Dual Diagnosis for Veterans and First Responders

The high rates of mental health conditions among veterans and first responders are well-known and well-documented. The risk of developing a substance use disorder is also a challenge among those who serve in respective high-risk, high-stress roles, from our members of the Armed Forces to police, fire, EMS and public safety telecommunications personnel.

On their own, a mental illness or alcohol or drug addiction can diminish your health and well-being and build walls between the people, activities and career that you love. But what happens when both challenges exist in the same person, at the same time?

These are called co-occurring disorders, when someone suffers from a mental illness condition and a substance dependency. Because both conditions have become deeply interconnected, they’re best treated through what’s called a dual diagnosis.

Keep reading to learn what a dual diagnosis is and how special treatment for co-occurring disorders works for veterans and first responders.

What Is Dual Diagnosis?

When a mental disorder and substance use disorder co-exist, a dual diagnosis clinically acknowledges both conditions together to receive special attention under one treatment umbrella. It doesn’t mean you have two diagnoses; it’s one diagnosis for two conditions that have a simultaneous, adverse interplay with each other.

Here are some examples of co-occurring disorders that call for dual diagnoses:

Post-Traumatic Stress Disorder (PTSD), a common mental health condition among military and first responders, co-occurring with alcohol use disorder
Depression alongside alcoholism or abuse of narcotic stimulants like cocaine
An anxiety disorder co-occurring with abuse of prescription drugs like benzodiazepines (normally used to treat anxiety)
Opioid or opiate use disorder — such as fentanyl or heroin — with bipolar disorder
Personality disorders (such as borderline personality disorder) or schizophrenia co-occurring with abuse of multiple substances

The Connection Between Substance Abuse and Mental Health

Substance abuse and mental health often share an indelibly dysfunctional relationship. Deep dependencies or addictions to alcohol or drugs can also lead to the development of a mental illness, which can lead to further substance abuse, creating a cycle difficult to exit on your own. The 2023 National Survey on Drug Use and Health found that 35% of people with a mental health disorder also struggled with a substance abuse problem.

There’s also a profoundly strong link between poor mental health and substance abuse in veterans and first responders. In a study of Iraq and Afghanistan conflict veterans, more than 94% perceived a negative connection between their substance abuse and PTSD symptoms — with 85.3% of the survey’s participants admitting that their PTSD symptoms were exacerbated when they increased their drinking or drug use.

If you’ve served on the front lines of deployment or in your community and noticed a similar pattern, you’re not alone. Statistics from the U.S. Department of Veterans Affairs (VA) show:

Co-occurrence is extremely common: Nearly one-third of all veterans who seek treatment for a substance use disorder are also diagnosed with PTSD. Conversely, 20% — about one-fifth — of vets in therapy for PTSD also fight a substance use problem.
The risk is higher for female veterans: Women with PTSD are nearly 2.5 times more likely to struggle with alcohol abuse and almost 4.5 times more likely to develop a drug use disorder compared to their female peers without PTSD.
Male veterans face a similar risk: Men with PTSD are more than twice as likely to face alcohol abuse and nearly three times as likely to battle a drug use disorder than their male counterparts without PTSD.
It’s a multi-generational issue: The National Vietnam Veterans Readjustment Study found that a staggering 74% of Vietnam veterans — nearly three-fourths — with a PTSD diagnosis also had a co-occurring substance use disorder.
The need for dual diagnosis treatment is growing: From 2003 to 2013, the number of veterans in VA care for both PTSD and substance abuse more than tripled.

Likewise, according to another recent National Survey on Drug Use and Health:

12%, or 2.4 million, veterans had a substance use disorder.
19.7%, or nearly 4 million, had a mental illness — with one in three struggling with serious mental health issues.
Of these veterans combined, 5.7%, or 1.1 million, had both co-occurring substance use and mental health disorders.

What Causes Co-Occurring Disorders?

