Integrated CBT for Dual Diagnosis brings substance use and mental health care into one treatment plan so patients don’t bounce between silos. This page turns manuals and research into a clinic-ready playbook that sequences assessment, engagement, and skills across co-occurring disorders. We begin with a unified case formulation: map triggers, cravings, mood/anxiety cycles, sleep, pain, and social context into one diagram that both patient and team understand. From there, we align goals and measures, keeping function (work/school/caregiving) and safety front-and-center. The core protocol blends motivational interviewing with CBT skills for both conditions—cue detection, craving management, problem solving, cognitive restructuring, and exposure where indicated—while matching medication choices to the same plan. If you’re comparing implementations at a co-occurring disorders conference, you’ll find stepwise algorithms for depression/anxiety + alcohol or stimulants, psychosis + cannabis, PTSD + opioids, and bipolar + alcohol, each with medication guardrails (e.g., avoid sedative stacking) and concrete CBT homework that fits real life. Because access is treatment, we design for low-threshold starts, evening/tele options, language support, and transport help; peers co-lead groups to normalize struggle and model change.

Integration is more than adding modules—it’s one choreography. Sessions interleave SUD and MH content so patients don’t feel their “other” problem is out of scope this week. Craving waves are reframed as practice opportunities; exposure is timed after sleep and nutrition stabilize; and relapse prevention covers both conditions, including scripts for high-risk moments (paydays, conflicts, grief, celebrations). Family or trusted supporters are invited with consent to reduce accommodation and reinforce skills at home. Registries track symptoms, cravings, function, and sleep; thresholds trigger augmentation or switch steps. We tailor for special populations: adolescents (guardianship and school routines), perinatal (safety and coordination with obstetrics/pediatrics), and older adults (falls, cognition, polypharmacy). Equity is embedded—plain-language materials, interpreters, cost navigation—and outcomes are shared on dashboards that close gaps by neighborhood and language. For medication and care-pathway alignment in primary care, pair this page with Integrated Behavioral Health; for exposure frameworks and OCD-adjacent content, see Exposure and Response Prevention.