Dual Diagnosis Treatment by Telehealth — Co-Occurring Disorders

Integrated telehealth care for patients with co-occurring substance use disorders and mental health conditions. Available in Washington State and Nevada. Care is delivered by secure video visit in most locations. In-person visits may be required in the Tacoma, WA and Reno, NV areas.

Availability note: Dual diagnosis treatment is currently available in Washington State and Nevada only, where both addiction medicine and psychiatric medication management services are offered.

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What is dual diagnosis?

Dual diagnosis — also called co-occurring disorders — refers to the simultaneous presence of a substance use disorder and a mental health condition. The term covers a wide range of combinations: depression and alcohol use disorder, anxiety and opioid use disorder, ADHD and stimulant misuse, bipolar disorder and alcohol dependence, PTSD and opioid use disorder, and increasingly, anxiety or depression co-occurring with Kratom dependence.

The prevalence is higher than most people realize. According to SAMHSA, approximately 21.5 million adults in the United States have co-occurring substance use and mental health disorders. Research published by the Journal of the American Medical Association found that roughly half of people with severe mental health conditions also have a substance use disorder, and vice versa.

Despite how common it is, co-occurring disorders are frequently treated in silos — mental health providers who do not address substance use, and addiction programs that do not adequately address mental health. The result is incomplete care that addresses one condition while leaving the other untreated, undermining the effectiveness of treatment for both.

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Why integrated treatment works better

The relationship between mental health conditions and substance use disorders is bidirectional and reinforcing.

Mental health conditions can drive substance use. Someone with untreated anxiety may use alcohol to manage social situations or generalized worry. Someone with untreated depression may use opioids to temporarily suppress emotional pain. Someone with untreated ADHD may use stimulants to self-medicate concentration and attention difficulties. Someone with untreated anxiety or depression may turn to Kratom for its calming or mood-lifting effects. The substance becomes a coping mechanism for an underlying condition that has not been adequately addressed.

Substance use can worsen mental health. Chronic alcohol use disrupts serotonin and dopamine regulation — the same neurotransmitter systems affected in depression and anxiety. Opioid use and withdrawal produce significant anxiety, depression, and emotional dysregulation. Kratom withdrawal is frequently accompanied by prolonged anxiety and depression that can persist for weeks to months after cessation. The substance that started as a solution becomes part of the problem.

When only one condition is treated, the untreated condition undermines recovery from the other. A patient who achieves sobriety but still has untreated depression faces a powerful biological drive to return to the substance that previously relieved that depression. A patient whose psychiatric medications are adjusted but who continues to use alcohol faces both the direct effects of alcohol on brain chemistry and the disruption to medication stability.

Integrated treatment addresses both conditions simultaneously, with a provider who understands how they interact. This is what Rezolv Health provides.

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Our approach to dual diagnosis

Rezolv Health does not run separate tracks for addiction and mental health. Both are addressed within a single clinical relationship, with a provider who has the training and context to manage the interaction between them.

Initial evaluation: A comprehensive intake that covers both your substance use history and your mental health history — symptoms, prior diagnoses, prior treatment, medications that have or have not worked. This is not two separate evaluations. It is one integrated assessment.

Treatment plan: A coordinated medication plan that addresses both conditions. This might mean buprenorphine for opioid use disorder alongside an SSRI for depression. Or naltrexone for alcohol use disorder alongside medication for anxiety. Or Kratom cessation support alongside treatment for underlying anxiety that the Kratom was managing. The medications are chosen with awareness of how they interact, and the plan is adjusted as both conditions evolve.

Ongoing monitoring: Monthly telehealth appointments that track progress on both fronts — substance use and mental health — and adjust the approach as needed.

Coordination with therapy: Medication management is most effective when combined with therapy for both conditions. Rezolv Health can coordinate with your existing therapist or provide referrals to therapists who specialize in co-occurring disorders.

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Frequently asked questions

What is dual diagnosis? Dual diagnosis refers to the simultaneous presence of a substance use disorder — such as opioid use disorder, alcohol use disorder, or Kratom dependence — and a mental health condition such as depression, anxiety, ADHD, or bipolar disorder. These conditions frequently occur together and interact with each other in ways that make treating one without the other less effective.

How common are co-occurring disorders? Very common. SAMHSA estimates that approximately 21.5 million American adults have co-occurring substance use and mental health disorders. Among people seeking treatment for substance use disorders, the majority have at least one co-occurring mental health condition.

Why is integrated treatment more effective than treating each condition separately? Because the conditions interact. Untreated depression is a powerful driver of substance use relapse. Ongoing substance use destabilizes psychiatric medication and worsens mental health symptoms. When both are treated simultaneously by a provider who understands how they relate, neither condition is being undermined by the other.

What conditions are treated under dual diagnosis at Rezolv Health? On the substance use side: opioid use disorder, alcohol use disorder, and Kratom dependence. On the mental health side: depression, anxiety disorders, ADHD, bipolar disorder, PTSD, and related conditions. Your intake form will capture your full history and your provider will assess what is appropriate for telehealth management.

Is dual diagnosis treatment covered by insurance? In Washington, commercial insurance and Apple Health (Medicaid) are accepted. In Nevada, all insurance including Medicaid is accepted. Coverage for both substance use treatment and mental health treatment is required under the Mental Health Parity and Addiction Equity Act for commercial insurance plans, and under Medicaid behavioral health benefits for Medicaid patients.

What if I am not sure whether I have a mental health condition? You do not need a prior diagnosis to be evaluated. Your intake form and initial appointment will include a clinical assessment of your mental health symptoms. If a mental health condition is identified and treatment is appropriate, your provider will discuss options with you.

Can Rezolv Health manage complex psychiatric conditions? Rezolv Health is well-positioned for most presentations of the conditions listed on this page. Patients with severe or unstable psychiatric presentations — acute psychosis, active suicidal ideation requiring crisis intervention, or conditions requiring inpatient or intensive outpatient psychiatric care — may require a higher level of care than telehealth medication management can provide. Your provider will be transparent about this if it applies to your situation.