Five Dual Diagnosis Group Therapy Discussion Ideas

Medically reviewed by Laura Angers Maddox
Updated February 26, 2024by BetterHelp Editorial Team

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.

What is a dual diagnosis?

Some mental illnesses have a higher rate of comorbidity with substance use disorders, also known as dual diagnosis. Living with more than one mental illness or health challenge simultaneously can be challenging, so having a group of people who understand you may prove advantageous. If you decide to enter group therapy for a dual diagnosis, there are a few topics your therapist may explore with you. 

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Ideas to explore in group therapy for dual diagnosis

About 50% of those with a mental health condition also experience a substance use disorder at some point. Individuals in this group may be referred to as having a dual diagnosis.

Those living with a substance use disorder and a mental health condition may face unique challenges and often benefit from professional intervention. One example of treatment is dual diagnosis group therapy, which occurs in a group setting. 

Mental health conditions and substance use disorders

With this type of treatment, individuals led by a mental health professional come together to address mental health and substance use concerns. As a mental health and substance use treatment, group therapy offers the benefit of allowing group members to experience a sense of community and to gain the knowledge that they are not alone in their struggles. Below are five topics that may be discussed in dual diagnosis group therapy. 

1. Inciting events

Inciting events are specific situations, people, feelings, or events that contribute to negative emotions or painful memories, often a central component of substance use disorders. For example, someone who experiences the inciting event of sadness may be compelled to use a substance to mask that uncomfortable feeling. Similarly, someone with anxiety may experience fear in crowded places, so being in a crowded place may worsen their desire to use substances. 

Understanding what is behind a dual diagnosis

A group offers a space for clients to discuss inciting events and learn how to identify and cope with them when they come up in life. Understanding what causes a desire to use substances can empower individuals to take control of their situation and make healthier decisions. A trained group leader may bring up the following talking points:

  • What events or scenarios cause you to want to use substances?   
  • How do you respond when an urge arises? 
  • What are some healthy ways to soothe yourself if these events occur? 

2. Mindfulness

Mindfulness involves focusing on bodily sensations without judgment or changing your present experience. Being mindful can translate to clearer thinking and healthier decision-making regarding mental health and substance use. Practicing mindfulness has been shown to improve mental health conditions like depression and anxiety. 

Benefits of mindfulness

Practicing mindfulness as meditation can be a calming and centering intervention for people with dual diagnoses, but it can also be discussed in group therapy as a coping skill. For example, people experiencing a substance use disorder may learn to cultivate mindfulness when faced with a problematic event instead of engaging in substance use, allowing them to cope with difficult emotions more healthily. 

Potential mindfulness activities

Below are a few group mindfulness activities that can be learned: 

  • The body scan: The body scan practice asks individuals to focus on one end of their body (the head or feet) and slowly work their way to the other, tuning into the sensations felt in each body part. 
  • Breathing in pairs: This activity involves pairing group members and encouraging them to align their breathing patterns, becoming aware of the sensations of the breath.
  • Discussing acceptance: A tenet of mindfulness is accepting present circumstances without judgment. Discussing how acceptance can lessen the pain of uncomfortable situations may be helpful.
  • Silent connection: This technique involves group members attempting to express themselves to one another without speaking using non-verbal communication such as eye contact, posture, nods, and smiling.

3. Healthy relationships

The people in your life may profoundly impact your mental health and well-being. Engaging in unhealthy relationship patterns may negatively affect mental health or impede progress in substance use treatment. Learning to encourage healthier relationships can improve your well-being and allow you to make new friendships or relationships. 

To help people improve their relationships, it may be beneficial to examine what negative relationship patterns may be occurring. Examples of common relationship challenges include poor communication, disrespect, codependence, dishonesty, and jealousy.

Examples of activities to try

Some activities to try in dual diagnosis group therapy to create healthier relationships include:

  • Commonalities Worksheets: This activity encourages individuals to find what they have in common with their partner, another person they're close to, or fellow group members, which can facilitate conversation and discussion of how they may complement one another.
  • Healthy Conflict Resolution Exercises: This exercise may include teaching individuals how to stay calm and respectful during conflict and compromise. 
  • Communication Skills Training: Communication training involves learning to clearly communicate one's needs and address concerns in relationships, along with active listening skills.

