Metamorphosis Centre for Change
Concurrent disorders, sometimes called dual diagnosis or co-occurring disorders, happen when a person has a substance use problem and a mental health problem at the same time. The two can feed each other. Effective care treats both together rather than one after the other, and it usually combines several approaches. Below are nine treatment options that are commonly used, along with how each one fits into a coordinated plan.
What Concurrent Disorders Look Like
There is no single pattern. A person might have an eating disorder and an alcohol problem, schizophrenia and cannabis use, or depression with opioid use. Some people notice that substance use started first, while others notice that mental health symptoms came first. In many cases both problems are active at once, and their severity rises and falls over time.
Concurrent disorders are common among people who seek care for addiction and among people who seek care for mental illness, which is why screening for both is important in any assessment.
Because the combinations vary so much, the first step is a careful assessment. Clinicians look at the type of substance involved, the severity of each problem, how each one affects daily life, and what supports the person already has.
Why Integrated Treatment Matters
Substance use can hide mental health symptoms, make them worse, or briefly relieve them. Mental health symptoms can push a person toward substances as a way to cope. Missed medication, a relapse in one area, and a crisis in the other can set off a cycle that is hard to break. Integrated treatment coordinates both sides of the problem so that progress in one area supports progress in the other. People with concurrent disorders often need more time and more support, which is why a plan that addresses the whole person matters.
Concurrent disorders also affect practical life. Someone who has lost a job or a home may find it hard to keep appointments, take medication on time, or attend group sessions. Treating teams often connect people with housing, income, or community supports for that reason. Treating symptoms alone is rarely enough when the surrounding life is unstable.
The Nine Treatment Options
The options below are not a checklist that everyone completes. A treatment team usually selects a mix based on the person's needs, their goals, and how each problem is affecting their life.
Some of these options are delivered in group settings, some in one-to-one sessions, and some are overseen by a physician or psychiatrist. Asking which options a program includes, and who delivers them, is a fair question to put to any provider.
1. Cognitive behavioural therapy (CBT)
CBT is a talk therapy that helps people notice and change thinking and behaviour patterns that keep substance use or distress going. It looks at how thoughts, feelings, and actions influence one another, and it teaches practical skills that can be used between sessions.
2. Dialectical behavioural therapy (DBT)
DBT focuses on emotional regulation, mindfulness, distress tolerance, and healthier relationships. It is often helpful for people who experience intense emotions or impulsive behaviour, including some people with personality disorders.
3. Acceptance and commitment therapy (ACT)
ACT encourages people to make room for difficult thoughts and feelings instead of fighting them or feeling guilty about having them. The focus is on acting in line with personal values, even when discomfort is still present.
4. Integrated group therapy
In integrated group therapy, substance use and mental health are addressed in the same group. Members hear from peers who face similar combinations of problems, which can reduce isolation and make it easier to speak honestly.
5. Relapse prevention
Relapse prevention work helps a person identify early warning signs, such as changes in sleep, mood, or social contact, and plan specific responses to them. Because a relapse in one area can trigger symptoms in the other, these plans cover both.
6. Motivational interviewing
Motivational interviewing is a client-centred conversation style. It helps people explore their own reasons for change and work through ambivalence at a pace that feels manageable. Many people find it easier to commit to treatment after a conversation like this.
7. Family therapy
Family therapy brings relatives into the process to improve communication, reduce conflict, and change patterns that may be contributing to substance use or mental health problems. Families also learn how to support recovery without taking over the person's choices.
8. Psychoeducation
Psychoeducation teaches people about their conditions, including triggers, health effects, and coping strategies. Understanding why symptoms happen can reduce fear and self-blame, and it gives people a clearer picture of what they can change.
9. Medication-assisted treatment
Some people benefit from medication, used alongside counselling and behavioural therapy, to treat a substance use disorder or to manage mental health symptoms. The right choice depends on the substance, the diagnosis, other health conditions, and personal history. These decisions belong to a physician or psychiatrist, and any medication should be monitored by a medical professional. Never start, stop, or change a medication on your own.
How Our Team Combines These Approaches
At the Metamorphosis Centre for Change, we combine traditional approaches such as CBT and DBT with experiential therapies that focus on mind and body wellness. These can include tai chi, yoga, art therapy, music therapy, and meditation. We also offer integrative options such as EMDR (eye movement desensitization and reprocessing) therapy, equine therapy, acupuncture, massage, and outdoor adventure therapy.
Care plans are shaped by several questions. How severe is each problem? Is the person safe at home? What support is available from family, friends, or community? Is housing and income stable? Each answer changes the mix of therapies and the level of care. A plan that works well in an outpatient setting may need to be adjusted for someone with a severe psychiatric illness or someone in early withdrawal.
Plans are created shortly after arrival and focus on the whole person, not only the addiction or the diagnosis. Our team reviews progress regularly and adjusts the plan as needs change. You can read more about our residential treatment and virtual outpatient options.
Frequently Asked Questions
Do I have to treat the substance problem before the mental health problem?
Not always. In some cases a team chooses to stabilize one problem first, such as withdrawal or acute substance use, and then address the other. What matters most is that both are part of the plan and that the care is coordinated.
Can someone recover from both at the same time?
Many people do. Progress depends on the severity of each problem, the support available, and how consistently the plan is followed. Recovery is often a long process with ups and downs, and a relapse does not mean treatment has failed.
Is the same plan right for everyone with concurrent disorders?
No. Two people with the same diagnosis may need very different care. That is why an individual assessment is the starting point for any plan.
Talk With Our Team
If you are wondering whether a combination of substance use and mental health concerns is affecting you or someone you love, a conversation can help clarify next steps. Call 705-429-3870 or contact us online. Our team can explain your options, including hybrid programs, and answer questions about costs and payment.
Written by Dr. Leonard Bienenstock, Medical Director and Addictions Doctor, M.D., CCFP
Dr. Bienenstock completed medical school at McGill University and his family medicine residency at Toronto Western Hospital. He has further training in addictions medicine and psychotherapy and serves as Medical Director at Metamorphosis Centre for Change.