Psychiatric Care for Substance Use and Dual Diagnosis

Substance use becomes a disorder when drinking or drug use is hard to control and causes problems at home, at work or school, in relationships, or with health. Dual diagnosis means a substance use disorder and another psychiatric condition, such as depression, anxiety, ADHD, bipolar disorder, or PTSD, occurring together. Each can worsen the other, so both need attention.

How our physicians help

Our physicians treat substance use and co-occurring conditions together, with medication and psychotherapy from the same physician when appropriate. Some situations need a higher level of care, such as medically supervised withdrawal, a hospital stay, or a residential or intensive outpatient program. Regular outpatient visits do not replace those programs; we help connect patients to them and coordinate with those teams.

Signs that use has become a problem

In teens, early clues are often falling grades, new friends, secrecy, or sharp mood changes. Adults may keep up work and family life for a long time. At any age, signs include:

• Using more, or for longer, than you meant to
• Trying to cut back and not being able to
• Needing more for the same effect, or feeling sick as it wears off
• Taking a prescription differently than prescribed
• Relying on a substance to sleep, calm down, or get through the day

Sorting out what came first

Our physicians ask what you use, for how long, what happens when you cut back, and if you have ever had withdrawal symptoms or an overdose. Plain answers help keep you safe.

Anxiety or low mood that appears only during heavy use or withdrawal may ease once the body settles. Symptoms that were there before use began, or that remain after a long stretch without substances, usually need their own treatment. We also look for sleep disorders, pain, and medical problems.

Goals, therapy, and medication

Treatment starts with your goals. Many people aim to stop completely, and others begin by lowering harm while they decide. Either way, plan changes with a physician so they are as safe as possible.

For alcohol and opioid use disorders, certain medications can ease cravings and lower the chance of returning to use. Some are given only through licensed clinics, and we can help connect you. For some other substances, no medication is proven to help.

Sleep and mood can take weeks or months to settle. Returning to use is common and is a reason to change the plan, not a reason for shame. After time away from opioids, the body loses tolerance and overdose risk rises, so tell your physician right away. Established therapies include:

• Motivational interviewing: conversations that help you sort out mixed feelings about change
• Cognitive behavioral therapy (CBT): practical work on triggers, cravings, and new habits
• Family therapy: brings parents into the work, especially for teens
• Peer support: groups such as 12-step meetings or SMART Recovery

When someone you love is using

You did not cause this, and you cannot control it alone. A program called Community Reinforcement and Family Training (CRAFT) teaches relatives how to encourage a loved one toward care without confrontation.

• Pick a calm, sober moment to say what you have seen
• Set clear limits, and try not to cover for consequences
• For teens, lock up alcohol and prescriptions at home
• If opioids, or pills or powders not from a pharmacy, may be involved, ask a physician or pharmacist about overdose-reversal medication

Deciding to call

Reach out if you have tried to cut back and could not, if you feel unwell between uses, or if people close to you are worried. If you use alcohol or certain medications regularly, speak with a physician before stopping.

Call 911 for a suspected overdose, including slow or stopped breathing, blue lips, or someone who cannot be woken. If you are thinking about suicide or harming yourself, call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service.

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