This might be your first time headed to a treatment facility. For many patients with a dual diagnosis, it’s not. With a quick search you will find data from the National Institutes of Health that the average person in recovery attends a treatment program for 3 to 4 treatment episodes. A nationally representative study shows that people with a history of psychiatric conditions report more recovery attempts. It highlights the need to address mental health and substance use together.
So, what can be different this time? Finding a program that treats both mental health and addiction can change the way your care is approached. Integrated dual diagnosis treatment looks at underlying clinical, behavioral, emotional, and environmental factors. With the right assessment, treatment team, and level of care, those findings inform an individualized plan. The plan targets greater stability, stronger coping skills, and the foundation for long-term recovery.
How to get diagnosed with dual diagnosis
The first step to recovery is admitting you have a problem. You will hear this several times throughout your journey and for many this is true. For others it’s when you are medication compliant long enough to see the difference in your symptoms.
The truth is there isn’t one path that guides you to life changing treatment. What works for one person, might not work for another. The best way to get a clear diagnosis is to document your symptoms and struggles. Share the history during your pre-admission assessment and again during your initial admission consultations. This will ensure you are entering the right level of care at a facility equipped to treat you fully.
It’s not uncommon to be ashamed of behaviors and symptoms associated with mental health conditions and addiction. However, the more honest you are the closer you will come to a resolution that truly works for you.
You have a dual diagnosis, now what?
The level of care you need depends on the severity of your condition. This is determined on a medical and clinical scale.
When substance use disorder is involved, the first step is to begin medical detoxification. The next step is to rid yourself of all mind-altering substances.
After detox completes, the next stage focuses on stabilizing your additional conditions and forming healthy habits. This supports your success across the continuum of care levels. This is often called residential inpatient treatment.
This may include an introduction to medication and therapeutic modalities. Depending on your condition and progression the continuation of lower levels of care, medication management and types of therapy will be determined on an individual level.
What are common dual diagnosis?
Substance use disorder is frequently accompanied by another mental health condition. In some cases, a person may begin using alcohol or drugs in an attempt to cope with symptoms such as anxiety, depression, trauma, insomnia, or emotional distress. In other cases, ongoing substance use may worsen existing mental health symptoms or contribute to new psychiatric symptoms. The relationship can be complex, and it is not always possible to identify one condition as the clear cause of the other.
Depression + Substance Use Disorder
Depression is one of the most common mental health conditions seen alongside substance use disorder. According to the 2024 National Survey on Drug Use and Health, 19.2% of adults with a past-year substance use disorder also experienced a major depressive episode, compared with 8.2% of adults overall. Depression and substance use can also affect one another in different ways. Some people use alcohol or drugs in an attempt to temporarily escape sadness, hopelessness, low motivation, sleep problems, or other depressive symptoms. At the same time, ongoing substance use, withdrawal, and the consequences associated with addiction can contribute to or intensify symptoms of depression.
The connection becomes especially important when certain substances also have legitimate psychiatric uses. Ketamine, for example, has been studied and used clinically for treatment-resistant depression, while its derivative esketamine (Spravato) is FDA approved for certain depressive disorders. However, ketamine is also a Schedule III controlled substance with the potential for misuse and abuse. Outside of appropriate medical supervision, it may be misused for its dissociative and hallucinogenic effects, and repeated high-dose misuse has been associated with cognitive problems, dependence, and serious urinary complications.
For someone experiencing both depression and problematic substance use, treatment should account for the full clinical picture. This includes identifying whether depressive symptoms existed before substance use began. It also covers whether they worsen during intoxication or withdrawal. It also checks whether medications or other substances may be affecting mood. Addressing both conditions together can help clinicians develop a treatment plan that supports psychiatric stability while also treating the substance use disorder.
Anxiety + Substance Use Disorder
Anxiety and substance use frequently overlap. According to the 2024 National Survey on Drug Use and Health (NSDUH), 7.4% of U.S. adults, or about 19.4 million people, reported moderate or severe symptoms of generalized anxiety disorder (GAD). Substance use was considerably more common within this group. Nearly 48.9% of adults with moderate or severe anxiety symptoms reported illicit drug use during the past year, compared with 22% of adults who had no or minimal anxiety symptoms. Misuse of prescription psychotherapeutic medications was also more than three times as common, at 13.1% versus 3.7%.
For some people, alcohol or drugs may initially feel like a way to quiet racing thoughts, reduce panic, sleep, or temporarily escape persistent anxiety. Benzodiazepines such as Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam), and Valium (diazepam) are prescription medications. They may be used to treat certain anxiety disorders and related conditions. Although they can be clinically appropriate when prescribed and monitored carefully, benzodiazepines also carry recognized risks of misuse, addiction, physical dependence, and withdrawal. The FDA requires all benzodiazepines to carry a boxed warning addressing these risks.
