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Summary: The type of mental health therapy that helps people with co-occurring disorders is one of several evidence-based modalities provided as part of an integrated treatment program that addresses all factors that may affect substance misuse and/or mental health.

Key Points:

  • When a person receives a diagnosis for a mental health disorder and a substance use disorder at the same time, they’re called co-occurring disorders.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) indicates the best approach for treating co-occurring disorders is with an integrated treatment program.
  • Integrated treatment for co-occurring disorders includes a combination of medication (if needed), counseling, behavioral therapies, social support, family participation, and lifestyle changes.
  • The goal of integrated treatment is to provide a holistic, whole-patient approach to treating substance use disorders and mental health disorders.

Integrated Treatment and Mental Health Therapy Helps People With Co-Occurring Disorders

The integrated treatment model includes a wide range of support for people in treatment for co-occurring disorders.  What we want to share now is not the entire integrated treatment picture, but rather two components of integrated treatment that are often part of mental health therapy for people with co-occurring disorders programs: behavioral therapy and psychotherapy.

Here are the most common modes of behavioral therapy and psychotherapy associated with SUD treatment in general, and with integrated treatment for co-occurring disorders in particular:

  • Cognitive-Behavioral Therapy (CBT)
  • Dialectical Behavior Therapy (DBT)
  • Acceptance and Commitment Therapy (ACT)
  • Motivational Interviewing (MI)
  • Mindfulness-Based Cognitive Therapy (MBCT)
  • Trauma-informed Therapy: CBT, DBT, ACT, MI, and MBCBT

Most people associate these types of therapy with mental health disorders like depression or anxiety, because those are the types of disorders clinicians use these to treat. However, these techniques are essential in SUD treatment for two reasons:

  1. People with co-occurring disorders might have a mental health disorder such as depression or anxiety.
  2. People with SUD benefit by exploring many of the same emotional and behavioral topics people with co-occurring disorders explore.

Let’s take a closer look at how the types of therapy we mention above can help people in treatment for co-occurring disorders

Psychotherapy and Behavioral Therapy: Mental Health Therapy for People With Co-Occurring Disorders

While these aren’t the only techniques in use in integrated treatment programs, they’re the most common, and have the broadest base of evidence to support their use. 

Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT)

The primary goals of cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) for SUD treatment are to connect patterns of thought and emotions with patterns of behavior and to help patients learn how those patterns impact the disordered use of substances.

Dialectical Behavior Therapy (DBT)

Whereas CBT focuses on the connection between patterns of thought and emotion, DBT focuses on the connection between patterns of emotion and patterns of behavior, while emphasizing distress tolerance skills and teaching patients the practical skills they need to manage challenging situations.

Acceptance and Commitment Therapy (ACT) and Motivational Interviewing (MI)

These approaches work to help patients decide what they want and create a clear plan of action to achieve goals they determine themselves.

Mindfulness-based Cognitive Behavioral Therapy (MBCBT)

This approach uses CBT techniques and skills and adds components of meditation and mindful awareness to help patients achieve balance, recognize automatic responses to certain situations, and manage difficult symptoms associated with both SUD and any co-occurring disorders.

Trauma-Informed Therapy

When any of these therapies are called trauma-informed, that means the clinician providing the therapy has undergone extensive training – and often pursued additional licensure and accreditation – related to the various significant ways trauma can impact both the course of a substance use and/or mental health disorder and the specific treatment needs associated with that disorder. In some cases, what works for one person with SUD without a history of trauma may not help a person with SUD and a history of trauma. In these cases, it’s critical for a therapist to recognize distinctions and implement appropriate treatment techniques.

Mental Health Treatment for People with Co-Occurring Disorders: Support in the Context of Real-Life Needs

We know that for people with co-occurring disorders, mental health therapy works best when integrated with other forms of support. Research shows treating substance use and mental health at the same time not only improves short-term outcomes but also reduces long-term use of mental health treatment services, improves housing stability, reduces involvement with the criminal justice system, an mitigates the risk of adverse interactions with typical medications.

In other words, integrated treatment improves outcomes across all areas of life.

For people with co-occurring disorders, improved long-term treatment outcomes – especially in life domains such as work, school and relationships – mean an increased likelihood of achieving sustainable, lifelong recovery.