In substance use treatment, we use the term “dual diagnosis” or “co-occurring disorder” when a person has both a mental health condition and a substance use disorder. Examples include depression combined with alcohol use disorder, post traumatic stress disorder with stimulant misuse, or bipolar disorder with opioid addiction.

Treating mental illness and substance use together matters because each can make the other worse. Mental health conditions can lead to drug use or alcohol misuse as a way to cope, and drug use can trigger or intensify anxiety, mood swings, and other mental health symptoms. Integrated care reduces relapse, improves overall health, and supports long term stability.

The Arbor Behavioral Healthcare provides dual diagnosis treatment as part of its continuum of care in the Central Texas Hill Country with our residential campus in Georgetown and sober living homes in Austin.

Mental health conditions and substance use

Mental health conditions and substance use are closely linked. People living with anxiety, depression, PTSD, bipolar disorder, or other mental disorders may turn to alcohol, opioids, benzodiazepines, stimulants, prescription medication taken in unsafe ways, cannabis, synthetic cannabinoids, or other drugs to numb distressing emotions, improve sleep, or boost energy. What starts as self-medication can become drug misuse or drug addiction, with powerful changes in the brain’s reward system and dopamine receptors that reinforce use despite harms. Several factors influence susceptibility to addictive drugs:

• Biological factors include genetic factors, differences in brain chemistry, and the developing brain in adolescents and young adults.
• Environmental factors include adverse childhood experiences, sexual abuse, family conflict, peer pressure, and limited parental supervision. Each of these can be a significant environmental risk factor for later substance use.
• Other factors include chronic stress, chronic pain, and easy access to prescription medication or addictive drugs.

People may progress from an initial drug used recreationally to a pattern of dependence and developing an addiction, as the brain requires more of a substance to produce the same effect.

Risks of untreated substance use disorder include:

• Worsening mental health conditions, including more severe anxiety or depression
• Relapse and cycling between periods of abstinence and drug use
• Physical health issues from withdrawal symptoms, overdose, or poor coordination leading to injury
• Legal problems, job loss, family conflict, and relationship strain
• Risky behaviors such as unprotected sex or impaired driving

See Understanding Drug Use and Addiction (NIDA) and Co-Occurring Disorders (SAMHSA) for authoritative research on the connection between mental health and substance use.

Signs and symptoms of dual diagnosis

Some indicators of co-occurring substance addictions and mental health conditions:

Emotional indicators

• Persistent sadness, hopelessness, or irritability
• High anxiety, panic, or intrusive memories related to trauma
• Mood swings, agitation, or aggressive behavior
• Shame, guilt, or low self esteem

Behavioral indicators

• Increasing drug use or alcohol consumption, using more than planned
• Repeated attempts and failure to stop drug use
• Secretive behavior, lying, or spending money to obtain substances
• Risky choices, legal problems, or missing work or school
• Isolation and loss of interest in healthy activities
• Ongoing use despite health problems and serious adverse consequences

Physical indicators

• Changes in sleep and appetite, weight loss or gain
• Physical symptoms such as trembling, sweating, nausea, or poor coordination
• Withdrawal symptoms when not using, including shakes, agitation, or cravings
• Tolerance: needing more to get the same effect

Because mental health and substance use symptoms overlap, dual diagnosis can be hard to recognize without a comprehensive assessment. For example, anxiety can look like stimulant withdrawal, and depression can look like opioid withdrawal. At The Arbor, assessment starts at intake at the Georgetown residential setting and continues through every level of care, including sober living in Austin and outpatient follow up, so both mental health and substance issues are evaluated in tandem.

Assessment and dual diagnosis at The Arbor

At The Arbor Behavioral Healthcare, a thorough diagnosis guides effective treatment. The Arbor’s integrated assessment process includes:

• Psychiatric evaluation, with psychiatric consults when needed
• Medical screening and lab work to evaluate physical health and safety
• Addiction and substance use screening to understand drug use patterns and withdrawal risk
• Trauma history, family history of mental health conditions, family member experiences with use disorder, and genetic factors
• Review of prescribed medications and any prescription medication interactions

Our multidisciplinary team combines addiction medicine and mental health expertise to develop a targeted treatment plan for each client.

Drug addiction treatment: the setting matters

At The Arbor, where you receive care is as important as the care itself. On our 67-acre ranch near Georgetown, Texas, residential treatment offers an immersive and structured environment: patients benefit from daily therapeutic contact, safety monitoring around the clock, and a removal of distractions so that healing can proceed without outside pressure.

Our sober living homes in Austin serve as a transitional bridge. Clients have continued oversight and accountability as they move from the structured life of residential care toward more regular community rhythms. And for those ready to re-engage with work, family, or school, outpatient and intensive outpatient aftercare provide ongoing check-ins, medication follow-ups, relapse prevention planning, and support to stay on track.

Integrated treatment across our continuum of care

Effective treatment for dual diagnosis addresses mental health and the substance use disorder at the same time. Our integrated approach includes:

• Individual therapy to build coping skills, address trauma, and strengthen self-control
• Group therapy to practice communication, reduce isolation, and learn from peers
• Trauma-informed care to process adverse childhood experiences and other trauma safely
• Family therapy to improve communication and repair trust with family members
• Peer support and support groups that reinforce recovery skills
• 12-step immersion or other mutual help engagement, when appropriate
• Medication management as appropriate for mood symptoms, cravings, and withdrawal symptoms
• Holistic supports that promote physical health, nutrition, sleep, and fitness, since mind body wellness improves outcomes

Care is tailored by level and location, from residential treatment to sober living to outpatient, maintaining continuity so clients can step down to the least intensive level that still supports safety and growth.

Support and aftercare: sustaining recovery at The Arbor

Recovery continues after primary treatment. The Arbor’s continuing care model focuses on:

• Personalized aftercare planning that prioritizes relapse prevention, advocacy, and links to local support groups
• Alumni programming and peer networks that provide encouragement and accountability
• Family involvement through education, communication coaching, and inclusion in outpatient care
• Transition supports that may include sober living, independent living, or community based services

Because mental health conditions can ebb and flow, aftercare plans include regular check ins, medication follow up when appropriate, and quick access to higher levels of care if symptoms return. Nutrition, fitness, sleep, and emotional health are part of everyday care, since physical changes in health can affect mood, energy, and coping. This whole-person approach supports durable recovery.

Get expert dual diagnosis care

Dual diagnosis is common, complex, and treatable. Integrated care that addresses mental health and substance use at the same time leads to better outcomes, fewer relapses, and improved quality of life across a person’s lifespan.

If you or a loved one are experiencing symptoms of co-occurring disorders, explore dual diagnosis treatment, read more about co-occurring care, and review the continuum of care. Contact The Arbor directly with questions, to verify insurance benefits, or request a tour.