Misuse is not uncommon. The 2024 NSDUH report from SAMHSA estimates that 4.6 million people age 12 or older misused prescription tranquilizers or sedatives in 2024, a category that includes benzodiazepines as well as other medications. This is particularly important in dual diagnosis treatment because stopping benzodiazepines abruptly after physical dependence has developed can cause serious withdrawal symptoms, including seizures. The FDA recommends gradual, individualized dose reduction rather than abrupt discontinuation when dependence has developed. Treatment for co-occurring anxiety and substance use disorder should therefore address the anxiety itself while also evaluating medication use, substance use patterns, dependence, and withdrawal risk.
Borderline Personality Disorder + Substance Use Disorder
Borderline personality disorder (BPD) and substance use disorder frequently occur together. An updated review of research on BPD and substance use disorders involving more than 10,000 people with a current substance use disorder found that approximately 22% also met criteria for BPD. Looking at the relationship from the other direction, population-based research has also found particularly high rates of substance dependence among people with BPD. Data from the National Epidemiologic Survey on Alcohol and Related Conditions found 47.4% of people with BPD had alcohol dependence. This figure shows substantial comorbidity with substance use disorders. (Current Addiction Reports)
BPD can involve difficulty regulating emotions, impulsive behavior, unstable relationships, intense fears of abandonment, and periods of significant emotional distress. The National Institute of Mental Health (NIMH) also identifies substance use disorder as a condition that commonly occurs alongside BPD. For some people, alcohol or drugs may become a way of temporarily escaping or managing difficult emotions. Substance use can then intensify impulsivity, emotional instability, relationship problems, and other symptoms, creating a cycle that can make both conditions more difficult to manage.
BPD and substance use can influence many of the same areas of a person’s life, treating only one condition may leave important needs unaddressed. Dual diagnosis treatment can combine substance use treatment with therapies designed to improve emotional regulation, distress tolerance, interpersonal skills, and healthier coping strategies. Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that was developed specifically for BPD and teaches skills for managing intense emotions, reducing self-destructive behaviors, and improving relationships.
Obsessive Compulsive Disorder + Substance Use Disorder
Obsessive compulsive disorder (OCD) can also occur alongside substance use disorder. Data from the nationally representative National Comorbidity Survey Replication found that 38.6% of adults with lifetime OCD also met criteria for a substance use disorder. About 23.7% had experienced alcohol dependence, while 21.7% had experienced a drug use disorder involving abuse or dependence.
OCD is characterized by recurring, unwanted thoughts, urges, or images known as obsessions and repetitive behaviors or mental rituals known as compulsions. For some people, alcohol or drugs may become an attempt to quiet intrusive thoughts, reduce anxiety, or temporarily escape the distress associated with OCD. Substance use may provide short-term relief while ultimately making symptoms, functioning, and overall mental health more difficult to manage.
When OCD and substance use disorder occur together, treatment may need to address both compulsive substance use and the underlying OCD symptoms that can contribute to distress. Evidence-based OCD treatment, including cognitive behavioral therapy with exposure and response prevention (ERP), can be incorporated. It should occur alongside substance use treatment based on the individual’s needs and stability. NIMH identifies ERP as an established behavioral treatment for OCD. It notes that ERP can be effective alone or with medication.
Post Traumatic Stress Disorder + Substance Use Disorder
Post-traumatic stress disorder (PTSD) has a particularly strong connection with substance use disorder. According to the U.S. The Department of Veterans Affairs National Center for PTSD reports that 44.6% of people with lifetime PTSD met criteria. They met criteria for an alcohol use disorder or another substance use disorder in a large national epidemiological study. Research has also found that people with PTSD are approximately two to four times more likely to have a substance use disorder than people without PTSD.
PTSD can cause intrusive memories, nightmares, hypervigilance, anxiety, sleep problems, emotional numbness, and other symptoms that can be difficult to manage. Some people begin using alcohol or drugs to temporarily reduce these symptoms. They seek sleep, to avoid traumatic memories, or to feel emotionally disconnected from their experiences. Substance use may offer temporary relief. However, it can later worsen PTSD symptoms and hinder healthy coping strategies. It also raises the chance of developing dependence or addiction. Research on co-occurring PTSD and substance use disorders shows the relationship can go both ways. Substance use may increase exposure to traumatic events. Trauma symptoms can contribute to continued substance use.
