the cycle of recovery and relapse. Coping mechanisms can only do so much when half of the underlying disorders remain untreated. Detox can only save you from the symptoms of withdrawal and use, but not from the thoughts and patterns that pushed you to substances in the first place.

Dual diagnosis helps find the robust, personalized care you need to address everything, not just one side or the other.

What Treatments Are Available for Dual Diagnosis Patients?

Treatment for dual diagnosis patients isn’t fundamentally different than treatment for patients with just mental health disorders or just substance use disorder. The primary difference is just in scope.

With dual diagnosis treatment, you will work with a care team involving multiple therapists and providers, working together to address the specific challenges you face. That can mean anything from traditional talk therapies to medications to combination treatments.

Sometimes, where appropriate, inpatient treatment may be recommended. This is most often relevant for substance use disorder, where getting away from access to and the environment where you used is critical.

While there, you won’t simply undergo the usual detox and wellness process. Instead, you will work with therapists who know your dual diagnosis and can provide additional mental health treatment in tandem with the physical treatment.

In these kinds of environments, you often have additional support as well, such as regular and intensive sessions of CBT, DBT, or EMDR, a focused and planned routine, and 24/7 support while you’re inpatient. The inpatient organizations providing this treatment often have aftercare planning and transition to outpatient treatment access as well.

This is not an involuntary commitment; you would participate in any such program willingly and according to your needs.

Where possible, the state of Michigan does provide support for integrated treatment for co-occurring disorders, with dual diagnosis treatments available for those on state insurance like Medicaid or the Healthy Michigan plans.

The key to dual diagnosis treatment is customization. You will meet with therapists and specialists, who will identify your needs and work with you to develop a treatment plan to address them. Whether that means inpatient or outpatient, with or without medications, or across different kinds of psychotherapy and peer support, the goal is something that will work for you. Just like you’re an individual, so too will your treatment need to be individualized.

How BMC Can Help

Here at BMC-Troy, we offer our services to the greater Detroit area. Our specialists provide a range of options, including CBT, DBT, EMDR, TRE, and PIT. We also offer medication management, so if medications are deemed an important part of your treatment plan, we can help keep track of them and adjust dosages alongside your progress.

When you contact us, we’ll work with you to determine what your needs are and how we can help meet them. We can help you seek a diagnosis in the first place, including dual diagnosis, and can work with several providers to get you the care you need. We’re also happy to be part of a care team, including external providers as well.

To get started, you can contact us directly, or you can start by filling out our new patient intake form. We’re more than happy to help you get started on the road to recovery.