Co-Occurring (Dual Diagnosis): Substance Use & Mental Health
“Co-occurring” (also called “dual diagnosis”) refers to when a substance use and a mental health condition happen at the same time. Treating both together is important for safety and long-term stability.
Our website is for information only. We help you understand your options and prepare for conversations with licensed providers, but we do not diagnose, treat, or guarantee outcomes.
What Dual Diagnosis Means
Substance use can make mental health symptoms worse. Mental health symptoms can also make it harder to cut down or stop using. Integrated care looks at the whole picture. This can include substance use, mood, sleep, trauma, relationships, school, or work. One plan is designed to treat all of it.
Signs Co-Occurring Care May Help
You may benefit from dual-diagnosis care if:
- Symptoms return or worsen when you try to reduce use
- You’ve tried single-focus treatment without enough progress
- You use substances to cope with anxiety, low mood, trauma, or sleep problems
- You feel stuck in a cycle of cravings, mood swings, and stress at home, school, or work
These are signals to seek a full assessment. Only a clinician can recommend a safe plan.
How Integrated Treatment Works
Integrated programs coordinate support for both substance use and mental health. You receive therapy, skills training, and, when appropriate, medication in a single, connected plan so nothing gets missed.
Detox (If Needed)
Detox provides short-term medical support if withdrawal could be risky or very uncomfortable.
Inpatient/Residential
Inpatient or residential treatment offers 24/7 structure in a safe setting if you need close support for mental health and substance use at the same time.
Day Program (PHP)
A Partial Hospitalization Program (PHP) runs most of the day, often several days per week.
Intensive Outpatient Program (IOP)
IOP involves several sessions each week, usually in blocks of a few hours. It offers strong support for coping skills, mood, and cravings.
Outpatient
Outpatient care is less frequent for those who are more stable in their recovery. It includes therapy and, when appropriate, medication.
Telehealth
Telehealth lets you attend some therapy and medication follow-up visits by secure video or phone.
Therapies You May See
Programs often use:
- CBT and DBT skills
- Motivational interviewing
- Trauma-informed therapy
- Family sessions (with consent)
- Relapse-prevention training
- Holistic supports like mindfulness or movement may be added as well. These do not replace medical care.
Medications (When Appropriate)
For some alcohol and opioid use disorders, FDA-approved medications may reduce symptoms or cravings. Psychiatric medications may help with anxiety, depression, bipolar disorder, PTSD, OCD, ADHD, or other conditions. A prescriber explains risks, benefits, and alternatives. Medication is voluntary.
Safety First
If you’re in immediate danger, having severe withdrawal, or thinking about self-harm, call your local emergency number now. For a mental health emergency, contact your country’s suicide and crisis line. Online information can support you, but emergencies need real-time help.
Building Your Support
Treatment centers can help build encouragement around you, step by step:
- Start with a clear assessment that covers substance use and mental health
- Ask for dual-diagnosis (integrated) care, not separate tracks that don’t connect
- Set 2–3 realistic goals (for example, sleep, cravings, school/work, relationships)
- Practice skills daily: grounding, coping, relapse prevention, safety planning
- Involve family or trusted supports, with your consent
- Plan aftercare before discharge (ongoing therapy, medications if appropriate, support groups)
What to Expect Day to Day
From one day to the next, integrated care often includes:
Check-ins on cravings, sleep, mood, safety, and medication effects (if used)
Simple plans for evenings and weekends to keep progress going
Skills practice for triggers, stress, and communication
Individual and group therapy
How to Choose a Dual Diagnosis Program
Check for state license and accreditation
Ask about medical and psychiatric staff availability
Review safety policies and detox support
Confirm aftercare planning and insurance coverage
Choosing the right program means finding a safe, accredited place that meets your needs and supports long-term recovery. Take time to ask questions and compare options before deciding.
Insurance & Costs
Coverage depends on your plan, network, and medical needs. Programs can check benefits, but your insurer makes the final decision. Ask about self-pay or payment plans if needed.
FAQs
Which should be treated first: substance use or mental health?
Usually, both are treated together. Your team may address urgent safety needs first, such as detox or stabilization, then continue integrated care.
Do I need inpatient care for dual diagnosis?
Not always. The right level depends on safety, withdrawal risks, home support, and your goals. Many people do well with outpatient care; others start inpatient.
Will I have to take medication?
No. Medication is offered only when clinically appropriate and with informed consent. Your prescriber explains options, risks, benefits, and alternatives.
What if I’ve tried treatment before?
Integrated care may help if single-focus treatment was not enough. Ask about dual-diagnosis expertise, coordinated medication management, and aftercare planning.
Can I work or attend school during treatment?
Many programs offer evening outpatient program and telehealth. Ask about schedules that fit your life.
Helpful Resources
In Crisis? Get Immediate Help
In Crisis? Get Immediate Help
If you or someone you know is in immediate danger or experiencing a medical emergency, call 911. You can also contact the Suicide & Crisis Lifeline for free, confidential support 24/7 at 988.
Additional Resources:
- SAMHSA’s National Helpline: 1-800-662-HELP (4357)
- National Domestic Violence Hotline: 1-800-799-SAFE (7233)
- Crisis Text Line: Text HELLO to 741741