When PTSD and substance use disorder occur together, treatment can address both conditions rather than requiring a person to resolve one before receiving care for the other. Trauma-informed dual diagnosis treatment may incorporate substance use treatment alongside evidence-based PTSD therapies. It includes coping skills, emotional regulation strategies, and medication management when appropriate. The approach also provides support for safely processing trauma as recovery progresses.
Schizophrenia + Substance Use Disorder
Substance use disorder is especially common among people living with schizophrenia. Research published by the American Psychiatric Association reports that an estimated 47% to 70% of people with schizophrenia experience a substance use disorder during their lifetime, with rates reaching approximately 80% when tobacco use disorder is included. Alcohol, cannabis, cocaine, and tobacco are among the substances most commonly used in this population. Research on substance use disorders and schizophrenia has also found that co-occurring substance use is associated with greater psychiatric symptom severity, reduced functioning, and increased medical complications.
The relationship between schizophrenia and substance use is complex. Some people may use substances in an attempt to cope with distress, social difficulties, sleep problems, medication side effects, or other symptoms. At the same time, certain substances can worsen psychiatric symptoms. Cannabis is particularly important to consider because research has associated frequent cannabis use with an increased risk of psychosis, especially among people who already have genetic or other vulnerabilities. The National Institute on Drug Abuse notes that the relationship is influenced by factors including frequency of use, age at first use, and individual vulnerability.
When schizophrenia and substance use disorder occur together, both conditions need to be considered in the treatment plan. Clinical research on co-occurring schizophrenia and substance use disorders supports an integrated approach that addresses psychiatric symptoms and substance use rather than treating them as unrelated conditions. Treatment may include psychiatric medication management, individual and group therapy, substance use counseling, relapse-prevention strategies, and ongoing monitoring as symptoms and recovery needs change.
Levels of Care for Dual Diagnosis
Mental health and substance use treatment can take place at several levels of care, ranging from short-term hospitalization and medical detoxification to residential and outpatient programs. The appropriate setting depends on several factors. These include severity of psychiatric symptoms, substances used, and withdrawal risk. Also important are physical health, safety concerns, prior treatment history, and stability outside a structured environment.
For people with a dual diagnosis, determining the right level of care requires looking at both conditions together. Someone experiencing severe withdrawal may need medical detoxification before beginning residential treatment, while a person experiencing an acute psychiatric crisis may first require hospitalization. In Florida, the Baker Act and Marchman Act may also provide pathways for involuntary evaluation or treatment when specific legal criteria are met.
Hospitalization
Hospitalization represents one of the highest levels of behavioral healthcare and is generally used when a person requires immediate medical or psychiatric stabilization that cannot be safely provided in a less intensive setting. This may include severe psychiatric symptoms, acute psychosis, suicidal or dangerous behavior, serious medical complications related to substance use, severe intoxication, or withdrawal requiring hospital-level management.
Treatment in a hospital is typically focused on stabilization rather than completing the entire recovery process. Once the immediate crisis has been addressed, the treatment team can determine whether the patient should transition to medical detox, residential treatment, a partial hospitalization program, or another appropriate level of care.
Baker act
Florida’s Baker Act establishes procedures for voluntary and involuntary mental health examinations. Under Florida Statute § 394.463, a person may qualify for an involuntary examination when there is reason to believe they have a mental illness and, because of that illness, they are unable or unwilling to determine whether an examination is necessary and meet additional criteria involving a substantial risk of harm or serious self-neglect.
A Baker Act examination is not the same as being involuntarily committed to long-term psychiatric treatment. The examination period may last for up to 72 hours after arrival at a receiving facility. During that period, clinicians evaluate the person’s condition and determine the appropriate next step, which may include release, voluntary treatment, or, when legal criteria continue to be met, a petition for additional involuntary services. (Florida Legislature)
For a patient with both mental health and substance use concerns, stabilization under the Baker Act may be only the beginning of care. Once an immediate psychiatric crisis is stabilized, further assessment may identify a need for dual diagnosis treatment that addresses substance use and the underlying mental health condition together.
Marchman act
The Marchman Act is Florida’s legal framework for certain involuntary substance use assessments, stabilization, and treatment. It differs from the Baker Act because its primary focus is substance use rather than a mental health crisis.
Under Florida Statute § 397.675, involuntary admission may be considered when there is a good-faith reason to believe a person is substance-use impaired, or has a substance use disorder with a co-occurring mental health disorder, has lost the power of self-control over substance use, and meets additional statutory criteria related to impaired judgment, serious self-neglect, or risk of physical harm.
