Dual diagnosis treatment in Texas: what integrated care is and how to find it

If you need help now: call 911 in an emergency. In a mental health or substance use crisis, call or text 988, any time; you don't have to be suicidal to call. Your county's local mental health authority also runs a 24/7 crisis line. SAMHSA's National Helpline, 1-800-662-4357, is free, confidential and open 24/7 for treatment referrals.

What dual diagnosis means

Any mental health condition together with any substance use disorder counts: drinking with depression, opioid use with PTSD, cannabis or stimulant use with anxiety or bipolar disorder, and so on. Treatment professionals more often say "co-occurring disorders"; in Texas rules the term is COPSD, co-occurring psychiatric and substance use disorders.

• It's common, and expected. NIDA's research principles say many people with addiction also have other mental disorders, and that someone who comes in with one condition should be assessed for the other.
• The ASAM Criteria, which many programs and plans use to decide the level of care, expect every level of care to treat co-occurring conditions as of the fourth edition.
• Symptoms can overlap. Drinking, drug use and withdrawal can cause or hide anxiety, low mood, poor sleep and other symptoms, which is why a good program assesses both and keeps checking as treatment goes on.

What integrated treatment looks like

Integrated means the mental health care and the substance use care are planned and delivered together, by one team or by clinicians who work closely and share the plan, rather than on two separate tracks. SAMHSA's TIP 42, updated in 2020, is the federal practice guide for it. What it looks like from your side:

Part of care	Integrated	Not integrated
Assessment	You're screened and assessed for both at intake, and again as things change	Only the drinking or drug use is assessed; mental health is "for later"
Treatment plan	One plan with goals for each condition	Two plans in two places, or none for the mental health side
Counseling	Sessions work on both, and on how each one affects the other	Substance use groups only, with a referral list for everything else
Medication	A psychiatrist or psychiatric nurse practitioner on the team or closely linked, managing psychiatric and addiction medicines together	You're told to stop psychiatric medicines, or to find your own prescriber
After discharge	The next step covers both: a therapist and a prescriber booked, plus recovery support	A list of phone numbers

The ASAM Criteria describe two kinds of program: co-occurring capable, which routinely screens for and treats stable mental health conditions alongside substance use, and co-occurring enhanced, staffed to treat less stable psychiatric conditions in an integrated way. If your mental health symptoms are severe or recent, ask whether a program is enhanced.

What Texas requires of licensed treatment programs

Substance use programs in Texas are licensed by HHSC as chemical dependency treatment facilities under 26 TAC chapter 564. For people with co-occurring disorders, the rules say:

Rule	What it means for you
26 TAC 564.906	A program can't exclude you because of a mental illness, the medications you're prescribed, a presumed inability to benefit, or how past treatment went.
26 TAC 564.907	Services must address both the psychiatric and the substance use disorder, and staff need specific skills, including recognizing the higher risk of self-harm.
26 TAC 564.909	Your treatment plan must have measurable goals for both disorders, and note what your family needs to learn about them.
26 TAC 564.803	If the assessment finds a possible mental health problem, the program must get a mental health assessment and seek mental health services for you, in-house or by referral.
26 TAC 564.901	A program can't discharge you for taking a prescribed medication.
26 TAC 564.801	To be in a licensed substance use program, you must have a substance use disorder. A mental health condition alone is treated elsewhere.

You can check a program's license on HHSC's chemical dependency treatment facilities page.

Who treats which condition

• Licensed chemical dependency counselors (LCDCs) treat the substance use. Texas rules say an LCDC isn't qualified to treat mental health disorders (26 TAC 562.3).
• LPCs, LCSWs, LMFTs and psychologists treat mental health conditions, and can treat substance use within their licenses. Many counselors hold an LCDC too, which lets one person carry both halves of your plan.
• Psychiatrists and psychiatric nurse practitioners diagnose and prescribe for both.

How to tell the licenses apart and check one: how to find an addiction therapist in Texas.

Levels of care for dual diagnosis

The level depends on how severe each condition is right now, how safe you are, and the support at home. A clinician's assessment decides it; for substance use most plans use the ASAM Criteria, and for mental health many use LOCUS (the Level of Care Utilization System) or their own guidelines.

