Diagnosis and Treatment

Generally, it is better to treat the SUD and the co-occurring mental disorders together rather than separately. Thus, people seeking help for a SUD and other mental disorders need to be evaluated by a health care provider for each disorder. Because it can be challenging to make an accurate diagnosis due to overlapping symptoms, the provider should use comprehensive assessment tools to reduce the chance of a missed diagnosis and provide targeted treatment.

It also is essential that treatment, which may include behavioral therapies and medications, be tailored to an individual’s specific combination of disorders and symptoms, the person’s age, the misused substance, and the specific mental disorder(s). Talk to your health care provider to determine what treatment may be best for you and give the treatment time to work.

Behavioral Therapies

Research has found several behavioral therapies that have promise for treating individuals with co-occurring substance use and mental disorders. Health care providers may recommend behavioral therapies alone or in combination with medications.

Some examples of effective behavioral therapies for adults with SUDs and different co-occurring mental disorders include the following:

• Cognitive Behavioral Therapy (CBT): CBT is a type of talk therapy aimed at helping people learn how to cope with difficult situations by challenging irrational thoughts and changing behaviors.
• Dialectical Behavior Therapy (DBT): DBT uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. DBT also teaches skills that can help control intense emotions, reduce self-destructive behaviors (e.g., suicide attempts, thoughts, or urges; self-harm; and drug use), and improve relationships.
• Assertive Community Treatment (ACT): This is a form of community-based mental health care that emphasizes outreach to the community and an individualized treatment approach.
• Therapeutic Communities (TC): TCs are a common form of long-term residential treatment that focuses on helping people develop new and healthier values, attitudes, and behaviors.
• Contingency Management (CM): CM principles encourage healthy behaviors by offering vouchers or rewards for desired behaviors.

Behavioral Therapies for Children and Adolescents

Some effective behavioral treatments for children and adolescents include:

• Brief Strategic Family Therapy (BSFT): BSFT therapy targets family interactions thought to maintain or worsen adolescent SUDs and other co-occurring problem behaviors.
• Multidimensional Family Therapy (MDFT): MDFT works with the whole family to simultaneously address multiple and interacting adolescent problem behaviors, such as substance use, mental disorders, school problems, delinquency, and others.
• Multisystemic Therapy (MST): MST targets key factors associated with serious antisocial behavior in children and adolescents with SUDs.

Medications

Effective medications exist for treating opioid, alcohol, and nicotine addiction and lessening the symptoms of many other mental disorders. Some medications may be useful in treating multiple disorders. For more information on behavioral treatments and medications for SUDs, visit NIDA’s Drug Facts and Treatment pages and treatment for mental disorders at the National Institute of Mental Health’s (NIMH) Health Topics page.

https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health

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