Dual Diagnosis vs. Co-Occurring Disorders: Understanding the Differences

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Pathways Recovery Center is a leading residential inpatient treatment facility committed to helping clients heal from substance abuse and co-occurring mental health disorders. The clinical team uses evidence-based and alternative holistic therapies to ensure clients have access to the right level of care. Understanding the differences between terms for co-occurring conditions allows people in recovery to make more educated decisions about their treatment and recovery. 

Accurate diagnosis is essential to ensuring clients receive effective and appropriate treatment for their conditions. Often, mental health disorders and substance use disorder (SUD) share many overlapping risk factors, symptoms, and side effects. Identifying co-occurring issues allows clinicians to present clients with the best treatment options for their condition. Knowing the difference between dual diagnosis and co-occurring disorders may help some clients better understand their treatment.

According to Psychiatry, "Currently, there are no diagnostic criteria for dual diagnosis or co-occurring disorders." However, there are some technicalities separating the two terms to a slight degree. Dual diagnosis inherently refers to two distinct conditions, one related to mental health and one related to substance abuse. Co-occurring disorders, on the other hand, encompass a wider range of disorders and circumstances. How the terms are used depends on who is using them and the context of the conversation. Clinicians are more likely to use the term dual diagnosis compared to the general public, who generally use "co-occurring disorders" to refer to comorbidities.

Substance Abuse and Mental Health: A Complex Interplay

SUD and mental health disorders have a direct and indirect effect on one another. Connections between the two are complicated and often involve multiple underlying root issues linked to both conditions. According to the National Institute of Mental Health (NIMH), "Though people might have both a SUD and a mental disorder, that does not mean that one caused the other." The relationship between mental health disorders and substance abuse is often complicated. 

A few ways mental health disorders and SUD interact include: 

  • The effects of substance abuse may cause mental health issues to develop 
  • Mental health issues may cause people to self-medicate and abuse substances to cope with symptoms
  • Both conditions may develop independently

Understanding how these conditions relate to one another helps clients and clinicians collaborate to create more effective treatment plans. The interplay between SUD and mental health issues determines which treatments may be most helpful. Pathways Recovery Center uses comprehensive assessments and screening tools to accurately diagnose active conditions and identify any underlying issues. 

Determining the root cause of various mental health issues and maladaptive behaviors, including substance abuse, allows clinicians to create more personalized care plans. Often, dual diagnosis and co-occurring disorders require integrative care to ensure clients receive the right level of support. 

Dual Diagnosis

People hear the term dual diagnosis when speaking with counselors, medical professionals, and addiction recovery specialists. Research papers, addiction recovery literature, and other sources may also use the term to describe substance abuse and a co-occurring mental health disorder. Often, the term is used interchangeably with co-occurring disorders by the general public and, in some cases, during conversations with medical professionals. Below are a few ways clients in treatment can differentiate between co-occurring disorders and dual diagnosis when speaking with their care team. 

#1. Definition and Characteristics

A dual diagnosis, as the word implies, refers to two concurrent diagnoses. In the mental health field, dual diagnosis almost exclusively applies to cases involving one mental health disorder accompanying one substance use disorder. For example, an individual with alcohol use disorder (AUD) and bipolar disorder (BD) and no other diagnosed disorders would have a dual diagnosis. 

Some of the most common dual diagnoses include: 

  • AUD and major depressive disorder (MDD)
  • Post-traumatic stress disorder (PTSD) and opioid use disorder (OUD)
  • Attention-deficit/hyperactivity disorder (ADHD) and SUD 

Any combination of a SUD and an accompanying mental health disorder can be considered a dual diagnosis. Many individuals with SUD have a dual diagnosis. 

#2. The Impact of Dual Diagnosis

Dual diagnosis often leads to more severe symptoms and side effects for both conditions. The impact can reduce a person's quality of life, damage relationships, and negatively affect overall well-being. Often, it takes months or years for people to get the help they need to heal. Treating dual diagnosis usually involves addressing all these issues to reduce the risk of relapse.

#3. Treatment Approaches and Solutions

Clinicians and clients can choose from several different approaches to dual diagnosis treatment. According to Alcohol Health and Research World, "One approach is to treat one disorder first and then the other (i.e., sequential treatment); the second approach is to treat both disorders simultaneously but in different settings (i.e., parallel treatment); the third is to treat both disorders simultaneously in the same setting (i.e., integrated treatment)." Pathways Recovery Center educates clients to ensure they make well-informed choices about their treatment and health. The clinical team uses a holistic approach and integrative care to treat dual diagnosis. 

Co-Occurring Disorders Demystified

"Co-occurring disorders" is an umbrella term used to describe comorbid substance use and mental or physical disorders. In most cases, co-occurring disorders refer to one or more substance abuse issues diagnosed alongside one or more mental health disorders. Below are brief explanations for how to differentiate co-occurring disorders from other conditions and the potential side effects of co-occurring disorders. 

