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Treatment Guide

Dual Diagnosis and Co-Occurring Disorders in WA State

Co-occurring disorders are a major problem in Washington State. It's actually quite common for people to suffer from them without realizing it. When an individual has an addiction, that addiction has a cause. More often than not, it's because of a co-occurring mental illness.

It might seem strange now, but at one time, these conditions were only treated separately from each other. That caused a lot of problems for patients. These were individuals who desperately needed help for both their addictions and their mental health conditions. Even so, they generally had to wait to get help for the mental illness while the addiction was addressed first.

Dual Diagnosis and Co-Occurring Disorders

To make matters even worse, the conditions were often treated at separate facilities. It was not uncommon for patients to have to wait for openings at the next facility. This made them prime candidates for a relapse, which started the cycle all over again.

Today, the approach to treating co-occurring disorders is so much different.

Although there are some facilities that still adhere to the "old" way, there has been a lot of progress. Many addiction treatment centers have become educated on dual diagnosis. This means that patients are receiving better treatment today than ever before.

Here at Northpoint Washington, dual diagnosis treatment is something we specialize in. We understand how important it is for people to receive the treatment they need. We also know that treating the root cause of an addiction is critical for recovery.

Perhaps this concept is something that's very new to you. You may be someone who has struggled with a mental illness and an addiction.

However, you only ever received treatment for one condition at a time. It's also possible that you've never received any type of treatment before. You're looking for something that will work well for your recovery.

Understanding co-occurring disorders and the treatment that is available to you is so important. In fact, it might be the first step in helping you get the addiction treatment you need.

What is the Definition of a Co-Occurring Disorder?

When someone is diagnosed with a mental health condition and a substance use disorder, that individual has a co-occurring disorder. A substance use disorder includes an addiction to any type of drug or alcohol. There are a number of different mental health conditions that someone can present with.

Of course, it's not always necessary to have a formal mental health diagnosis to have a co-occurring disorder. Many people come to addiction treatment centers for help with their addictions without a diagnosis. Some of them have lived their entire lives struggling with mental health symptoms. It just never occurred to them to get help for them.

This is very unfortunate. So many people learn the false belief that having a mental illness is just their lot in life. They may know that others don't struggle the way they do, but they view their challenges as being normal. To cope, they make the decision to start using drugs or alcohol.

Additionally, there are others for whom the addiction part of their disorders came first. They may have started drinking or using drugs, and then as time went on, they developed a mental illness.

Both ways are very typical, and both define what co-occurring disorders are.

It's quite possible that you're suffering from a co-occurring disorder, but you aren't sure. You've never gotten an official diagnosis, but you can sense that something isn't right. It's important for you to identify where there might be a problem. That way, you can be sure to get the help you need.

What are the Different Types of Co-Occurring Disorders and Their Symptoms?

There are several different types of co-occurring disorders. Each one has its own symptoms. Keep in mind that sometimes, these disorders do overlap. It's not uncommon for people to be suffering from more than one of them at a time.

Depression is defined as a condition that involves long periods of sadness, hopelessness and worthlessness. There are several different types of depression. People who have depression often suffer from:

  • Problems with concentration
  • Feeling tired all the time
  • Constantly feeling guilty or helpless
  • Insomnia or excessive sleeping
  • Restlessness and irritability

General anxiety, or generalized anxiety disorder is characterized by periods of excessive worry. Individuals often worry about everyday life, without reason to. Worries can be related to family, friends, finances, work, health, etc.

Symptoms of general anxiety include:

  • Always feeling tense
  • Having an unrealistic view of problems
  • Always feeling on edge
  • Becoming easily irritated
  • Frequent headaches and muscle tension

A panic disorder is different from general anxiety. It involves sudden attacks that occur without warning. These attacks can be triggered by various circumstances. However, they often occur during times of total relaxation.

