Dual Diagnosis vs. Rehab: What's the Difference?
What is a dual diagnosis treatment program?
A dual diagnosis treatment program helps people who have a substance use disorder and one or more co-occurring psychiatric diagnoses, including a mood disorder like major depression or bipolar disorder, an anxiety disorder, schizophrenia or another thought disorder, or a personality disorder. Therapies and programs are structured to help patients address both issues simultaneously instead of sequentially. Research indicates that evidence-based dual diagnosis treatment programs help people with co-occurring disorders reach better long-term outcomes for both their substance use and psychiatric disorders.
What is the difference between an addiction treatment program and a dual diagnosis treatment program?
Significant variety exists among addiction programs and dual diagnosis programs, and it can therefore be difficult to describe each category universally. Some dual diagnosis programs and addiction treatment programs are very similar. Generally, addiction treatment programs are focused on helping patients stop drinking or using substances by enforcing rules and expectations and by providing counseling and therapeutic activities to help people start adopting skills to resist urges and maintain sobriety. They often are focused on the 12-step approach. Some addiction programs also provide medical supervision for patients who need to detox from substances like alcohol, heroin, opioids, or benzodiazepines.
Dual diagnosis programs have some of the same elements as addiction programs in terms of programming, and also offer evidence-based treatment and therapies for mood, thought and anxiety disorders. The treatment team has expertise in helping patients explore the connection between their psychiatric illness and their alcohol or substance use. Patients learn about 12-step programs as a way to maintain sobriety and also learn skills from cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and other evidence-based therapeutic approaches depending on their psychiatric diagnosis. Substance use is viewed as part of a larger pattern of pathology, thoughts, emotions, and behaviors.
Addiction treatment programs are usually more appropriate for individuals with a primary substance use disorder. They may have symptoms of depression or anxiety, but those symptoms may result more from substance use than from an underlying clinical mood or anxiety disorder. For these patients, their psychiatric symptoms may begin to improve once they establish sobriety and begin working a recovery program. After beginning to address the substance use disorder, many experience a decrease in psychiatric symptoms - at least to the extent that those symptoms cause disability or meet the criteria for a clinical diagnosis of major depression or an anxiety disorder.
Patients who require a dual diagnosis program have a different experience. If they focus singularly on addressing their substance use disorder without also treating their psychiatric symptoms, they often have poor outcomes for both issues. Psychiatric symptoms like depression and anxiety often get worse when a patient stops drinking or using drugs. Many patients may have initially started using substances in an attempt to manage psychiatric symptoms. When faced with sobriety, without psychiatric treatment to support the use of effective and healthy coping mechanisms, those symptoms are exacerbated. This feeling of powerlessness can lead to relapse and continued substance use.
Comparing Dual Diagnosis and Addiction Treatment
The key difference is that addiction treatment primarily addresses substance use, while dual diagnosis treatment addresses both substance use and an underlying psychiatric disorder. Skyland Trail's residential dual diagnosis program is designed for adults whose primary psychiatric condition co-occurs with a substance use disorder.
| Question | Addiction treatment | Skyland Trail dual diagnosis |
|---|---|---|
| Primary problem | Substance use disorder | Psychiatric disorder + SUD |
| Psychiatric treatment | May be secondary | Central component |
| Psychiatrist | Varies | Yes |
| Mood disorders | May be addressed | Core treatment |
| Thought disorders | May be addressed | Core treatment |
| Detox | Often available | Not offered |
| >Residential psychiatric care | Varies | Yes |
| Substance-use treatment | Yes | Yes |
| Relapse prevention | Yes | Yes |
How do I know if I need an addiction program or a dual diagnosis program?
It can be difficult to determine which program would be the best fit for you, and a psychiatric assessment often is required to determine the relationship between your substance use and psychiatric symptoms.
As part of an assessment, a mental health professional will consider your history and explore which developed first - symptoms of depression, anxiety or psychosis - or experimentation with alcohol, marijuana, or other drugs. They will also ask about any periods of sobriety you’ve had in the past and how that affected, or did not affect, your psychiatric symptoms. When you stopped drinking for six months, did you feel less depressed or more depressed? When you stopped smoking marijuana, did you still hear voices that no one else could hear?
Other aspects of an assessment will evaluate the severity of both the substance use and the psychiatric symptoms. Some addiction treatment programs may offer programming that would be sufficient for someone with less severe psychiatric symptoms. Likewise, some dual diagnosis treatment programs may not be able to support a patient who needs to detox from severe or prolonged substance use. Some substances - like opioids, alcohol, heroin, or benzodiazepines – require specific medical treatment for detoxification that may not be available in a dual diagnosis program.
The most important first step if you need treatment is to get treatment. If, after beginning treatment, you and your treatment team determine that a different type of program would be better for you, you can make adjustments. Taking the first step is critical. If a person is willing to enter a treatment program, family and friends should help connect them with services as soon as possible.
Many patients complete a short-term addiction treatment program and then enroll in a dual diagnosis program to sustain and continue their recovery. Sometimes addiction treatment is required prior to entering a dual diagnosis program if detox is needed or if the patient is not able to establish a period of abstinence from substances.
Do I need dual diagnosis treatment if I recreationally use alcohol or marijuana?
A psychiatric assessment from a mental health professional is the best way to determine an answer. An assessment can help determine the extent to which substance use impacts your mood, cognitive skills, relationships, energy levels, etc. Even if you do not enter a formal dual diagnosis program, understanding the relationship between your substance use and your mental health can be important.
Many psychiatric treatment programs offer education and therapy groups to help patients better understand that relationship and incorporate goals related to substance use or sobriety in their wellness plans to help them stay healthy long-term. You may determine after examining your history that drinking with certain people or in specific situations is not healthy for you. Or you may decide that ending use of a substance, at least for a period of time, is the best way for you to feel good or make progress toward your goals.
Does entering a dual diagnosis program mean I’m an addict?
Entering a dual diagnosis treatment program means that you need evidence-based treatment for a substance use disorder and a psychiatric illness like depression, bipolar disorder, anxiety, or schizophrenia. It means that, right now, you need treatment. Treatment can help you understand your current relationship with substances and then determine how that relationship may need to change for you to experience a healthy future you define for yourself.