Depending on the circumstances, the Marchman Act can involve protective custody, emergency admission, assessment and stabilization, or a petition for court-ordered treatment. Florida law requires providers to determine whether the individual meets admission criteria and to place the person in the most appropriate and least restrictive available setting that can safely address their needs. (Florida Statute § 397.6751)
A Marchman Act proceeding should not be viewed as a level of treatment by itself. Instead, it is a legal pathway that may help someone enter assessment, stabilization, or substance use treatment when statutory criteria for involuntary care are met.
Medical detox
Medical detoxification is often the first clinical step when stopping alcohol, opioids, benzodiazepines, or other substances could cause significant withdrawal symptoms. During detox, medical professionals monitor the patient’s physical and psychological condition, manage withdrawal symptoms, and may administer medications when clinically appropriate.
The intensity of detox varies based on the substance involved, amount and duration of use, previous withdrawal history, medical conditions, psychiatric symptoms, and other risk factors. SAMHSA recognizes multiple levels of withdrawal management, ranging from ambulatory services to medically managed inpatient care. Patients with significant withdrawal risk, unstable medical conditions, or complex co-occurring psychiatric symptoms may require 24-hour medical monitoring.
Detox can help a patient become medically stable, but detox alone is not a complete treatment for substance use disorder. After withdrawal has been safely managed, patients generally benefit from continued addiction and mental health treatment that addresses the behaviors, psychiatric symptoms, triggers, relationships, and other factors connected to ongoing substance use.
Residential treatment
Residential treatment provides 24-hour structure and support in a live-in treatment environment. It may be appropriate for patients who have completed medical stabilization but continue to need a high level of clinical support before transitioning to outpatient care.
For someone with a dual diagnosis, residential treatment provides an opportunity to address substance use and mental health symptoms within the same treatment plan. Depending on the patient’s diagnosis and needs, care may include individual and group therapy, psychiatric evaluation, medication management, relapse prevention, coping-skills development, behavioral therapies, recovery planning, and treatment for co-occurring conditions such as depression, anxiety, PTSD, bipolar disorder, or schizophrenia.
The structure of residential treatment can also provide distance from substances, triggers, unstable environments, and routines that may have contributed to previous relapses. As the patient becomes more stable, the treatment team can begin planning for the next stage of recovery, which may include a partial hospitalization program (PHP), intensive outpatient program (IOP), or standard outpatient treatment.
Partial Hospitalization Program (PHP)
A Partial Hospitalization Program (PHP) provides a high level of structured treatment without requiring an overnight hospital stay. For patients with a dual diagnosis, PHP can serve as a step down from residential treatment or as an alternative when 24-hour residential care is not medically necessary but intensive clinical support is still appropriate.
At Milton Recovery Centers, PHP for dual diagnosis is designed to address both substance use and co-occurring mental health conditions within one coordinated treatment plan. Depending on the patient’s needs, treatment may include individual and group therapy, psychiatric care, medication management, relapse-prevention planning, coping-skills development, and evidence-based approaches for conditions such as depression, anxiety, PTSD, bipolar disorder, schizophrenia, and other behavioral health concerns.
Mental health symptoms and substance use can influence one another, treating both conditions at the same time can help clinicians better understand triggers, symptom patterns, medication needs, and barriers to recovery. As patients become more stable and independent, they may transition from PHP into an intensive outpatient program (IOP) or another appropriate level of ongoing care.
Intensive Outpatient Program (IOP)
An Intensive Outpatient Program (IOP) provides structured mental health and substance use treatment while allowing patients to continue living at home or in a supportive recovery environment. It may be appropriate for people who no longer need residential or PHP-level care but still benefit from several hours of treatment on multiple days each week.
At Milton Recovery Centers, IOP for dual diagnosis is designed to treat substance use disorder alongside co-occurring mental health conditions within the same coordinated plan of care. Depending on the patient’s needs, treatment may include individual therapy, group therapy, psychiatric services, medication management, relapse-prevention planning, coping-skills development, and support for conditions such as depression, anxiety, PTSD, bipolar disorder, schizophrenia, and other behavioral health concerns.
IOP can also help patients begin applying recovery skills in everyday life while maintaining regular clinical support. As patients return to work, family responsibilities, school, or other routines, the treatment team can help identify new triggers, monitor mental health symptoms, adjust treatment strategies when appropriate, and build a plan for continued stability and long-term recovery.
I Don’t Want to Take Medication Forever
The determination of what medication and the length of time you take the medication is determined by your psychiatrist and clinical team.
For some conditions medication is a temporary tool used to stabilize and heal the damage done.