Symptoms of panic disorder include:

  • Problems with breathing during an attack
  • Chest pain or heart palpitations
  • An intense feeling of dread
  • A smothering or choking feeling
  • Fainting or dizziness

PTSD, or Post-Traumatic Stress Disorder occurs when someone has lived through a traumatic event. The disorder can begin soon afterwards, or symptoms may not begin to develop for several months.

Symptoms of PTSD include:

  • Having flashbacks of the event
  • Experiencing audible triggers
  • Avoiding situations that are similar to the event on purpose
  • Struggling to maintain positive relationships
  • Constantly being on the lookout for danger

There are several different types of eating disorders. However, they are all characterized by having an unhealthy relationship with eating and food. For someone with an eating disorder, he or she constantly obsesses about food.

Symptoms of an eating disorder include:

  • Having a poor self-image
  • Constantly obsessing about how much food is being eaten
  • Bingeing and purging behaviors
  • A dependence on laxatives, in some cases
  • Only eating in secret

People who suffer from bipolar disorder often cycle through different shifts in their moods. These cycles can be manic or they can be depressive. Most people with bipolar disorder are in the depressive state most of the time.

Symptoms of bipolar disorder include:

  • Bouts of uncharacteristic, impulsive behaviors
  • Becoming easily tearful
  • Frequent periods of sadness and hopelessness
  • Needing very little sleep to feel rested
  • Becoming very moody

OCD, or obsessive-compulsive disorder is a type of anxiety. It is characterized by repetitive thoughts and behaviors. Those with OCD are generally forced to participate in rituals to help control their disturbing thoughts.

Symptoms of OCD include:

  • Being afraid of dirt or germs
  • The fear of harming someone else
  • The fear of making an error
  • The fear of behaving in a socially unacceptable way
  • The need for order or symmetry

There are many different types of personality disorders. As a whole, they are characterized by rigid patterns of behaviors and thoughts. These patterns are not flexible, and they can occasionally interfere in one's quality of life.

Symptoms of personality disorders include:

  • Having a fear of being abandoned
  • Having unstable relationships
  • Poor self-image
  • Self-destructive behaviors
  • Constantly feeling empty inside

People with schizophrenia aren't always aware that they have it. Symptoms can come and go. When many symptoms are present, it may be difficult to tell the difference between what's imaginary and what's real.

Symptoms of schizophrenia may include:

  • Visual, auditory or tactile hallucinations
  • Experiencing delusions
  • Having confused thoughts
  • Strange speech patterns
  • Problems with concentration

ADD or ADHD are conditions that are generally thought to happen within children. However adults can suffer from them as well. Their symptoms may be more subtle than in children.

Symptoms of adult ADHD/ADD may include:

  • Problems with organization
  • Car accidents or reckless driving
  • Relationship problems
  • Becoming easily distracted
  • Exhibiting a short attention span

Postpartum depression should not be confused with the "baby blues." This is a short period of time while hormones are adjusting for a new mother. Postpartum depression is a severe form of depression that lingers after a baby is born.

Symptoms of postpartum depression include:

  • Avoiding friends and family members
  • Being unable to care for oneself or the baby
  • Problems with bonding with the baby
  • Severe mood swings
  • The onset of panic attacks or anxiety

Seasonal affective disorder is also known as seasonal depression. It is a type of depression that occurs during the fall and winter months. It may be caused by certain changes in the brain that can occur during this time of the year.

Symptoms of seasonal affective disorder can include:

  • Unexplained weight gain
  • An increased need for sleep
  • A bigger appetite
  • Chronic fatigue
  • Problems with concentration

Social anxiety occurs when someone experiences a lot of stress during social situations. Things like making eye contact or small talk with others cause a great deal of discomfort. This condition can be debilitating to those who suffer from it.

Symptoms of social anxiety include:

  • Fear of being judged by other people
  • Fear of being humiliated in front of others
  • Constant shaking or sweating in public
  • Fear of offending someone
  • Fear of being the center of attention

There are several different types of sleep disorders people may suffer from. Not getting good, restful sleep can interfere with one's quality of life. It's also necessary for optimal health.