Even when the reasons aren’t visible, the origins of a co-occurring disorder can be due to a number of different risk factors that can overlap with each other:

Genetics: A family history of mental health disorders or substance abuse can make you genetically predisposed to developed one — or both — at some point in life.
Environment and home/family life: Growing up or living in a household where substance abuse is prevalent and normalized can also increase one’s risk of eventually developing a mental illness or addiction.
Trauma: Living through or witnessing a significantly traumatic event is one of the most common pathways to a trauma disorder, where many people may begin to drink or abuse substances to excess to stave off their feelings or pain. The exposure to traumatic moments that vets and first responders face every day makes them particularly vulnerable to a co-occurring disorder.
Stress: Chronic levels of stress — a demanding job, health troubles, relationship issues — can hurt one’s mental health and potentially lead to using substances as a coping mechanism.
Poverty: Unemployment, job instability, financial troubles, debt, unable to make ends meet and the lack of resources attached to living below the poverty lines can all become triggers for mental illness and substance abuse.
Grief and loss: Losing a loved one can lead to feelings of depression, complicated grief, survivor’s guilt and more, where self-medication with drugs or alcohol becomes an unhealthy response.

What Happens First: Substance Abuse or Mental Health Disorders?

The Cleveland Clinic likens co-occurring disorders to a classic chicken-or-egg scenario: which one comes first, or at least tends to happen initially? The fact is that co-occurring disorders and dual diagnoses happen together, and while a substance use disorder may not directly cause mental health issues, says the clinic, they’re both inextricably linked.

For instance, mental health issues might surface first. A person might be struggling with tangible symptoms of depression or anxiety and turn to drinking or drugs to self-medicate. While it may seem to help at first, this attempt at managing their mental health without the help of a professional can backfire, where their substance abuse further fuels their mental health symptoms before they devolve into a disorder, creating a complex, deeper case of addiction co-occurring disorders.

A co-occurring disorder can happen the other way around, too. Heavy substance use can actively alter brain chemistry in a way that, apart from the physical symptoms and dependency, activates a latent vulnerability for a mental illness, influencing someone to drink or use drugs even more irresponsibly.

Who Benefits from Dual Diagnosis Treatment?

Anybody can become at risk for a mental illness, substance use disorder or co-occurring disorder — and everyone can benefit from dual diagnosis rehab, regardless of gender, race, orientation or age. It’s one reason why treating both disorders together with a tailored plan is proven for better recovery outcomes, according to the National Institute on Drug Abuse (NIDA).

“Diagnosing and treating co-occurring substance use and other mental disorders is complex, because people may have overlapping symptoms,” notes NIDA. “Comprehensive assessment tools can reduce the chance of a missed diagnosis.”

Dual Diagnosis Treatment for Veterans

Participation in combat and the stress of military service, combined with the challenges of reintegrating into civilian life after honorable discharge, are just some of the drivers for mental illnesses and substance use disorders.

“Untreated mental health conditions — especially those induced by stress or trauma — can be painful to deal with,” writes Sgt. Kenny Naidoo for the VA. “It’s no wonder that so many veterans turn to substances to cope.” In dual diagnosis treatment centers, many of the staff and clinicians are veterans themselves who’ve gone through the same troubles and understand the experiences of a serviceman or woman with a dual diagnosis.

Dual Diagnosis Treatment for First Responders

Akin to veterans alike, first responders — from the new patrolman to the seasoned firefighter, the 911 operator to the emergency room doctor — remain on the front lines of trauma and stress every day, and this can lead to high rates of PTSD, anxiety and depression. Unfortunately, the high-stakes pressures of the role can lead to mental health issues, substance abuse or both.

“The presence of (substance use disorders) … as a potential indicator for mismanaged trauma … suggest substance abuse exacerbates PTSD symptoms and increases with the severity of psychological trauma,” notes a study by NAADAC, the Association for Addiction Professionals. Finding help through co-occurring disorders treatment gives our public safety professionals the respect they deserve.

Treatment for Dual Diagnosis

When you sign up for rehab and receive a dual diagnosis, integrated treatment for addiction co-occurring disorders begins. But what does it look like? What does dual diagnosis mental health include? For someone entering treatment for only a mental health disorder or only an addiction, treatment remains on a singular track. But for a dual diagnosis, treatment involves addressing both issues, meaning that each treatment track must complement the other.

