Dual Diagnosis Treatment in Houston, Texas

Mental illness and substance use disorder are closely connected. When they co-occur, it’s known as dual diagnosis and both disorders need treatment, preferably at the same time by staff that is expert in both.

Houston—the largest city in Texas, located in the largest county in Texas, in the state with the longest stretch of border with Mexico—is more in need of access to dual diagnosis treatment than many others.

Houston’s population accounts for almost half of the population of Harris County, the largest county in Texas. Houston has almost as many people as the whole of Dallas County, the second largest.

Mental illness in Houston, TX

Between 2019 and 2020, the nationwide rate of people with a mental health disorder more than tripled, from about 10% to more than 30%.

Of the 10 worst U.S. cities for mental health, four are in Texas, including the top two, according to one September 2021 ranking. Houston had the second-worst.

Texas as a whole has the second-highest rate in the nation of serious mental illness (SMI), including:

Among the most common mental illnesses are:

Two possible reasons for the state’s poor mental health rate are its high incarceration rate (people with mental health disorders are eight times as likely to be imprisoned as to get treatment) and prescription medication costs (more than $23 billion annually).


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Substance use disorder in Houston, TX

Substance use disorder is considered both a mental health disorder and a chronic illness in the same way as diabetes, asthma, and cancer. There seems to be a genetic predisposition for addiction, though it’s not necessarily the only or most important risk factor.

The rate of substance use disorder in Texas isn’t that bad, compared to national rates, but it’s not all good. Houston’s rate is slightly worse than the state as a whole.

In 2021, Texas ranked well for:

  • Adult drug users (fourth-lowest rate)
  • Overdose deaths (third lowest)
  • Drug use and addiction (third lowest)
  • Adults with unmet drug treatment needs (second lowest)

However, Texas had the second-lowest number of drug treatment centers per capita.

From 2017 to 2019, Harris County had an opioid overdose rate of 12.4 per 100,000 population. That’s much lower than the US rate of 21.0 but slightly higher than Texas’s overall 10.6, and getting worse over time.

In 2019, the biggest drug threats in Houston, Texas were methamphetamine and cocaine. Heroin and other opioids were third, followed by marijuana. Since the crackdown on heroin and legal prescription opioids such as oxycodone (OxyContin, Percocet) and hydrocodone (Vicodin, Norco), another opioid has become a growing and even dominant threat: fentanyl.

A December 2021 drug bust in Houston, Texas netted more than 300 pounds each of cocaine and methamphetamine, almost four times as much marijuana, and much smaller quantities of heroin (13 pounds) and fentanyl (40 pounds).

Although the quantities of meth and cocaine are much greater, fentanyl is a greater concern because it is a synthetic opioid as much as 50 times more potent than heroin. Fentanyl is much more likely to cause a fatal overdose.

Fentanyl in Houston, TX

Although it is manufactured for prescription in a variety of forms—including a transdermal patch and a lollipop—black-market fentanyl is much more likely to be manufactured in illicit drug labs, without quality control or precise measurements.

In 2016, two-thirds of fentanyl poisoning cases involved misuse of medically produced fentanyl. By 2018, that percentage dropped to less than one-third (28%).

Most of the fentanyl sold in the United States now enters the country by land via Mexico, according to a 2022 US government report, including through Texas. Houston, Texas is federally designated a High Intensity Drug Trafficking Area: drugs come in and are distributed throughout the nation.

From 2019 to 2021, the percentage of drug overdose deaths involving fentanyl in Harris County tripled from 14% to 42%. During the same period, while the total number of drug overdose deaths increased by 52%, the number of fentanyl overdose deaths rose by 341%, from 104 to 459: more than one every day.

While fentanyl was not named specifically in any deaths in 2018, of the 957 methamphetamine recorded deaths, 66 also “involved” fentanyl. Of the 524 deaths involving “other opiates,” fentanyl was found in 176. In 2018, of 684 heroin deaths, 80 also involved fentanyl.

Fentanyl’s numbers may be higher. It can be difficult to determine which drug killed someone, especially if analysis finds someone had used more than one drug.

As many as seven drugs have been found in one overdose death. While poly-drug use is common, another factor can be that fentanyl is added to or substituted for other, more expensive, or hard-to-obtain drugs, including heroin.

Fentanyl can be pressed into pill form and made to look like highly sought-after prescription meds, you may not know it’s fentanyl. Such ignorance can be fatal. You can overdose on fentanyl without realizing you were taking fentanyl.

Authorities estimated that a little more than six pounds of fentanyl seized in September 2021 potentially could have killed hundreds of thousands of people.