Symptoms of a sleep disorder include:

  • Not being able to fall asleep at night
  • Not being able to stay asleep
  • Constant snoring or sleep apnea
  • Feeling sleep deprived
  • Falling asleep during the day or during activities

Cyclothymic disorder is a type of bipolar disorder. However, it is much more mild. Those who have it may have mild depression at times, and then switch to hypomanic episodes. The patterns of mood shifts tend to be irregular.

Symptoms of cyclothymic disorder include:

  • Having periods of mild depression
  • Having periods of hypomania
  • Having periods of feeling relatively normal
  • Having problems in relationships
  • Experiencing weight fluctuations, based on mood

There are a number of different sexual disorders people may suffer from. These are mental illnesses that quickly take over their lives. These disorders tend to become worse before they get better. They can quickly become addictions themselves.

Symptoms of sexual disorders may include:

  • Having frequent sexual fantasies
  • Experiencing sexual urges often
  • Behaviors that involve objects or items
  • Risky sexual behaviors
  • Social and occupational impairment

When someone suffers from a phobia, they experience an irrational fear of something. This usually surfaces as a sense of dread or panic when that fear is encountered. There are several different types of phobias.

Symptoms of phobias may include:

  • A racing heart rate
  • Becoming short of breath
  • Having the inability to speak
  • Experiencing a dry mouth
  • Become nauseous or vomiting

When any of the above occur alongside addiction, the situation only becomes worse. It's easy to see why so many people would choose to use drugs or alcohol to cope. However, doing so is not going to result in long-term recovery. If anything, it will only add to the problems the mental illness already causes.

More Information About Co-Occurring Disorders

Co-occurring disorders are diagnosed much more often than most people think. There are so many people in the United States who suffer from mental illnesses. For many of them, using drugs or alcohol offers them an easy way of escaping reality.

According to SAMHSA:

  • There were about 43.6 million people in the United States with some type of mental illness in 2014.
  • That works out to be just over 18% of the country's population.
  • Over the last year, 20.2 million adults were diagnosed with a substance use disorder.
  • Of these individuals, close to 8 million of them also had a mental illness.
  • Serious mental illnesses affected about 9.8 million adults in 2014.
  • These mental illnesses affect their ability to maintain housing, hold down jobs and more.

It's clear by these statistics that mental illnesses and addictions often go hand in hand. Sometimes, addictions are caused by everyday, normal stress. However, they are frequently caused by mental problems that people are completely unaware of.

There is no one right answer to this question. Scientists aren't at all sure about the exact cause of co-occurring disorders. However, they do have some ideas about what might cause mental illnesses. The mental illnesses themselves often lead to addictions.

There are a number of risk factors associated with mental illnesses. These can include:

  • Environmental Factors: Various environmental factors can play a critical role in mental illness. For example, someone who was raised in a home where substance abuse was prevalent has a greater risk.
  • Family History: Having a blood relative with a mental illness increases one's risk for developing one. The risk is even greater when the blood relative is one or both parents.
  • History of Trauma: Living through a traumatic event places individuals at a much greater risk of mental illness.
  • Physical Health: Some physical health problems, such as diabetes or heart disease, can easily lead to mental health problems.
  • Previous Mental Illnesses: Someone who was previously diagnosed with a mental health condition is always at risk of having one again. This can be true even if the original condition happened during childhood.
  • Stressful Life Situations: Financial problems, relationship problems or work problems can contribute to mental illnesses.

It's difficult to say which condition happens first. Sometimes people will self-medicate their mental illnesses with substances. For example, someone with depression might be very prone to drinking alcohol. For a while, the alcohol tends to help make the symptoms easier to deal with.

The opposite is also true. Using substances in excess can lead to mental illnesses too. In these individuals, their mental illnesses might have remained dormant for a long time. Using drugs or alcohol only caused their symptoms to emerge more quickly.