Mental health treatment might involve:

Psychiatric medication: For disorders with severe symptoms, you might work with a psychiatrist to see if certain medications are a necessary component of therapy.
Psychological symptom management: Symptoms may be something you feel and think, but how do you identify and take control of them? Your therapist will help you learn to understand how they take shape and how to manage them, like PTSD triggers that might once have seemed uncontrollable.
Specialized therapies: In mental health, trauma-informed care means that certain types of talk therapy, like Cognitive Behavioral Therapy (CBT) or EMDR, are research-based, proven practices that can help you make sense of what you think and how you feel and act — and how to grow and recover in healthy ways.
Skill-building: Mental illness can rob one of their ability to simply cope with the disorder. A major focus of treatment is on developing a toolbox of healthy, practical coping skills to deal with stress, emotional pain and triggers in your daily life.
Peer support: Therapy is often one-to-one with a counselor, but sometimes you might engage in group treatment with other people like you in recovery for the same reasons. It’s a chance to connect with others who have similar lived experiences.
Lifestyle changes and wellness: Holistic dual diagnosis treatment centers offer alternative therapies like meditation, yoga and expressive and experiential therapies to help heal mind, body and spirit from a co-occurring disorder.
Mental health education: A dual diagnosis might seem intimidating at first, like something that can’t be fathomed or truly understood. But through treatment, you’ll learn and become acquainted about the nature of your specific mental health condition, which empowers you by demystifying your symptoms and the treatment process.

And here’s what to expect from the substance abuse portion of dual diagnosis treatment at dual diagnosis inpatient treatment centers:

Detoxification: The first step in treatment at dual diagnosis rehab centers is detox, a period of time to allow your body to withdraw from addictive substances. This can often be accompanied by withdrawal symptoms, so you’re cared for and monitored in a safe, comfortable environment by a caring, compassionate team of doctors, nurses and staff.
Medication: Like with mental health treatment, medication is sometimes necessary to ease symptoms and make therapy a more accessible experience.
Withdrawal symptom management: The clinical team continues providing constant medical and emotional support to manage the discomfort of withdrawal, which can sometimes linger after detox has finished.
Behavioral therapies: CBT, Dialectical-Behavioral Therapy (DBT), Acceptance and Commitment Therapy (ACT) and others help you reframe negative mental narratives can change behaviors that can contribute to substance abuse and poor mental health.
Support groups: Group therapy is one of the backbones of substance abuse treatment, and when rehab is complete, you’ll have the opportunity to continue attending support groups in a similar vein, like 12-step programs like Alcoholics or Narcotics Anonymous.
Relapse prevention planning: One important component of dual diagnosis treatment is learning how to identify the triggers that can lead you to abuse drink or drugs and develop the willpower and clarity to avoid relapsing.
Addiction education: You may have questions about the nature and science of addiction: what it does to the brain and body and drives one to abuse. Gaining a better understanding offers you more control and autonomy over an addiction, leverage to find recovery on your own terms.

Medication Management for Substance Abuse and Mental Health Disorders

Where does medication fit exactly in a dual diagnosis treatment plan? Oftentimes, some co-occurring disorders can be defined by symptoms severe enough to raise a barrier to the

effectiveness of talk therapy. In these moments, a referring psychiatrist might determine if prescribing medication — for a short period — is the right approach.

The type of medications you might be prescribed are meant to work together to treat the mental health and addictive sides of a co-occurring disorder together. It might include antidepressants or a mood stabilizer along with drugs like naltrexone for alcohol use disorder or a benzodiazepine for anxiety. The medication regimen you’re on is closely built and tailored to ease and manage symptoms of mental illness and a drug disorder to stabilize and give you much-needed focus to move forward and upward.

Dual Diagnosis Therapy Services

Dual diagnosis holds value because it’s integrated treatment for co-occurring disorders that gives equal weight to substance abuse and mental health disorders at the same time while being personalized to your unique needs. Even if you’ve dealt with the same pair of conditions as someone else, neither treatment plan will be the same because your symptom severity, physiology and neurological makeup and experiences will differ.

Aliya Veterans’ core programming at inpatient dual diagnosis treatment centers is centered on some of the therapies we mentioned earlier that are ideal for treating a co-occurring disorder, like CBT, DBT and EMDR — tried-and-true treatments that help connect the dots between, for example, a specific traumatic memory that might compel someone to self-medicate, or, chronic depression and cravings for alcohol despite one’s best efforts to stop drinking.

