Trauma-Informed Care

Co-occurring Disorders and Dual-diagnosis Facilities:


An individual diagnosed with co-occurring disorders (also known as dual-disorder, or dually-diagnosed) is a person who is characterized as experiencing symptoms of both substance abuse and one or more forms of mental health difficulties, including histories of trauma. In order to secure a COD diagnosis, attending medical or mental health professionals must be able to establish the issues as independent of one another. For example, a person who experiences bouts of depression after a drug binge may not be considered dually-diagnosed as their depression is likely a symptom or side effect of concurrent or recent drug use. According to Psychology Today, “common examples of co-occurring disorders include the combinations of major depression with cocaine addiction, alcohol addiction with panic disorder, alcoholism and polydrug addiction with schizophrenia, and borderline personality disorder with episodic polydrug abuse” (2012).

These diagnoses tend to vary when accounting for gender, something which can be linked to the forms of abuse suffered by the victim. According to Jacobsen, Southwick, & Kosten (2001), “Among men with PTSD, alcohol abuse or dependence is the most common co-occurring disorder, followed by depression, other anxiety disorders, conduct disorder, and non-alcohol substance abuse or dependence. Among women with PTSD, rates of comorbiddepression and other anxiety disorders are highest, followed by alcohol abuse and dependence”.

Dual-diagnosis facilities are treatment programs that specialize in addressing the unique needs of individuals with co-occurring disorders. Most rehabilitation centers today staff a psychiatrist and mental health professional (be they a licensed social worker, psychologist, or other human service professional with training in psychotherapeutic intervention). It is imperative to successful treatment outcomes that dually-diagnosed persons seek help for their disorders in such a facility. Extant literature suggests that the key to lasting sobriety lay in the adequate treatment of interfering issues such as PTSD through supportive healing of past traumatic experiences (Ford, Hawke, Alessi, Ledgerwood, & Petry, 2007).



Diagnosis Dictionary: Co-occurring disorders. Psychology Today. Retrieved September 14, 2012, from

Ford, J.D., Hawke, J., Alessi, S., Ledgerwood, D., Petry, N. (2007). Psychological trauma and PTSD symptoms as predictors of substance dependence and treatment outcomes. Behavior Research and Therapy, 45(10), 2417–2431.

Jacobsen, L.K., Southwick, S.M., Kosten, T.R. (2001). Substance use disorders in patients with posttraumatic stress disorder: A review of the literature. The American Journal of Psychiatry, 158(8), 1184-1190.



What Trauma Victims Can Expect in Drug Treatment:


While in treatment, dually-diagnosed individuals should expect to receive an individualized treatment plan tailored to address their specific substance abuse patterns, drug(s) of choice, mental health concerns, and environmental factors which may exacerbate these issues. It is common that the individual will participate in both group therapy with other clients, and in individual sessions with their primary therapist or counselor. Occasionally, other mental health professionals specializing in psychiatry or specific interventions may additionally aid in the individual’s treatment process. Co-occurring disorders seem, oftentimes, to be the most adequately or successfully addressed when treatment teams employ a multidisciplinary approach that may also include the work of holistic approaches (including herbal medicine, acupuncture, hypnosis, exercise, biofeedback, animal therapy, dietary modification, etc.) or methodologies such as Dialectical Behavioral Therapy (DBT). Clients can anticipate addressing issues including the relationship to one-self and others, “meaning-making” of traumatic events, affect in relationships, and “presence,” and how these may relate or contribute to continued substance abuse (Shapiro, 2010). Regardless of the specific methods employed, a multifaceted, overarching, and mindful approach to treatment will significantly promote the healing of these crippling disorders and drastically improve the lives of distressed individuals and their loved ones.


Shapiro, R. (2010). The trauma treatment handbook: Protocols across the spectrum. New York, NY: W. W. Norton & Company.