People with dual diagnoses are very likely to abuse certain substances. They tend to choose their substances based on their symptoms. For them, the goal is to help themselves feel better. So, for someone with anxiety, that individual might choose something to help them calm down.

Some of the most commonly abused substances for those with dual diagnoses include:

  • Heroin
  • Marijuana
  • Prescription medications
  • Alcohol
  • Hallucinogenic drugs
  • Tranquilizers
  • Cocaine

If you have a co-occurring disorder, you probably didn't think there was any other way to help yourself. Your goal was to treat your symptoms and feel better; even for a short time. However, what you probably have found out was that it doesn't work well for long.

Perhaps you're someone who has never been dually diagnosed. You may suspect that you have mental illness, but you're just not sure. You know that your drug or alcohol use has gotten out of hand, and you know you need treatment. How do you know whether or not you have a co-occurring disorder?

It can be very helpful to answer some questions about your mental illness and your substance abuse. Your answers may determine whether or not you have a co-occurring disorder in need of treatment.

Answer the following as honestly as you can.

  • Do you frequently use drugs or alcohol as a way to cover up symptoms you experience?
  • Did you use substances prior to having mental health symptoms?
  • Do you feel quite sure that your substance abuse problems started after your mental illness?
  • Have you ever been formally diagnosed with a mental illness?
  • Do you use drugs or alcohol to combat depression or anxiety?
  • Do you tend to drink or use drugs when you're feeling stressed out or sad?
  • Do you feel that you need to use substances in order to feel normal?
  • Have others asked you to get help for a substance abuse problem?
  • Do you feel that drinking or using drugs is only making your mental health symptoms worse?
  • Do you need to use larger amounts of substances now to get the same results?
  • Do you experience withdrawal symptoms when you stop using?
  • Have you ever had a relapse?

If you answered many of these questions with a yes, it's quite probable that you have a co-occurring disorder.

If you do have a co-occurring disorder, it's important for you to get the right kind of treatment. Getting treated at a facility that specializes in integrative addiction treatment is preferred. That way, both conditions can be treated at the same time. This will give you a better chance of long-term recovery.

The Benefits of Dual Diagnosis Treatment Centers in Washington State

There are so many benefits to going to a dual diagnosis treatment center. This type of treatment has proven to be effective, time and time again. Patients who have received separate treatments immediately notice the difference. They feel better faster, and they have more hope for a longer, sustained recovery.

Dual diagnosis treatment can benefit you in a number of ways. These include:

  • Lowering your risk of suicide dramatically
  • Lowering your risk of having a relapse
  • Giving you a better chance of a long-term recovery
  • Providing you with unconditional support for both conditions
  • Offering you ways to cope without using drugs or alcohol

For those who opt for integrative addiction treatment, they immediately find that their treatment plans are different. They are targeted specifically for each patient. The negative side effects of mental health conditions are addressed and overcome. For those who need medication therapy, integrated treatment is a great option. There are many medications that can be used to help with both conditions.

The various types of therapy that are available for those who are dually diagnosed make such a difference. They provide patients with a high level of support, which is desperately needed at this stage. People learn to:

  • Identify the triggers associated with their addictions
  • Find alternate methods of coping
  • Rely on others as a source of support
  • Avoid certain triggers, where appropriate
  • Find a healthy balance in the way they live their lives

Your Options for Integrative Addiction Treatment Explained

As far as your treatment goes, you can choose from a number of different options. Not every method is right for everyone, and it's important to find what you need. Your recovery should be the first thing on your mind. That means that if a treatment option is recommended for you, it's right for you. Even if you don't agree with it, it's important to give it an honest chance.

The different methods of dual diagnosis treatment include:


During inpatient treatment, patients stay at a facility for a period of about 30 days. This gives them time to get acclimated to a new way of thinking. It helps them to focus on addressing their addictions and the causes of them. People are often nervous about going to an inpatient treatment facility. They may worry about being far away from their families or friends. They may be concerned about taking time off from work, or missing out in other ways.

