How are patients with dual diagnosis treated?

Nov 11, 2021

Treating patients presenting with dual diagnosis can be challenging. Symptoms of both illnesses may overlap and interact. Establishing a proper treatment plan and priorities is vital to helping these individuals recover. To learn more about the best ways to treat dual diagnosis keep reading.

Jocelyn Patterson

Jocelyn Patterson

Jocelyn Patterson, LMHC, ATR-BC, and counselor at BetterHelp.

Always Consider the Patient’s Safety First

Treating patients with dual diagnosis can become more complicated because multiple symptoms and behaviors interact with each other. So, when treating dual diagnosis, the most important thing to consider is safety. Safety is a mental health counselor’s number one concern. Always.

With dual diagnosis, you’ll want to treat the symptoms or behaviors that create a safety risk first. Always. Any behavior that puts the patient’s physical safety or others’ physical safety in question is where you should start.

You don’t necessarily want to think about which diagnosis you’ll treat first, but rather which symptoms that relate to safety you’ll treat first (as they relate to either diagnosis). A clear example of this would be a client that suffers from Major Depressive Disorder (MDD) and Antisocial Personality Disorder.

While the antisocial features impact the patient’s daily life (tendencies to go against social norms, deceitfulness, lack of responsibility), you’d want to focus on the symptoms related to impulsivity or disregard for safety first. At the same time, there may be current MDD symptoms like feeling sad or tired. You’d want to focus on any present symptoms related to thoughts of death or suicidal ideation first.

You can treat elements of both diagnosis at the same time. Once you’ve established some stability and trust with the patient (knowing what signs to look out for to keep everyone safe), you can move on to the other symptoms that the patient may feel are important.

Utilizing Multi-Faceted Intervention Plans

In the mental health field, patients come to treatment for various conflicts, illnesses, and disorders. It can be challenging to create a treatment plan for patients suffering from dual diagnosis. Generally speaking, dual diagnosis are co-occurring disorders. Addiction disease intertwines with a mental health illness. Substance abuse is generally not a standalone illness.

A comprehensive biopsychosocial evaluation encompasses the recommended modules for individualized psychotherapy, sometimes integrated with psychiatric medication, numerous forms of intervention, reanalysis, and an aftercare plan. The treatment is customized to the individual and will require cooperation with their support system.

Behavioral interventions are a multi-component treatment plan creating a problem list then the course of action where recovery and emotional stabilization go beyond psychotherapy and psychiatric medication. Other additional interventions may include inpatient treatment programs, intensive outpatient programs, career and housing assistance, family counseling, and financial management.

It must fit the patient’s tolerance, drive, and capabilities. The treatment plan must be evaluated regularly and adjusted if needed. We need to understand that the recovery process must treat both diagnosis simultaneously. However, statistically, mental health providers and treatment facilities encounter challenges because the patient can be medication noncompliant, fail to respond to the treatment plan, be aggressive, and have poor daily functioning overall.

Social engagement generally involves drug use and a high risk for relapse. Integrated treatment is proven to be effective. The treatment plan should be in one setting where mental health and substance abuse professionals collaborate to coordinate the intervention and a consistent strategy.

John P. Carnesecchi

John P. Carnesecchi

John P. Carnesecchi, LCSW, CEAP, Founder and Clinical Director of Gateway to Solutions.
Aimee Daramus

Aimee Daramus

Aimee Daramus, Psy.D. and Licensed Clinical Psychologist at AudeoTherapy.

Prioritize Suicidal Urges and Substance Abuse

Safety issues like suicidal urges or self-harm should be the priority. Then, you and the client should decide together what’s causing the most pain or dysfunction in their life. Typically, substance abuse issues come before other mental health issues since substance use can confuse diagnosis by hiding symptoms or mimicking other problems.

Behavioral Therapy and Medications

When a person has a dual diagnosis, they must address both illnesses. You must abstain from using drugs or alcohol for the therapy to be effective. Behavioral therapy and medications may be used. Support networks can also help with emotional and social issues.

A psychiatric condition or disorder that leads to or is connected with troublesome alcohol and/or other substance use is an example of a dual diagnosis.

Dan Barrett

Dan Barrett

Dan Barrett, Co-Founder of Pacific Precious Metals.

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