Nearly half of all people with a drug or alcohol addiction have a “dual diagnosis” in the form of another mental health disorder that is related to their substance abuse, according to the National Survey on Drug Use and Health. Research has further revealed that the more severe the dual diagnosis, the greater the likelihood of substance abuse— with alcohol, followed by marijuana and cocaine, the most common substances of abuse among people with dual diagnoses.

At Beach House Center for Recovery, we understand how overwhelming a dual diagnosis can be. That is why we offer “dual diagnosis treatment”: the gold standard of care for anyone struggling with addiction and another mental illness.

Dual diagnosis treatment is a comprehensive approach for treating substance use disorders that co-occur with another mental illness, such as anxiety, depression or post-traumatic stress disorder (PTSD). The goal of dual diagnosis treatment is to help clients with these co-occurring disorders (also known as “comorbidities”) learn how to manage both illnesses (alcohol and anxiety, for example) via a combination of medication and behavioral therapies.

The therapists and group facilitators did an amazing job in keeping me engaged while educating me on my disease and helping me process its emotional and behavioral components. The medical staff, especially nursing, made sure all of my medical needs were met on a daily basis. – Michelle

Not all dual diagnosis treatment centers are alike in how they treat co-occurring mental illness and substance abuse— or, in the quality of the care they provide.

Here Is What Clients Can Expect from Our Dual Diagnosis Treatment Program:

• An in-depth physical and psychiatric assessment at time of admission
• A customized plan of treatment tailored to the client’s individual needs
• A multidisciplinary team of caring and experienced medical and clinical professionals
• The integration of dual diagnosis treatment at every level of care
• Evidence-based therapies for all types of co-occurring disorders
• A client-directed, outcome-informed approach
• Medication-assisted treatment (MAT) for clients who need it
• A 7:1 client-therapist ratio (well below industry standards)
• State-of-the-art, brand-new facility located near miles of quiet beach preserve
• 12-step recovery groups
• The option of family therapy through our Family Program
• Renowned high safety standard, including 24/7 one-on-one medical monitoring for clients who need it

What Is a Dual Diagnosis?

A dual diagnosis can be any one of a number of mental illnesses that either cause, co-occur with, or develop as the result of an addiction to alcohol or other substances of abuse. The signs of a dual diagnosis can vary individually. Generally, though, the following signs can be indications of a co-occurring disorder that could benefit from professional diagnosis and treatment:

• Sudden and/or dramatic changes in mood, behavior and/or personality
• Neglecting personal hygiene
• Cognitive impairments
• Noticeable changes in weight or appetite
• Relationship problems
• Severe tension or anxiety
• Changes in sleep (insomnia or sleeping too much)
• Feelings of despair, hopelessness or worthlessness
• Hallucinations and/or irrational thoughts
• Troubles fulfilling responsibilities at home, work or school
• Using drugs or alcohol to cope/self-medicate

With any dual diagnosis, early intervention and treatment from the right professionals is key to a successful recovery.

Today, preventing and providing addiction treatment means understanding clients’ personal needs along with a complex set of clinical considerations. Abstinence-based treatment, medically-assisted treatment and adverse childhood experiences must be understood and incorporated into treatment plans, when appropriate, to address the root causes of addiction and generate lasting recovery. – Chief Clinical Officer Anna Ciulla, LMHC, RD, LD

Types of Dual Diagnoses Treated

There are many types of dual diagnosis, and they run the gamut from more commonly occurring conditions like anxiety and depression to much rarer mental illnesses like schizophrenia. These disorders fall within the following categories:

• Anxiety disorders – “About 20 percent of Americans with an anxiety or mood disorder such as depression have an alcohol or other substance use disorder, and about 20 percent of those with an alcohol or substance use disorder also have an anxiety or mood disorder,” according to the Anxiety and Depression Association of America. One especially common dual diagnosis: alcohol and anxiety.
• Attention deficit hyperactive disorder (ADHD) – Research suggests that people with ADHD, many of whom are prescribed addictive stimulants (“smart drugs”) for their condition, are also more predisposed to substance abuse.
• Bipolar disorder – Substance abuse occurs at dramatically higher rates among people with bipolar disorder, who are more apt to use alcohol, cannabis and/or illicit drugs to self-medicate the symptoms of their underlying condition.
• Depressive disorders – As a leading cause of disability among Americans between the ages of 15 and 44, depression is common in this country and can often co-occur with alcohol and other substances.
• Personality disorders – A diagnosis of “borderline personality disorder,” especially, correlates with higher rates of substance abuse and addiction.
• Post Truamatic Stress Disorder (PTSD) – Research has revealed that traumatic experiences in early childhood are at the root of many addictions. PTSD is defined by a constellation of symptoms related to the experience of a traumatic event. Substance abuse often arises as an effort to cope with these often painful and uncomfortable symptoms.
• Schizophrenia – Characterized by hallucinations, delusions and irrational thoughts, the diagnosis frequently occurs alongside substance abuse, especially alcohol, cocaine and marijuana.