Level	What it is	Often a fit when
Outpatient therapy and psychiatry	Weekly counseling for both, plus medication visits	Both conditions are stable enough that you're managing daily life
Intensive outpatient (IOP)	At least 9 hours a week for adults, while you live at home	Weekly care isn't enough, but you're safe at home
Partial hospitalization (PHP)	At least 20 hours a week, with a psychiatric prescriber on the team	You need daily structure and quick medication changes, but you're safe at night
Residential	Living at the program, with care around the clock	Home isn't safe or supportive, or outpatient care hasn't worked
Hospital or crisis care	Psychiatric hospital, emergency room or crisis unit	You're at risk of harming yourself or someone else, have psychosis or mania, or need medical care for withdrawal

There are substance use IOPs and PHPs that treat both conditions, and mental health IOPs and PHPs, for conditions like depression or bipolar disorder, that may or may not treat substance use. If you have both, ask which kind a program is. Outpatient rehab in Texas explains how outpatient care works, and inpatient vs outpatient rehab who needs to live at the program.

Do I have to get sober before treating depression or anxiety?

No. The point of integrated care is to treat both at once, and Texas programs can't exclude you for a mental illness or your medications. Two things can change the order:

• Safety first. Thoughts of suicide, psychosis, mania or dangerous withdrawal need crisis or medical care right away: call 988 or 911, or go to an emergency room.
• Withdrawal first, when it's risky. Heavy daily drinking, or stopping some drugs, may need medically managed detox before or alongside the rest. See alcohol detox in Texas.

Medication for both conditions

• Psychiatric medication and addiction medication can be taken together, managed by one prescriber or two who talk to each other. Bring a list of everything you take to the first visit.
• For alcohol use disorder, the FDA has approved naltrexone, acamprosate and disulfiram; for opioid use disorder, buprenorphine, methadone and naltrexone. See how to get Suboxone in Texas.
• A Texas program can't discharge you for taking a prescribed medication (26 TAC 564.901), including medication for addiction.

How to find dual diagnosis treatment in Texas

Cima Find Care lists the Texas programs that say, on their SAMHSA FindTreatment.gov record, that they offer a program or group for people with co-occurring mental health and substance use disorders: dual diagnosis treatment in Texas, and by city in Houston, Dallas, San Antonio, Austin, Fort Worth, El Paso, Arlington, Plano, Frisco, Lubbock and Amarillo.

• A listing is what the program reports. Programs that aren't on FindTreatment.gov have no such field, so a program can treat both and not be on the list. Ask the questions below either way.
• Looking for a dual diagnosis IOP near you? Start with the IOP lists (Texas, Houston, Dallas, San Antonio, Austin) and ask each program how it treats mental health.
• Your health plan can name in-network programs that treat both; ask for the behavioral health number on your card.
• No insurance: your local mental health authority provides or arranges mental health care for people who are uninsured or have little money, and your region's OSAR (call 2-1-1) connects you to state-funded substance use treatment. See free and state-funded rehab in Texas.

Not sure where to start? Answer four quick questions.

Questions to ask a dual diagnosis program

1. Do the same clinicians treat my mental health and my substance use? Which licenses do they hold?
2. Is there a psychiatrist or psychiatric nurse practitioner on the team? How soon is the first appointment?
3. Will I keep taking my psychiatric medications? Do you offer, or work with someone who prescribes, medication for addiction?
4. How do you assess both conditions, and how often do you check again?
5. What happens if I have a mental health crisis during the program, at night or on a weekend?
6. Would you call yourselves co-occurring capable or co-occurring enhanced?
7. Is the program licensed by HHSC, and in network with my plan for this level of care?
8. What does the plan look like after I leave, for both conditions?

Paying for dual diagnosis treatment

• Private insurance: under federal parity law, a plan's limits and approval rules for mental health and substance use care can't be stricter than for comparable medical care. See does insurance cover rehab?
• Texas Medicaid covers mental health care (therapy, psychiatric evaluation and medication management, hospital care) and substance use treatment, with no copays, and its plans can cover PHP and IOP in place of a hospital stay. See rehab that takes Medicaid in Texas.
• Medicare covers partial hospitalization and, since January 1, 2024, intensive outpatient care for mental health conditions, including substance use disorders, at certain hospitals and clinics (Medicare.gov).
• Veterans can get both through VA health care: see VA substance use treatment and our guide to VA care and Community Care for Texas veterans.