#1. Definition and Features

Co-occurring disorders are any two or more medical disorders occurring simultaneously. The general public, politicians, news, media personalities, and other laypeople may use this term to refer to any concurrent medical conditions. When used in reference to substance abuse, co-occurring disorders generally refer to two or more mental health issues occurring with SUD. 

Some examples of co-occurring disorders include: 

  • Bipolar disorder, AUD, and generalized anxiety disorder (GAD) 
  • Marijuana use disorder (MUD), AUD, and MDD 
  • AUD, OUD, PTSD, and ADHD 

Often, common mental health disorders like anxiety and depression manifest together as distinct diagnoses alongside SUD. There is no limit to how many conditions may be diagnosed for individuals with co-occurring disorders. 

#2. The Consequences of Co-Occurring Disorders

Co-occurring disorders have more severe effects on a person's health, career, and relationships. Multiple comorbid mental health disorders have the potential to cause severe distress and reduced quality of life. Treating multiple conditions is not always easy, and in some cases, the care team might need to refer clients to higher levels of care for complex mental health issues before addressing symptoms of SUD. Pathways Recovery Center prioritizes personalized care to ensure clients with co-occurring disorders can access the services and resources they need to achieve and maintain long-term sobriety and positive mental health. 

#3. Strategies for Effective Treatment

Treatment centers may offer tailored care plans to ensure clients heal from the damaging effects of living with multiple conditions. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), "The presence of two or more disorders can complicate diagnosis and treatment." However, "Integrating both screening and treatment for mental and substance use disorders leads to a better quality of care and health outcomes for those living with co-occurring disorders by treating the whole person." Pathways Recovery Center uses comprehensive screening and integrative care to provide clients with the most appropriate and effective treatments. Synchronized treatment for SUD and mental health disorders provides clients with a healthier foundation for sober living. 

Key Differences Between Dual Diagnosis and Co-occurring Disorders

Below are brief descriptions of the primary difference between dual diagnosis and co-occurring disorders.

#1. Diagnostic Criteria

Currently, no diagnosis criteria exist to differentiate dual diagnosis from co-occurring disorders. The two terms have understood nuances. However, mental health experts and researchers have failed to reach a consensus on determining the criteria for each. Steps have been taken to try and add clinical criteria for dual diagnosis and co-occurring disorders into the Diagnostic and Statistical Manual of Mental Disorders. However, currently, no standard definition exists for clinicians to utilize. 

#2. The Treatment Implications

Treatment plans are tailored to address co-occurring disorders and dual diagnosis by taking into account multiple factors, including: 

  • Type of disorders 
  • Severity of symptoms 
  • Client's general health
  • Potential side effects 

Pathways Recovery Center uses evidence-based diagnostic criteria to accurately diagnose comorbid conditions. An accurate diagnosis allows clinicians to use an integrative approach to care. According to the previously mentioned article by SAMHSA, "Together with early detection, integrated treatment can improve outcomes and quality of life for people with co-occurring disorders, including:

  • Reduced or discontinued substance use
  • Improvement in psychiatric symptoms and functioning
  • Increased chance for successful treatment and recovery for both disorders
  • Improved quality of life
  • Decreased hospitalization
  • Reduced medication interactions
  • Increased housing stability
  • Fewer arrests

Individuals with dual diagnosis may require less intense treatment compared to clients with multiple co-occurring mental health disorders. 

#3. Prognosis and Recovery

Clients with co-occurring disorders or dual diagnoses may have many different potential outcomes. Some disorders must be managed long-term using medications and therapy, while others may resolve quickly with the help of mental health and addiction recovery specialists. The prognosis is not necessarily better for individuals with dual diagnosis. 

Often, the prognosis and eventual outcome depend on many factors, including: 

  • An accurate diagnosis 
  • Type of co-occurring disorders 
  • Severity of symptoms 
  • Client's support system 
  • Treatments used 

Most people with co-occurring disorders or dual diagnoses have multiple underlying issues that clinicians must address to stabilize clients. The clinical team at Pathways Recovery Center collaborates closely with clients and their loved ones to ensure the root causes of the disorders are addressed. 

Pathways Recovery Center: A Beacon of Hope

Treatment programs at Pathways Recovery Center address any social, biological, and psychological factors affecting a person's mental health. The residential programs provide clients with a safe and comfortable space to heal and grow. Clients with multiple co-occurring conditions may face unexpected challenges. A structured residential environment offers clients the support they need to manage their condition effectively. Clinicians ensure clients have access to the tools, resources, and skill development they need to recover from SUD and co-occurring mental health issues. 