Dual diagnosis therapy is about making those connections between two disorders and, by seeing how they interact and influence each other, you can work on developing new skills, new coping mechanisms that honor recovery of both.

Dual Diagnosis FAQ

What is an example of a dual diagnosis?

A common dual diagnosis example might be when a veteran who displays clear anxiety from combat-related PTSD begins abusing benzodiazepines, an anti-anxiety drug, but becomes dependent and addicted to them. Another co-occurring disorder that can receive a dual diagnosis is alcohol use disorder and depression, where someone drinks in an attempt to lift their feelings, but ultimately worsens both problems.

What is the most common dual diagnosis?

There are many combinations of co-occurring disorders and dual diagnoses, such as PTSD and opioid use disorder, or abusing methamphetamines while struggling with bipolar disorder. But according to a study, alcoholism and depression comprise the most common dually diagnosed condition. People with clinical alcohol dependence, it found, are 3.7% more likely to have a depressive disorder, with nearly 3% risking alcoholism and dysthymia, a chronic form of depression.

What are the behaviors of a dual diagnosis?

Behaviors characteristic of a co-occurring disorder can qualify for a dual diagnosis and involve a number of symptoms from both conditions:

Using alcohol, opioids, marijuana or other drugs to cope with or numb feelings of depression, despondency or anxiety that can be borne from a traumatic job.
Withdrawing from and friends, family and activities you once enjoyed.
Intense cravings for drink or drugs combined with sudden mood swings or outbursts.
Trouble managing daily responsibilities and obligations at home, work or school. · Hiding or lying about one’s drug use or going to great lengths to obtain illicit substances.
Worsening of mental health symptoms when substance use increases, and vice versa.

What is the most effective treatment for dual diagnosis?

The clearest dual diagnosis treatments are integrated, meaning they combine a few potential approaches to treat the duality of two disorders at once, through the same clinical team. NAMI, the National Alliance on Mental Illness, says this could take shape through psychotherapy, dual diagnosis residential treatment, supportive housing options and more.

The number one goal of dual diagnosis residential treatment is combining both a mental health and substance abuse disorder in one plan to maximize the benefits of recovery. “Because each dual disorder can aggravate the course of the other, both disorders must be treated if the patient is to have the best chance for a good outcome,” notes a National Institutes of Health study.

What is dual disorder treatment?

Comprehensive and following a continuum of care (where all the touchpoints needed at certain points during treatment are available and offered), a dual disorder treatment center includes everything from detox to withdraw from substances when addiction is prevalent; a mix of behavioral therapies (like CBT or ACT) that address mental health and addiction issues together; group therapy with peers that addresses both disorders; addiction and mental health education; holistic therapy; and aftercare, where you’re supplied with resources outside of residential dual diagnosis treatment centers, transitional housing and family support.

Dual Diagnosis Treatment at Aliya Veterans

Many of the clinical staff at Aliya Veterans, from our therapists, counselors, addiction specialists, social workers and key support, have military and public safety backgrounds and understand the importance of special treatment for PTSD, trauma, depression, alcohol abuse or other mental health and substance use disorders so common among those who serve.

Recovery is a steadfastly personal mission as invaluable as any deployment or 911 response, where your mental, emotional and physical well-being are priceless and need special care when a co-occurring disorder has entered the picture. Our dual diagnosis treatment centers for veterans and first responders were built to equip you with effective coping techniques, life skills relapse prevention plans and other helpful resources to help you maintain sobriety and a palpable sense of well-being after treatment for drug and alcohol addiction.

Get Help for Substance Abuse and Mental Health

Dealing with a co-occurring disorder is grappling with two issues at once, and it can feel like it’s too difficult to find help. Remember that help is available and help is effective for substance abuse and mental health disorders.

Most important — you don’t have to navigate the journey alone. For vets and first responders, serving on a battalion, squadron, platoon or emergency team calls for watching each other’s backs, a goal we aim for every day in mental health and addiction treatment, to give you the support you need with care and compassion, a philosophy that’s more than just clinical, but a personal promise from us.

As you explore the rest of our site, take the opportunity to reach out to us today. Our admissions experts at long term dual diagnosis treatment centers are on hand 24/7, every day, to field your questions and offer answers about dual diagnosis treatment near me, what’s involved and insurance coverage plus more. Call us today or fill out our secure contact form for more.