Why High-Quality Dual Diagnosis Treatment Is Critical

Diagnosis of co-occurring disorders can be complicated for various reasons:

• Some very different disorders share some of the same psychiatric symptoms, so getting an accurate diagnosis of the condition that is co-occurring with substance abuse can be complex.
• There is also the fact that the two illnesses comprising the dual diagnosis (depression and addiction, for example) have symptoms that mirror one another.
• Substance addictions like alcoholism can mimic the symptoms of other mental disorders, leading to misdiagnosis— when in fact the only illness that really needs treatment is a drinking problem.

These complexities make high-quality dual diagnosis treatment essential to recovery. For advice about how to find a trusted provider, see these “12 Tips for How to Find Quality Addiction Treatment You Can Trust.”

How is Dual Diagnosis Diagnosed and Treated?

A dual diagnosis is best diagnosed and treated by a multidisciplinary team of medical and clinical professionals, in a trusted drug and alcohol rehab facility and via the following two steps:

• Medical detox from one or more substances is the first essential step towards a clear diagnosis. During this process of medically managed drug or alcohol withdrawal, medical staff can closely monitor symptoms 24/7. They can then begin to assess whether the symptoms they are seeing are occurring because of withdrawal alone, or may be linked to another mental illness.
• Inpatient Rehab is the next immediate step in getting an accurate diagnosis, once detox is complete and the remnants of one or more drugs have been eliminated from the body. Inpatient rehab provides clients with the most intensive level of care available within a drug-free environment. This affords the opportunity to be closely monitored for any lingering symptoms of withdrawal—a common phenomenon known as “PAWS” (post-acute withdrawal syndrome)—and other comorbidities.

During this phase of treatment, clients participate in group and individual therapies administered by experienced clinical professionals who are trained to spot and treat dual diagnoses. Thanks to the intensive nature of these daily interactions with clients, therapists are better able to gauge and monitor for the presence of any co-occurring mental illnesses.

Once a dual diagnosis has been determined, MAT (medication-assisted treatment) may then be administered in combination with targeted behavioral therapies.

Research shows that dual diagnosis is a big concern in addiction.  It may be that a primary mood disorder drives a person to self-medicate. Then, because the substance may lessen psychological distress for a time, the person soon becomes dependent on that substance, needing more and more of it to achieve a stable mood. In the reverse setting, substance abuse can change brain chemistry and lead to depression, anxiety and other mood disturbances. MAT, or medication- assisted treatment, helps to manage the symptoms that can lead to relapse and also help to sustain sobriety.  We know the best results come with an interdisciplinary approach. MAT is an important part of that approach. – Medical Director Dr. Meera Joseph, MD

Types of Therapies Used to Treat Dual Diagnoses

The types of therapies used to treat dual diagnoses can vary depending on clients’ individualized needs. The following “evidence-based” therapies have been shown to improve treatment outcomes for clients with dual diagnoses:

• “Therapeutic Alliance” refers to the collaborative relationship between a client and their therapist and the warmth and genuineness of their connection. At Beach House, we prioritize this client-therapist bond, because research shows that it may be the single biggest clinical predictor of client treatment outcomes (Proctor, 2014). Therapeutic alliance is so critical to treatment outcome, in fact, that it has outperformed other therapies known to work for addiction, such as cognitive behavioral therapy (CBT) and motivational interviewing (MI), which are featured below (Proctor, 2014). We therefore work to ensure that all of our therapists know how to create and strengthen therapeutic alliance, and are evaluated according to standardized measures of therapeutic alliance—so that they can make real-time improvements in the care we provide our clients.
• Cognitive Behavioral Therapy (CBT) focuses on correcting and replacing thoughts and behaviors that feed the addiction cycle and impede recovery, by contributing to relapse. Much of CBT’s emphasis is on identifying and modifying irrational thoughts, managing negative emotions, and preventing relapse. All of our clinicians are trained in CBT and use it to help clients learn healthier anger management skills and better ways of coping with stress and other cues and triggers for substance abuse. CBT is associated with better treatment outcomes in multiple controlled clinical trials (McHugh, Hearon, and Otto, 2010).
• Trauma-Informed Therapy, including Dialectical Behavioral Therapy (DBT) skills, helps clients heal from the experiences of trauma and post-traumatic stress disorder (PTSD) that are often at the root of substance abuse. Our therapists teach clients DBT skills involving how to manage the painful emotions associated with a post-traumatic stress response, so that clients can successfully overcome this very common relapse trigger. In addition to these DBT skills, clients learn how to develop the following cognitive-behavioral tools through trauma-informed therapy: grounding skills, resource building, safe place work, and resiliency skills.
• Motivational Interviewing (MI) empowers clients to make core life changes necessary to sustaining a life free of drugs and alcohol, by helping them develop greater self-directedness and self-advocacy. MI’s therapeutic effectiveness has been most widely studied among the alcohol abuse population where at least 32 studies have linked MI to improved treatment outcomes (Jhanjee, 2014). Like CBT, MI is viewed as most effective when combined with other psychosocial interventions.
• 12-Step Group Therapy combines the spiritual recovery principles of the “12 steps” with the practical support and help of group members who share the same problem. A large body of evidence has found that 12-step group participation correlates with better long-term recovery outcomes. For instance, one major randomized trial, among multiple studies, found that participation in a 12-step program resulted in treatment outcomes similar to those for CBT and MI (Jhanjee, 2014).