For many people, inpatient treatment is the best approach when recovering from an addiction. It is especially helpful for those who need dual diagnosis treatment.


There are outpatient clinics that focus on treating co-occurring disorders. It's important to remember that outpatient treatment isn't always right for someone who is new to rehab. This form of treating addiction is usually reserved for those who have completed an inpatient program. Even so, there are times when it is appropriate.

During outpatient treatment, patients meet with a therapist regularly. There may or may not be support groups offered as well. The focus will be on addressing the source of the addiction.


Intensive outpatient treatment is a form of rehab that allows patients to still live at home. Even so, they still receive a very high level of care. Appointments may be held several times a week, and the hours are flexible. This makes it perfect for someone who can't go to inpatient treatment because of work.

Intensive outpatient treatment has made it possible for many people to get a high level of support.


Detoxification is a process that will be utilized for patients, depending on their addictions. There are some addictions that require it, such as alcoholism and prescription drug addictions. For others, it is often recommended.

The goal of detox is to address the physical side of the addiction. This helps to improve overall patient outcomes during recovery.


Residential treatment or long-term treatment is often needed for those with co-occurring disorders. These facilities are for those who need longer to recover than 30 days. They are all very different from one another. Some allow patients to continue working while they live at the facility.

For patients whose home situations are not therapeutic, long-term treatment offers them hope. For these individuals, recovery is much more likely.

How are These Types of Substance Use Disorders Treated?

There are several different treatment methods that are used at dual diagnosis treatment centers. Research has shown that a varied treatment plan offers more hope for a successful recovery. Of course, all patients are screened for the types of services they need. Even so, many patients receive some variation of the following:

  • Nutrition Therapy: Most people with co-occurring disorders find that their diets don't them up for success. They are usually depleted of many of their vitamins and essential minerals. This can make overcoming an addiction very difficult. It can also make mental health symptoms much worse. Nutrition therapy helps to align the body, making it easier to process toxins. It also serves to support an improved sense of well-being.
  • Physical Fitness: This is also an important part of the recovery process. Exercise improves overall health, which is so important during dual diagnosis treatment. It's a way to rid the body of toxins and it boosts serotonin and dopamine levels.
  • Individual Counseling: Counseling with a qualified therapist is another important aspect of treatment. It is during this time when diagnoses are made regarding mental illnesses. These may have been undiscovered up until then. The therapist's job is to identify the co-occurring disorders that are present. He or she is also tasked with helping patients find better ways to cope, other than substance abuse.
  • Group Therapy: Group therapy has been celebrated as one of the most important aspects of treatment. This is true for those with mental health disorders, as well as those with addictions. There are many different types of support groups that a patient might participate with.
  • Alternate Forms of Therapy: Other forms of therapy are also beneficial for those being treated for co-occurring disorders. Yoga, art therapy and equine therapy are just some examples.

Additional Information:

For most people with dual diagnoses, inpatient treatment is the right option for them. They may feel resistant to making that change in their lives, or making that commitment to treatment. However, there are just so many different benefits to be experienced.

Those who choose to go to inpatient treatment for their co-occurring disorders will find that:

  • They are able to address the physical sides of their addictions first. This will make it much easier for them to recovery successfully.
  • They will always have the support they need.
  • They will have nursing care available every day of the week, all day long. This is important, in case of an emergency situation.
  • They'll be able to remove themselves from situations that may have led to their addictions.
  • They'll have the opportunity to meet new people who share the same recovery goals they have.
  • They will have plenty of time to completely focus on recovering.

If you're feeling nervous about the thought of going to an inpatient treatment facility, there's no need to be. The goal is to care for all of your needs during rehab. This is time that you can take for yourself, which you probably haven't had in quite some time. By investing in your recovery now, you will reap the benefits years down the road.

If you opt for inpatient treatment, it will last about 30 days or so. However, many people make the mistake of thinking that is when their journey ends. It is actually just the beginning.

