Co-occurring substance use and mental health treatment in Ohio

A co-occurring disorder is a mental health condition and a substance use disorder present at the same time. Dual diagnosis is the older term for the same thing. Common pairings include alcohol with depression and opioids with anxiety, and post traumatic stress disorder can sit alongside any substance.

Which condition came first is often impossible to settle. Treatment starts without that answer, because by the time someone calls, both are usually active.

Care for the two is often divided between separate rehabs and mental health clinics, with records that never meet. SAMHSA recommends integrated treatment for co-occurring disorders, meaning one team working from one plan. Four problems are common when care is split:

• The mental health clinic will not start until you have some period of abstinence
• The addiction program reads the depression as substance induced and treats only the drug use
• Whoever writes the prescriptions does not know what else is being taken
• A return to use gets written up as noncompliance, and the condition behind it stays untreated

Both sides are assessed at the same visit. The substance history and the psychiatric history are taken together, and a nursing assessment reviews your physical health and the medications you take now. What comes out is a single treatment plan, and the same clinical team works from it for both conditions.

In partial hospitalization, the day includes an hour of relapse prevention and an hour of nurse education alongside four hours of therapy group.

The same clinicians treat both conditions, and they hold LCDCIII, LICDC, LSW, LISW, LPC and LPCC credentials.

• Cognitive behavioral therapy (CBT): finding the thought patterns and habits that keep substance use and low mood or anxiety feeding each other, and practicing other responses between sessions
• Motivational interviewing (MI): working through ambivalence about change, which often applies to both conditions at once
• Group therapy: most of the scheduled hours from partial hospitalization down to outpatient, led by licensed clinicians
• Individual counseling: 1 to 2 sessions alongside group in partial hospitalization and intensive outpatient
• Dialectical behavior therapy (DBT): skills for intense emotions and the urges that follow them
• Case management: support with the practical side of treatment, and coordination with your other providers
• Peer support: support from peers who have gone through similar experiences

Medication assisted treatment (MAT) pairs FDA approved medication for opioid or alcohol use disorder with counseling and therapy. Medication is prescribed and monitored under the guidance of a healthcare professional, and it is used during ambulatory detox where it is needed.

Psychiatric medication sits on the same treatment plan, so the person managing what you take for depression or anxiety knows what you take for cravings or withdrawal. Medication appointments are weekly in partial hospitalization and every 2 to 3 weeks in intensive outpatient and outpatient. The MAT page lists the medications and what each one treats.

Call (614) 665-8878 to book an assessment at the Columbus facility or the Dayton facility, or to ask about virtual IOP if you live elsewhere in Ohio. Leora accepts all major commercial insurance and Medicaid.