For other conditions, the long term use and medication compliance is one of the most important parts of treating the mental health condition.
The recommendation to start medication shouldn’t be taken lightly. You should feel comfortable asking questions, doing research and you are entitled to a second opinion if you feel one is necessary.
Will I Need Therapy Forever?
Therapy is a broad term for the guided approaches used to support healing, build coping skills, strengthen relationships, and help people better understand patterns in their thoughts, emotions, and behaviors. There is no single timeline that applies to everyone. In short, therapy can continue for as long as it is serving a meaningful purpose in your life and recovery.
Your needs may also change over time. During early recovery or periods of significant mental health symptoms, therapy may be more frequent and structured. As you become more stable, sessions may decrease or shift toward maintenance. Some people continue weekly therapy for years, while others return periodically during stressful transitions, major life changes, grief, relationship challenges, or when old patterns begin to resurface.
Therapy does not always look the same throughout that process. Different formats and therapeutic approaches can serve different purposes depending on your diagnosis, goals, symptoms, and stage of recovery.
Individual Therapy
Individual therapy provides one-on-one time with a therapist to work through personal concerns in a private setting. Sessions may focus on mental health symptoms. They cover substance use patterns, trauma, relationships, and triggers. Coping skills, relapse prevention, and other issues affect recovery and daily functioning.
Telehealth Therapy
Telehealth therapy allows patients to meet with a licensed mental health professional through a secure virtual platform. It can make ongoing care more accessible for people balancing work, family responsibilities, transportation challenges, or distance from their provider. Telehealth may be used for ongoing individual therapy, psychiatric follow-up, or other behavioral health services when clinically appropriate.
Group Therapy
Group therapy brings together people working through similar mental health or substance use concerns under the guidance of a clinician. In addition to learning new skills, patients have an opportunity to hear different perspectives, practice communication, recognize shared experiences, and receive support from others who understand aspects of the recovery process.
Family Therapy
Mental health conditions and substance use can affect the entire family system. Family therapy can help improve communication and establish healthier boundaries. It also addresses patterns that contribute to conflict and helps family members support recovery without taking responsibility for another’s treatment.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is a structured psychotherapy commonly used to help people process traumatic or distressing experiences. Rather than requiring a person to repeatedly describe every detail of a traumatic event, EMDR uses guided recall combined with bilateral stimulation while the patient works through distressing memories, beliefs, and emotional responses. It may be incorporated into treatment for PTSD and other trauma-related concerns when appropriate.
Motivational Interviewing (MI)
Motivational Interviewing is a collaborative therapeutic approach designed to help people explore uncertainty about change and strengthen their own reasons for moving forward. It is frequently used in substance use treatment because recovery often involves periods of ambivalence. Instead of confronting or pressuring the patient, MI helps identify personal goals, values, barriers, and motivations that can support meaningful behavioral change.
Accelerated Resolution Therapy (ART)
Accelerated Resolution Therapy, or ART, is a trauma-focused psychotherapy that uses guided imagery and eye movements to help patients change the way distressing memories and emotional responses are experienced. ART may be used for trauma-related symptoms, anxiety, depression, and other concerns when a trained clinician determines it is appropriate.
Therapy is not something a person has to “graduate from” on a fixed schedule. The goal is for the level, frequency, and type of support to evolve as your needs change. For some people, that means intensive therapy early in recovery followed by occasional sessions later. For others, maintaining a regular relationship with a therapist becomes an important part of protecting their mental health and continuing to grow.
Find Dual Diagnosis Treatment at Milton Recovery Centers
Living with both a mental health condition and substance use disorder can make recovery feel more complicated, especially when each condition affects the other. Effective dual diagnosis treatment looks at the full clinical picture rather than treating addiction and mental health as separate concerns. With the right level of care, patients can begin addressing substance use, psychiatric symptoms, underlying patterns, coping skills, relationships, and the factors that may have made previous attempts at recovery difficult to sustain.
Milton Recovery Centers provide dual diagnosis treatment in Florida and Ohio for adults who need coordinated support for substance use and co-occurring mental health conditions. Depending on your needs, treatment may include medical detox, residential care, partial hospitalization, and intensive outpatient treatment. Additionally, services may encompass psychiatric care, medication management, individual and group therapy, and ongoing recovery planning.
If this is not your first time seeking treatment, that does not mean another attempt cannot be different. A correct diagnosis, suitable treatment setting, and clinical approach reveal what has driven both conditions. This shows what you need to move forward. Contact our admissions team to speak about dual diagnosis treatment in Florida or Ohio and determine which level of care may be appropriate for you.
