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Finding the Best Treatment for CODs

The number of treatment options for co-occurring substance use and mental health disorders can seem overwhelming. However, keeping in mind a few key factors and accepted approaches can help you select the right treatment.

Because there are so many combinations of dual or co-occurring substance use and mental health disorders and because the symptoms and severity can vary widely from person to person, there is no simple chart that says, "People with co-occurring disorders A and B need treatment C." It's never that easy. Treatment always needs to be geared to each individual. Professionals consider not only each client's disorders and symptoms but also a variety of other factors. These factors might include their previous treatment response, age, sex, cultural background, and/or religious beliefs; their health care plan; where they live; what language they're most fluent in; and so on.

Nevertheless, some generalities about treating co-occurring disorders do apply:

  • The most successful treatments address all parts of the disorder together in a single, integrated way-usually in the same setting, with a single professional or group of professionals.
  • The most successful treatments usually combine medication with talk therapy: focused, regular discussion and interactive learning under the guidance of one or more professionals. Talk therapy is particularly valuable in helping people make long-term positive changes in their lifestyle, thinking, and decision-making.
  • A client's own commitment to recovery and willingness to change, learn, and grow also make a huge difference. People who take treatment seriously and come to it with open minds do far better than those who resist it, distrust it, or make only a halfhearted commitment to it.
  • Caring, intelligent, well-trained professionals are the beating heart of successful treatment. Any treatment program or recovery plan is only as good as the professionals who implement it. The caring and respectful relationship between the provider and the client is critical to a successful recovery.
  • The support of loved ones makes a huge difference. When someone's family and/or friends actively support recovery, this person is likely to recover faster and more fully. In contrast, when people don't lend their support-or even get in the way of the person's recovery-successful treatment usually requires much more effort from the client.

At first glance, the number of treatment options may seem overwhelming. In practice, though, choices are often easy to make, for three reasons:

  • When a client meets with a professional to discuss assessment results, the professional typically recommends options for treatment and some therapists and/or programs that can best provide it. The professional may even say, "I work with people who have co-occurring disorders, and I can take on a new client. Would you like to work with me?" or "The clinic I work for offers an integrated treatment program specifically for co-occurring disorders. Would you like to speak to someone here about it?"
  • In many locales, treatment options are limited. There may be only one fully integrated treatment program nearby, or there may be only one or two mental health professionals who offer an integrated approach. (Getting treatment in a location away from home is always an option, of course.)
  • The client's health insurance plan or HMO may cover a limited range of treatment programs and/or professionals.

However, wide or narrow the options, the client almost always has choices to make-ideally in close consultation with a mental health or addiction professional and the client's family.

One-on-One or Group Therapy?

Should you choose a treatment program, one-to-one therapy, group therapy, or a combination of these? There are distinct benefits to each option. They aren't either/or choices. For example, integrated treatment programs normally include a good deal of group therapy and some one-to-one therapy as well.

Some people with co-occurring disorders can do best when they get started with a formal treatment program, such as an inpatient residential program, plus medication when appropriate. Once they have completed the formal program, which typically lasts thirty to ninety days with an array of educational and therapeutic components, they and their professionals can together decide on next steps. To learn exactly what therapies are involved in any formal treatment program, it is best to contact the center itself.

For people with serious co-occurring disorders, it is often best to start with both a formal treatment program and ongoing one-to-one therapy, as well as medication. Using therapy, support groups, and medication simultaneously helps clients stay focused and on track-as well as clean and sober-during the all-important initial weeks of recovery.

Some people with mild co-occurring disorders need nothing more than regular one-to-one talk therapy or some combination of one-to-one and group therapy. However, this option is recommended only when an assessment clearly suggests that the option is sufficient. While one-to-one and group therapy may be more convenient and flexible than a formal treatment program, they're considerably less effective for some people.

An Integrated Approach

A fully integrated or dual diagnosis-enhanced treatment is designed for people with co-occurring disorders. It looks at mental health disorders and substance use issues in an integrated fashion. These integrated programs are strongly recommended over all other treatment program options.

In our research, we found that in 2009, less than 10 percent of all programs were integrated across representative states in the United States. However, the field is slowly becoming increasingly sophisticated, so more and more programs are quickly developing co-occurring capability. These programs describe themselves as enhanced programs providing integrated treatment or integrated services.

Excerpted and adapted from Living with Co-occurring Addiction and Mental Health Disorders: A Handbook for Recovery by Mark McGovern. Center City, MN: Hazelden, 2009.



Living with Co-occurring Addiction and Mental Health Disorders
Living with Co-occurring Disorders and Mental Health Disorders includes exercises to introduce readers to the early stages of recovery. Download the worksheets

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