Managing Dual Diagnosis: Cummins’ Tracy Waible on How to Identify and Treat Substance Use with Co-Occurring Disorders

Jan. 21, 2020


Substance use disorder, otherwise known as substance addiction, afflicts millions of people across the United States every year. According to statistics from the National Survey of Drug Use and Health, the exact number is around 20.3 million people aged 12 or older. Substance use disorder, or SUD, can be a devastating disease for the person who has it as well as their loved ones, affecting everything from their physical and mental health to their economic stability.

In addition, it’s not uncommon for someone with substance use disorder to also struggle with other mental health issues. When this is the case, the person is said to have a dual diagnosis or a co-occurring disorder. According to the same survey mentioned above, 9.2 million adults had both a mental illness and SUD in 2018. However, about half of adults with co-occurring disorders did not receive treatment for either ailment.

As these statistics show, co-occurring disorders are a very significant issue in modern mental health. If a person who is suffering from co-occurring disorders does not receive proper treatment for both conditions, then there’s a high probability that their problems will only continue. Therefore, it’s important that mental health professionals and their patients know how to identify and treat co-occurring disorders.

As part of its mission to inspire the hope of recovery for everyone, Cummins Behavioral Health is dedicated to improving the lives of individuals who suffer from substance use disorder. We spoke with Tracy Waible, our Director of Recovery Services, to learn more about SUD with co-occurring disorders and the best way to treat this difficult condition.

The Problem with Co-Occurring Disorders


"There's a high correlation between substance use disorder and an array of other mental health disorders," says Tracy Waible (LCSW, LCAC), Director of Recovery Services at Cummins Behavioral Health.

In general, substance use is more common among people who have a mental health issue than it is among people who do not. In cases of co-occurring disorders, it’s possible for either disorder to develop first. An individual who has a mental health disorder may turn to substance use as a way of managing their symptoms, but research has shown that alcohol and drugs worsen the symptoms of many mental disorders, proving that substance use is not an effective coping strategy for mental illness.

People who suffer from mood disorders or who have experienced traumatic situations can be at especially high risk of developing co-occurring SUD. “There’s a very high correlation between PTSD and substance use disorder,” Tracy says. “A lot of people that come through our programming might have experienced trauma as a child, which could lead to them developing substance use disorder over time.”

In fact, trauma and mental illness are two key risk factors for developing SUD, especially when they occur during a person’s childhood. According to the National Institute on Drug Abuse, risk factors are qualities of an individual or their environment that put them at risk for developing behavioral problems. Risk factors are offset by protective factors, which are qualities that promote successful coping and adaptation to life situations. Understanding risk factors and protective factors is an important part of preventing and treating substance use disorder, as Tracy explains:

“When someone comes to Cummins seeking treatment for substance use, we use the Surgeon General’s Report on Drugs, Alcohol and Health to go through the risk factors and protective factors for developing SUD. We even train our elementary providers to do this, because some of the risk factors have to do with behavioral health issues that emerge as early as kindergarten. For adults, we use this activity to decrease stigma and shame. They can see what risk factors they had as a child, what protective factors they lacked, and how they got to where they are now. Overall, we see what we can do for prevention or wrap-around services to bolster some of those protective factors for people.”

Providing Dual Treatment for a Dual Diagnosis


We know that SUD can often come with a co-occurring disorder, and we know that treating both disorders is essential for a person’s recovery. The question that remains is how to manage treatment of a dual diagnosis.

As with any person coming into treatment, the first thing a therapist should do is assess the appropriate level of care for the client. “We use an evidence-based tool called the ASAM Criteria at intake to decide how many hours of service someone needs,” Tracy explains. At Cummins, a therapist can identify any disorders an individual may have on top of SUD and refer them to a variety of additional outpatient services, including individual therapy, family therapy, peer services, skills training and employment services. Medication-assisted treatment for substance use and medications that can help manage mental health symptoms are also available.

If a person requires a high level of care for their substance use disorder, then they might be a good fit for Intensive Outpatient Treatment, also known as IOT. This level of treatment lasts longer and goes more in-depth than standard outpatient SUD care. “IOT is nine hours a week, and it’s done in a group setting. We currently have two IOT groups in Hendricks County and one group each in Marion, Boone, Montgomery and Putnam counties,” Tracy says.

In addition, all substance use treatments provided at Cummins leverage peer recovery services to increase consumer comfort and improve treatment outcomes. Tracy explains,

“Peer recovery specialists take part in our IOT groups and are embedded in all of our SUD programming. They offer lived experience and help consumers find hope that recovery is possible. If a person isn’t sure that they want to engage in IOT, the peer recovery specialist can talk them through our services and why they’re important. They can also help people feel more comfortable when they get to their first group session, because they’re someone the person has already met and is comfortable with. Finally, peer specialists will also see some of the group members individually to help them find community resources like 12-step meetings.”

If you or someone you know is struggling with substance use disorder, we encourage you to look into treatment with Cummins BHS. Our therapists and counselors can provide treatment for substance use as well as any co-occurring mental health issues you may have.

In the words of Tracy Waible, at Cummins, “Our philosophy is to treat the whole person. We want to look at every area of their life to see how we can help them move forward in those areas and be happy, healthy, productive human beings.”


For more information about the different types of services Cummins provides, we recommend reading our blog posts on school-based services and employment services, which you can find below!