Some of the treatments and services offered in residential programs include: 

  • Tailored care plans
  • Medication-assisted treatment (MAT)
  • Individual and group counseling
  • Substance use education
  • Peer support
  • Access to 12-Step meetings
  • Relapse prevention
  • Treatment planning
  • Aftercare referrals and planning
  • On-site chef to encourage healthy eating
  • Fitness, yoga, and outdoor activities  
  • Art therapy and other alternative therapies

Holistic treatment at Pathways Recovery Center uses evidence-based therapies and complementary services to help clients successfully maintain sobriety. The whole-person approach to care considers each client's mental, physical, and spiritual well-being during rehabilitation and aftercare planning. 

How Residential Treatment Programs Improve Long-Term Outcomes

Residential treatment programs improve long-term recovery for clients with dual diagnosis or co-occurring disorders. Programs allow people to heal without the distractions of everyday life interfering with their recovery. The extra structure often reduces the severity of symptoms and the risk of relapse. 

People in residential programs benefit from becoming part of a welcoming community of peers with similar life experiences. Being around others who understand the challenges of managing multiple mental health issues reduces stress and may help some people heal more quickly. Not everyone needs residential treatment. However, more complex or persistent mental health issues may require a higher level of care than outpatient treatment. 

Some of the benefits of participating in residential treatment include: 

  • Access to 24/7 medical support and supervision
  • Increased accountability 
  • Skill development 
  • Less pressure from friends and family 

Individuals with multiple mental health issues have a higher risk of relapse during early recovery. However, residential treatment programs lower the risk significantly by using integrative treatments. According to the Department of Veterans Affairs (VA), "[P]atients who suffered from mental and alcohol disorders, and were treated for both concurrently using dual diagnosis protocols, produced better short and long term alcohol outcomes than sequential treatment because of the effectiveness of the integrated treatment of the co-occurring disorders and other measures that have been historically associated with elevated relapse."

Do Co-Occurring Disorders Require Additional Levels of Care?

No two cases are the same. The levels of care required for co-occurring disorders depend on many factors. Treatment plans personalized to the needs and preferences of the client provide more effective care for individuals with co-occurring disorders. 

The clinicians at Pathways Recovery Center may refer clients to higher levels of care to address more severe mental health disorders, including: 

  • Active suicidal thoughts or behaviors 
  • Active self-harming behaviors 
  • Severe forms of psychosis
  • Clients exhibiting any behaviors making them a danger to themselves or others 

Individuals diagnosed with co-occurring disorders often benefit from gradually stepping down through multiple levels of care until they transition to aftercare. The slower transition away from structured care gives people with numerous conditions the time they need to learn how to effectively manage their mental health independently. 

Charting a Path to Wholesome Recovery

Specialized and comprehensive care is the best way to reduce the adverse side effects of co-occurring disorders and dual diagnosis during treatment and early recovery. 

Treatment plans at Pathways Recovery Center provide a wholesome path to recovery by doing the following: 

  • Ensuring all clients are accurately diagnosed and presented with appropriate treatment options 
  • Personalizing each service and treatment to help clients achieve optimal outcomes 
  • Opening up a line of communication between the clinical team and clients 
  • Ensuring clients have a clear understanding of their diagnosis and prognosis 

Effective treatment is not possible without an accurate diagnosis of all active conditions. Clients must undergo a clinical assessment to determine what disorders require treatment alongside SUD. An accurate diagnosis shapes the direction of treatment and ensures a positive recovery journey. The clinical team is highly trained to notice the differences between similar conditions, reducing the risk of misdiagnosis. Clients are educated on co-occurring disorders or dual diagnosis and how they may affect recovery from SUD. 

Pathways Recovery Center is available to help individuals and families struggling with SUD, dual diagnosis, or co-occurring disorders. Clinicians provide expertise, education, and guidance to clients and their loved ones. The compassionate care team has decades of combined experience helping people heal and recover from substance abuse and mental health disorders. 

Many people are unaware of the slight differences between dual diagnosis and co-occurring disorders. However, knowing the distinction can help clients in recovery better understand their diagnosis and treatment plan. In many cases, people with SUD have more than one co-occurring mental health disorder. The additional symptoms and side effects can interfere with treatment and recovery unless all active and underlying issues are treated simultaneously using personalized, integrative treatment. Pathways Recovery Center uses evidence-based methods and alternative holistic therapies to help clients recover from co-occurring SUD and mental health disorders. Clinicians collaborate with clients and their families to provide high-quality, person-centered care. To learn more about our treatment programs and services, call our office today at (888) 771-0966.

Clinically reviewed by 

Moses Nasser
Dr. Moses Nasser, a double board-certified physician in Family Medicine and Addiction Medicine, with expertise in holistic healing, addiction medicine, and psychiatric care, holds an X-waiver to prescribe buprenorphine and has extensive experience in mindfulness-based customer service and medication-assisted treatment.

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