Alcohol abuse in Houston, TX

Substance use disorder and substance use disorders do not refer only to drugs such as methamphetamine, cocaine, and heroin. Alcohol, despite being legal for those ages 18 and older, can also be an abused substance.

Binge drinking (five or more drinks in two hours at least once per month for men, four for women), heavy drinking (three or more drinks per day, 14 drinks per week for men, two per day or seven per week for women, or binge drinking five or more times in 30 days), and alcohol dependence are also substance use disorders that may require substance use disorder treatment.

Alcohol use doesn’t have to rise to such levels to be harmful. A modest amount of alcohol combined with other drugs, mental states, or activities can be fatal.

While Texas does not lead the nation in alcohol consumption (in 2022, the average Texan consumed 2.26 gallons of alcohol annually, in 29th place, below the national average of 2.47, and less than half of Utah’s 4.67), in 2019 it fared much worse for alcohol-impaired driving fatalities with the highest number and the fifth-highest rate.

What is dual diagnosis in Houston, Texas?

Dual diagnosis is the co-occurrence of a mental health issue and a substance use disorder (SUD). The two can have similar effects and may be mistaken for the other or overlooked during diagnosis.

About half (49.2%) of people with a SUD also have a mental health disorder, and a fifth (18.4%) of people with a mental health disorder also have a SUD.

There’s no one reason why they co-occur so often, but at least three possibilities.

Mental illness leads to substance use disorder

Most people with a clinical-level mental health issue don’t immediately realize it. They may feel off but not understand why. Even when they do, in the U.S., almost half—45%—don’t seek treatment. Of those who didn’t seek treatment, 36% said they preferred to handle it themselves.

One way they handle it, even if they don’t realize what they are trying to handle, is by self-medication with alcohol or drugs. Substance use may treat the symptoms in the short term, but this leads to:

  • Tolerance. The substance loses its effect over time, requiring larger or more frequent doses.
  • Dependence. If the substance use stops, the individual feels worse than before use started.

Substance use leads to mental illness

Abuse of some substances has been linked to the development of some mental illnesses in at least two ways:

  • The substance use triggers a mental illness to which the individual was genetically predisposed.
  • Substance use hijacks the brain’s neurotransmitters, reducing the production of feel-good chemicals except when drugs are used, causing depression or anxiety.

Common cause

Both mental health and substance use disorders can both be caused by the same things, including genetics, chemicals in the environment, and traumatic events or post-traumatic stress disorder (PTSD).

Dual diagnosis treatment in Houston, Texas

When individuals have a dual diagnosis, they have two problems that need treatment. That wasn’t always thought to be the case.

Even when both the mental health and substance use disorder were identified, only one problem—the one thought to be worse or causing the other—was treated. Depending on the expertise of the health professional involved, only one might be recognized.

More recently, the two problems were treated sequentially, first one (the worse one), then the other if it still seemed necessary. This required separate teams because not all mental health professionals were trained in substance use disorders, and vice versa.

Now, the best treatment is believed to be treating both problems simultaneously, preferably by the same treatment team. That requires a team well-versed in both mental health and substance use disorders.

Because dual diagnosis is so common, the best substance use disorder treatment centers in Houston, Texas will look for co-occurring mental health disorders during the initial intake interview or assessment.

Among the treatment decisions that must be made at intake are:

  • Is detox needed? If the client hasn’t completed physical withdrawal, then medically monitored withdrawal may be necessary.
  • Outpatient or inpatient care? There are two basic levels of care. Clients may transition from one to the other.
    • Inpatient care is when clients need to live at the rehab treatment center and be monitored 24/7 to prevent relapse.
    • If they don’t need or can’t afford it, outpatient care is less expensive and disruptive. The client lives at home, maybe continues to work or go to school, and visits the rehab center for a certain number of hours per day or per week.
  • Aftercare. Relapse remains a risk throughout the client’s life. Aftercare details how and what the client can do to remain sober after treatment ends. This includes attending a peer support fellowship (Alcoholics or Narcotics Anonymous, SMART Recovery).

Types of dual diagnosis treatment in Houston, Texas

There are many types of dual diagnosis treatment in Houston, TX. Successful long-term treatment usually involves more than one.

Behavioral therapies

Because clients eventually leave the treatment center, evidence-based behavioral therapies teach them to anticipate and cope with triggers and setbacks on their own. Types of behavioral therapy include:

Medication-Assisted Treatment (MAT)

While behavioral therapies that teach clients how to understand and cope with their dual diagnosis are considered the best long-term treatment, medication-assisted treatment (MAT) with behavioral therapy is the gold standard. It just shouldn’t be the only treatment.

