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An integrative approach to treating co-occurring disorders

Dual diagnosis, now formally called co-occurring disorders, is defined as a mental health illness such a depression, bipolar disorder or an anxiety disorder co-existing with a substance use disorder such as opioid abuse or binge drinking. Often one disorder precedes another, and together they both have the potential to spiral out of control. For example, an individual experiencing depression may self-medicate by using alcohol or prescription painkillers to cover up the depression symptoms. On the other hand, chronic drug or alcohol intake can result in changes in brain chemistry, leading to alterations in mood and potentially triggering a mental health disorder.

A mental health disorder is 50 percent more likely to occur with a substance use disorder and vice versa, according to the Journal of the American Medical Association; it is very common to have both conditions occurring. According to Substance Abuse and Mental Health Services Administration, the prevalence of co-occurring disorders in 2014 affected approximately 8 million adults in the U.S. The interplay between the different problems that can make up a co-occurring disorder can make treatment complicated. As the behavioral health world comes to understand this problem more thoroughly, treatment options improve.

Treatment options for co-occurring disorders

The standard of treatment for co-occurring disorders is known as integrated intervention. Simply stated, this means that each disorder is treated as an individual disorder simultaneously. SAMHSA recommends: “People with co-occurring disorders are best served through integrated treatment. With integrated treatment, practitioners can address mental and substance use disorders at the same time, often lowering costs and creating better outcomes. Increasing awareness and building capacity in service systems are important in helping identify and treat co-occurring disorders. Early detection and treatment can improve treatment outcomes and the quality of life for those who need these services.”

One of the first steps in treating individuals with co-occurring disorders is for them to undergo substance detoxification. Detoxification involves clearing the body’s system of the addicting substance. Depending on the specific substance, a low dose substance agonist may be used to alleviate the physical withdrawal effects. An example is treating opioid dependence. Commonly, an opioid partial agonist such as buprenorphine or a full agonist such as methadone is administered in tapered dosages over time until the substance is completely eliminated from the body. Patients can choose to undergo inpatient detoxification or outpatient detoxification, but most professionals agree that inpatient detoxification is the most effective and safest modality.

Detoxification only addresses the substance use component of co-occurring disorders, so treating the mental health disorder is just as important. Medications may be prescribed to help treat the mental health disorder. SSRIs are the most common class of antidepressants prescribed for depression; anxiety disorders are often treated with anxiolytics such as benzodiazepines; schizophrenia can be treated with typical and atypical antipsychotics. However, literature shows that both pharmacologic therapy as well as behavioral therapy are the best overall approaches.

Psychotherapy is a main component in the integrative approach to treating co-occurring disorders. Psychotherapy is a general overall approach that educates patients on their condition, risk-modification, triggers and behavioral patterns. The goal is for patients to learn specific tools to help them work through their disorders and to recognize their own triggers. Cognitive behavioral therapy has been used in patients with co-occurring disorders and provides them with coping tools to help change ineffective patterns of thinking. It encompasses the intimate relationship between the individual’s thoughts, feelings and behaviors, and helps the patient understand what is and is not appropriate. By solving problems and learning skills to address the problems if they resurface, individuals can gain the power to improve their lifestyle regardless of their diagnosis.

Better understanding means better treatment

In some ways, co-occurring disorders are integrative disorders, one must exist with another. Therefore, it makes sense that integrative treatment approaches are used to best treat co-occurring disorders.

Sovereign Health of El Paso makes sure to stay up-to-date on the latest research to provide the best treatment possible for our patients. We offer treatment programs for substance use disorders and co-occurring disorders. If you or your loved one is struggling, please do not hesitate to contact us via our 24/7 helpline.

About the author

Kristen Fuller, M.D., is a medical writer at Sovereign Health, who enjoys writing about evidence-based topics in the cutting-edge world of medicine. She is a physician and author, who teaches, practices medicine in the urgent care setting and contributes to medicine board education. She is also an outdoor and dog enthusiast. For more information and other inquiries about this article, contact the author at

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