Ongoing treatment is essential for you if you have a co-occurring disorder. Your addiction is a disease. This is something that is very hard for people to understand. If you think about your addiction as being just like diabetes or heart disease, it can be helpful. Diseases require ongoing treatment in order to control them. Unless ongoing treatment is obtained, a relapse is very likely.

For you, this might mean continuing to go to some form of outpatient treatment after completing inpatient rehab. Many people benefit from a step-down approach. They may enroll in an intensive outpatient treatment program first. Eventually, they will start to attend outpatient counseling and a 12 Step group.

Even though your recovery journey is just beginning, you're making the right decision to start it now. You'll find that it will be the most rewarding journey you ever take.

Someone who is addicted to drugs or alcohol should always be concerned about relapsing. This is even truer when that person has a co-occurring disorder. Additionally, relapse is very likely for those who don't get treatment for both conditions together. These individuals are not receiving the integrated care they need. Integrative addiction treatment is what makes recovery a possibility.

Professionals who are experienced with dual diagnosis treatment understand the importance of getting the right kind of help. When help is obtained separately, it's common for the two types of therapies to contradict each other. This can lead to confusion in the mind of the patient.

Relapsing can be very dangerous, and it's something that should be avoided at all costs. If you were to relapse back into your drug or alcohol use, you are at a very high risk for an overdose. This is also the main reason why cold turkey quitting is so discouraged. Unless the root cause of the addiction is addressed, recovery is unlikely.

Getting the right kind of treatment from the beginning will help people avoid relapsing. It will also improve their chances of recovering from both conditions.

There are many different dual diagnosis treatment programs to choose from. That can make it difficult to know what you should be looking for. Not all of these programs are created the same. It can be so helpful for you to identify what you need.

If you're searching for treatment for a co-occurring disorder, you should look for facilities that:

  • Will bill your health insurance company directly. This will minimize your out of pocket costs.
  • Have staff members who are highly experienced in treating co-occurring disorders.
  • Have a higher than average success rate.
  • Are accredited facilities.
  • Will provide you with a referral to an appropriate outpatient treatment program afterwards.
  • Offer every patient his or her own detailed, targeted treatment plan.

When a family member is suffering with an addiction and a mental illness, it's heartbreaking. You might not know what to do, or how you can help. Situations like this can be paralyzing. Maybe you've tried to have a conversation with your loved one about the problem. However, nothing you say seems to make any difference at all.

In cases like this one, you need a solution. Many facilities offer intervention services, and we offer them at Northpoint Washington. During an intervention, you'll be instructed on what to say to your loved one. You'll learn how to set limits, appeal to his or her emotions, and encourage treatment.

Interventions have been very helpful for many people. They work very well when other methods have failed. After the intervention is over, your family member will even be able to go to treatment immediately.

This might be something you want to consider if you are desperate for an answer. Help is available for your family member, and an intervention can make such a difference.

How Can Northpoint Washington Help You With Co-Occurring Disorder Treatment?

Right now, you may be feeling scared about what will happen to you if you continue down the same path. Whether you've been dealing with this problem for a month, or several years, you know you need help. Making the decision to go to treatment is difficult, but it's a challenge that you can overcome.

For so many people, their mental health issues make it hard for them to reach out. They may even admit they have a problem, but they're nervous about going to treatment. Maybe that's how you feel as well. You'll be happy to know that there is nothing for you to be afraid of. So many people have taken the risk and gotten help for their co-occurring disorders. For the vast majority of them, it was the best decision they've ever made.

Here at Northpoint Washington, we offer dual diagnosis treatment that will meet you where you are. Regardless of what type of substance you use, or what your mental health issue is, we can help you. We have been able to help so many people who felt like they had hit rock bottom. They thought there was no hope for them. Maybe you can identify with that feeling. We can promise you that our commitment to helping you recover is strong. We'll be with you every step of the way.

Are you ready to face the challenge of getting help for your co-occurring disorder? If you are, Northpoint Washington is with you every step of the way. Please contact us to get more information about how you can start.

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Northpoint Washington: Opening April 2019

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