In addition to antidepressants and antipsychotics for mental health disorders, there are two main types of drugs useful for treating opioid and alcohol use disorders:

  • Opioids with a low-plateau—principally buprenorphine (Suboxone) and methadone—prevent withdrawal cravings but usually cannot cause euphoria.
  • Other drugs discourage relapse through negative effects.
    • After physical withdrawal ends, naltrexone prevents euphoria from opioids and alcohol. If physical withdrawal is not complete, naltrexone causes instant withdrawal symptoms.
    • Acamprosate reduces cravings for alcohol in abstinent clients.
    • Disulfiram causes unpleasant side effects—headache, nausea, vomiting, blurred vision, anxiety—if alcohol is consumed.

Complementary therapies

These therapies are not science-based, but that doesn’t mean they can’t be effective or don’t have some supporting evidence (if only anecdotal):

  • 12-Step facilitation. Meeting with peers who share a mental health or substance use disorder—Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery—helps reinforce sobriety.
  • Contingency management. Awarding tokens, prizes, or affirmations for continued sobriety.
  • Assertive Community Treatment. Multidisciplinary support and outreach services to maintain sobriety.
  • Holistic treatments. Use of alternative medicine-based practices—acupuncture, movement, meditation, diet—to manage mental and physical pain. Also may include art, music, or equine therapies.


  1. kff.org – Mental Health in Texas
  2. certapet.com – The Best & Worst Cities for Mental Health in America
  3. worldpopulationreview.com – Mental Health Statistics by State 2022
  4. dmagazine.com – New Research Shows Why Young People in Dallas Are Struggling With Their Mental Health
  5. mentalhealth.gov – Depression
  6. mayoclinic.org – Bipolar disorder: Symptoms & causes
  7. hhs.gov – What are the five major types of anxiety disorders?
  8. medlineplus.gov – Psychotic Disorders
  9. cdc.gov – What is ADHD?
  10. mayoclinic.org – Personality disorders: Symptoms & causes
  11. mayoclinic.org – Borderline personality disorder: Symptoms & causes
  12. nimh.nih.gov – Substance Use and Co-Occurring Mental Disorders
  13. store.samhsa.gov – Facing Addiction in America
  14. wallethub.com – Drug Use by State: 2021’s Problem Areas
  15. houstonstateofhealth.com – Death Rate due to Drug Poisoning: 2017-2019 (most recent)
  16. socialwork.utexas.edu – State of Texas Drug Use Patterns and Trends, 2019
  17. justice.gov – Dozens arrested in 105-count narcotics indictment
  18. rand.org – Commission on Combating Synthetic Opioid Trafficking Final Report
  19. houstonchronicle.com -Deaths tied to fentanyl skyrocket in Harris County, where the drug kills more than one person every day
  20. khou.com – Feds: Shipment headed to Houston had enough fentanyl to kill hundreds of thousands of people
  21. crashstats.nhtsa.dot.gov – Traffic Safety Facts, 2019 Data: Alcohol-Impaired Driving
  22. samhsa.gov – Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health
  23. forbes.com – Almost Half Of Americans Don’t Seek Professional Help For Mental Disorders
  24. medlineplus.gov – Dual Diagnosis
  25. justice.gov – Drug Abuse and Mental Illness Fast Facts: Questions and Answers
  26. ncbi.nlm.nih.gov – Integrating Treatment for Co-Occurring Mental Health Conditions
  27. sunshinebehavioralhealth.com – Texas Rehab Centers & Addiction Treatment
  28. drugabuse.gov – Behavioral Therapies (Principles of Drug Addiction Treatment: A Research-Based Guide, Third Edition)
  29. drugabuse.gov – Cognitive-Behavioral Therapy (Alcohol, Marijuana, Cocaine, Methamphetamine, Nicotine)
  30. depts.washington.edu – Dialectical behavior therapy
  31. drugabuse.gov – Motivational Enhancement Therapy (Alcohol, Marijuana, Nicotine)
  32. drugabuse.gov – The Matrix Model (Stimulants)
  33. samhsa.gov – Medication-Assisted Treatment
  34. samhsa.gov – Naltrexone
  35. nami.org – Acamprosate (Campral)
  36. medlineplus.gov – Disulfiram
  37. drugabuse.gov – 12-Step Facilitation Therapy (Alcohol, Stimulants, Opiates)
  38. drugabuse.gov – Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine)
  39. case.edu – Assertive Community Treatment
  40. sunshinebehavioralhealth.com – Holistic Treatment for Drug & Alcohol Addiction

Medical disclaimer:

Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.

Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.

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