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Dual Diagnosis

What is dual diagnosis?

The term “dual diagnosis,” sometimes also referred to as “co-occurring disorders” means that a person is suffering from both a substance use disorder and a diagnosable psychiatric condition.

The relationship between substance abuse and mental illness is complex and the two often accompany one another. Many people who seek treatment are suffering from both an addiction and an untreated psychological disorder. For long-term recovery and mental health, both the psychological disorder (such as anxiety, depression, bipolar disorder, etc.) and the addiction must be treated. At Milestones, we identify all the issues our clients are facing and develop a comprehensive treatment plan to address their needs.

For instance, a patient with untreated Generalized Anxiety Disorder may also suffer from Alcohol Use Disorder. This makes sense, doesn’t it? The anxious person may drink to excess in order to quell the chronic tension and distress. After all, alcohol is readily available, socially acceptable, and relatively inexpensive. Or a bipolar client may –  in the throes of a manic episode –  with little self-regulation and feelings of grandiosity, engage in a multi-day cocaine binge. This will certainly lead to further mental, emotional, physical, and likely legal problems. Co-occurring disorders affect the patient deeply, and often impair one’s ability to function successfully. For example, maintaining employment, enjoy successful relationships with others, attend and completing school, etc.

Is dual diagnosis a common phenomenon? According to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 10 million people in the United States will have a combination of at least one mental health and one substance use disorder in any twelve-month period. One recent article stated that 37% of alcohol abusers and 53% of drug users also have at least one serious mental illness.

Who is affected?

It is not always possible to determine which came first, the psychiatric condition or the chemical dependency. However, we do know that people who suffer from psychiatric disorders are generally more at risk for substance abuse. One study showed that a person with Antisocial Personality Disorder was at a 15.5% increased risk for substance abuse and a person with a history of manic episodes 14.5%.

Why is this? Often times, people dealing with psychiatric disorders attempt to self-medicate in order to escape depressive or anxious feelings, the memory of past trauma, and the discomfort of hallucinations and delusions.

But the reverse can also be true: a person may drink or use drugs to the point where they induce mental health disorders. Alcohol or drug abuse can also result in suicidal thoughts and attempts, partly because of impairment in impulse control, decrease of inhibitions and judgment, and increase in negative ruminations and thought patterns.

The dual diagnosis patient can become lost in a downward spiral. Many of these patients have a poor self-image. Plagued by thoughts and feelings of self-hatred, they will self-sabotage with drugs or alcohol, and seek out other people with similar issues and backgrounds in order to feel accepted by a group who shares the same experiences and destructive behaviors. They may become defeated and feel a sense of resignation, and believe that the only way to escape bad feelings is to continue using. However, effective treatment and support are available.

The family’s role

How can the family help their dual diagnosis loved one to recover?

First, let’s look at what they must not do: stop enabling by giving financial support, excusing poor behavior, and making empty threats. Instead, insist that the patient get professional help immediately.

Second, family members must seek support for themselves as well. Al-Anon is well-established and well-regarded program. It is also a no-cost service. We also highly recommend the Betty Ford family program in Rancho Mirage. Finally, there are a variety of mental health support groups for families struggling to understand and cope with the consequences of their loved one’s mental health issues. The National Alliance on Mental Illness (NAMI) is an excellent resource.

At Milestones, our therapists conduct family sessions to address family wounds, learn new ways of communicating, and help members plan for the future. Our therapists and staff are expert in helping families in crisis, and provide phone coaching and regular communication, in addition to family sessions.

As a prerequisite to successful treatment, we ask that families be candid and forthright with the Milestones treatment team regarding any history of chemical dependence and/or psychiatric disorder. It is common for family systems to hold secrets, and these can prove toxic to the family system and an impediment to recovery.

What is effective treatment?

A true dual diagnosis treatment program treats both mental health and substance use issues, understanding the intertwined relationship between the two. If you only address one, the other is likely to resurface – and sooner rather than later.

With regard to chemical dependency treatment, high-quality programs typically offer psychoeducation regarding relapse prevention, support and coaching for family dynamics, skill-building for self-care and emotional regulation, examination of behavioral and cognitive patterns, identification of high-risk areas and triggers, and practice/role-play with healthy replacement behaviors and cognitions. Of course, treatment plans vary from client to client. There is no “one size fits all” road to recovery. Trained professionals will assist the client in looking at resources and existing strengths in order to create an effective aftercare plan – a critical component in dual diagnosis recovery.

Furthermore, we work closely with a board-certified addiction psychiatrist who will evaluate a patient upon admission and may recommend medications to treat chemical dependency and psychiatric disorders. Our psychiatrist meets weekly with patients to provide ongoing medication management and adjustments as needed. We may also, on occasion, request psychological testing by a qualified and experienced psychologist in order to gather additional information helpful in treatment planning.

Exercise, proper nutrition, sober recreational activities, caring supervision, individual counseling sessions (minimum four times per week) and group sessions are also a crucial part of our dual diagnosis treatment center.

The process of dual diagnosis treatment often begins with a medically supervised detoxification at a reputable clinic or hospital. While many addicts benefit from such treatment, it is essential to the health and welfare of the person who suffers from alcohol or benzodiazepine dependence. A failure to medically detox from either of these dependencies can be fatal, if untreated.


If you or your loved one have a substance use problem combined with a psychiatric disorder such as anxiety, depression, bipolar disorder or other, there is help available and it is important that you receive the best residential treatment available.

We hope the information contained in this article has been helpful to you. Please feel free to contact us at Milestones Ranch Malibu with any questions or comments you may have. Call: (800) 791-6859 for assistance.

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