Dual Diagnosis: AUD and Depression

Dual Diagnosis: AUD and Depression integrates care for alcohol use disorder and depressive syndromes, where each condition worsens the other. This page turns evidence into routine practice: single assessments for both domains; timing choices for initiating acamprosate or naltrexone; and sequencing CBT/ACT with behavioral activation and sleep repair. If you’re evaluating a dual diagnosis conference (AUD & depression), you’ll find pathways for inpatient, ED, and primary care starts with warm handoffs to community services. Because measurement must guide pivots, we link to Anxiety and Depression for scales and stepped-care decisions.

Care plans anchor on safety, function, and momentum. We outline withdrawal precautions and thiamine for at-risk patients, strategies for insomnia and early-morning awakenings, and ways to manage activation or sexual side effects when selecting antidepressants. Behavioral activation targets anhedonia; contingency strategies reinforce early alcohol-free days. Family involvement and peer support reduce isolation; harm-reduction keeps people alive as motivation grows. Equity requires language access, transport solutions, and low-cost meds; dashboards track cravings, mood, function, and adverse events to refine care.

Unified Assessment, Treatment, and Safety

Integrated assessment

  • Document timelines for use and mood; set functional targets and risks.
  • Use PHQ-9 alongside alcohol screens to baseline and track change.

Medication strategy

  • Start acamprosate/naltrexone based on goals and liver status.
  • Choose antidepressants mindful of sleep, weight, and interactions.

Psychotherapy integration

  • Behavioral activation plus CBT/MI; consider couples or family sessions.
  • Relapse scripts and coping plans support weekends and triggers.

Sleep and circadian repair

  • Stabilize routines; use non-sedative strategies first.
  • Reassess mood once sleep improves to adjust treatment.

Delivery Models, Equity, and Outcomes

ED/inpatient starts
Initiate meds at bedside when safe; book follow-ups before discharge.

Primary care integration
SBIRT, brief interventions, and registry-based follow-up.

Peer and family supports
Lived-experience coaching and family education.

Risk management
Naloxone where polysubstance risk exists; means safety for suicidality.

Perinatal and older adults
Adjust dosing and monitoring; coordinate obstetric or geriatric care.

Digital tools
Mood/drink logs with prompts and clinician dashboards.

Equity lens
Language and cost supports; targeted outreach to under-served groups.

Quality improvement
Track remission, function, retention, and safety; iterate care.

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