4. Anxiety and depression as related to a dual diagnosis

Anxiety and depression are common symptoms of mental health conditions and substance use disorders. For some, anxiety is a challenging and uncomfortable feeling that can be hard to cope with. Similarly, those living with depression may have difficulty finding the motivation to seek treatment. Some people are diagnosed with anxiety or depressive disorders, which can make it harder to cope. 

Understanding anxiety and depression

Someone with a substance use disorder may cope with anxiety or depression by using a substance. Those with a mental health disorder may experience anxiety or depression as debilitating symptoms. Learning how to cope with and manage anxiety and depression can be a foundational step in an individual's recovery journey. 

Group therapy can be a beneficial setting to discuss these concerns, as each group member can discuss their personal experiences. Group members who have managed their symptoms can inspire others who may be struggling. 

Anxiety and depression discussion ideas

Several activities and conversations can be utilized in dual diagnosis group therapy to alleviate anxiety and depression, including the following: 

  • Regular check-ins: Asking each member to discuss their level of anxiety or depression at each group therapy session can allow members to stay aware of their feelings and connect.
  • "Happy place" exercise: This exercise encourages individuals to visualize a happy or safe space they can mentally "visit" when acute anxiety arises.
  • Positive reflecting: This exercise asks members to talk about a time in the past when they effectively coped with anxiety or depression. 
  • Self-care practices: Allowing group members to discuss how they care for themselves during periods of anxiety or depression can offer other members ideas for coping. 

5. Self-care

Whether someone is experiencing a mental health condition, substance use disorder, or both, self-care can be an essential part of mental healthcare. Self-care, which includes partaking in daily habits that improve well-being (such as exercising, eating a healthy diet, getting adequate sleep, and spending time with loved ones), can lead to lowered stress, increased energy, and improved mental and physical health

Self-care may not be natural for everyone, especially individuals unfamiliar with self-care or who have struggled with implementing self-care in the past. Some misconceptions state that self-care is selfish or self-indulgent. However, individuals' habits around caring for themselves may improve daily life and relationships while supporting recovery and mental health treatment.

Self-care activities

Self-care activities to try in dual diagnosis group therapy sessions include:

  • A self-care vision board: Creating a vision board is an activity that encourages group members to create a vision board, including images and phrases that exemplify what self-care means to them.
  • Burnout discussions: Burnout discussions involve group conversations about identifying signs of burnout in each individual and discussing ways to prevent or heal burnout.
  • Gratitude journaling: Gratitude journaling is an activity that can help individuals maintain a more positive perspective. Group members can write down a few aspects of their lives they're grateful for and discuss them at the end of each session.
  • Group meditation: Group meditation can involve learning a meditation strategy that individuals can use during distress. 
Getty/Luis Alvarez
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How to find professional support for a dual diagnosis 

Therapy, whether one-on-one or in a group, can be a beneficial tool for improving mental health conditions and treating substance use disorders. Seeking assistance through therapy can lead to increased self-esteem, improved relationships, and mental relief. It's also one way to invest in yourself in the long term. Studies show that the skills and lessons learned in therapy continue to benefit people even after completing it.

Online therapy

Additionally, many different types of therapy suit an individual's needs and preferences. For example, online therapy can be a convenient option for those with busy schedules or limited means of transportation, as it can be used from home. With an online platform like BetterHelp, you can connect with a licensed therapist with experience and training in the specific area you're seeking support in. In addition, you may be able to sign up for weekly support group sessions.  

Alternative dual diagnosis support options 

Online therapy has been proven as effective as in-person therapy for addressing various mental health concerns. One recent study showed that older and younger adults could benefit from online therapy, so age doesn't necessarily have to be a barrier to mental health assistance. Further, studies have shown that both individual and group therapy sought through online platforms can be efficacious in improving symptoms of mental health conditions. 


Dual diagnosis group therapy can take on many forms, and each group leader or therapist may use a different approach to support. Although the topics of each group therapy session may vary, five foundational topics to try in dual diagnosis group therapy include inciting events, mindfulness, healthy relationships, anxiety and depression, and self-care. Discussing these topics can help group members find solutions to their concerns, receive encouragement from their peers, and work toward improving their mental health and overall well-being. 

Seeking support can be essential in managing the symptoms associated with substance use and mental health disorders. If you're seeking more personalized guidance, consider signing up for individual or group therapy online or in your area for further support.

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