Home / Mental health / Dual diagnosis
Co-occurring addiction and mental health
Dual diagnosis treatment in Spain
A licensed 28-day residential programme in the Málaga countryside, run by an English-speaking team, for people who have been sent back and forth between an addiction service and a mental health service without either one treating the whole picture.
Both conditions treated in one house by one team, a price published in full, and no referral fees paid to anyone for sending you here.
Checked for accuracy on 28 July 2026. Next review due July 2027. This page is general information about our programme and is not a substitute for advice about your own situation.
Dual diagnosis is treated at Sierra Recovery as one 28-day residential programme in the Málaga countryside, published in full at £9,900, with the addiction and the mental health condition worked concurrently rather than in sequence. There is no separate track: the seventeen-module curriculum contains a dual diagnosis module and the trauma, emotions and self-esteem work runs alongside the addiction work from the first week. Sierra is a registered health centre authorised for addiction healthcare, not a psychiatric hospital, so anyone acutely unwell is told so at assessment rather than admitted. Any medically supervised withdrawal is completed before arrival, both for safety and because a psychiatric picture taken during withdrawal is unreliable. Below is what that actually involves and where the line is.
Programme
28 days residential
Published price
£9,900
Group work
3 sessions a day
Room
Private, as standard
Language
English throughout
Registration
N.I.C.A. 67331
What dual diagnosis actually means
Dual diagnosis, also called co-occurring disorder or comorbidity, means an addiction and a mental health condition present at the same time in the same person. Depression and alcohol. Anxiety and benzodiazepines. Trauma and opioids. ADHD and stimulants. Bipolar disorder and almost anything.
It is not an unusual complication. It is the normal case. In treatment populations, co-occurrence is closer to the rule than the exception, and the reason it gets treated as exceptional is administrative rather than clinical: addiction services and mental health services are usually separate organisations with separate funding, separate buildings and separate thresholds.
The result is familiar to anyone who has lived it. The mental health service says come back when you are clean. The addiction service says we do not treat the psychiatric side. Each is behaving reasonably within its own remit, and between them a person falls through, gets worse, and is then told they did not engage.
Why treating them separately does not work
Because they are not two problems sitting next to each other. They interact, continuously and in both directions.
| What happens | Why it matters clinically |
|---|---|
| The substance treats the symptom | Alcohol quiets anxiety. Stimulants lift depression and sharpen an unmedicated attention deficit. Opioids numb trauma. The drug is doing a job, and taking it away without replacing the function guarantees the return. |
| The substance worsens the condition | Alcohol is a depressant. Stimulants drive anxiety and psychosis. Cannabis raises psychosis risk. Whatever relief arrives first, the condition is worse a year later. |
| Withdrawal imitates mental illness | Stimulant withdrawal looks exactly like depression. Benzodiazepine withdrawal looks exactly like severe anxiety. Diagnosing during withdrawal produces wrong diagnoses and wrong prescriptions. |
| Each raises relapse risk in the other | An untreated depression is one of the strongest predictors of relapse. A relapse is one of the strongest triggers of a depressive episode. Left alone, the loop is self-sustaining. |
| Sequential treatment loses people | Treat one, then refer for the other, and the gap between the two is where most people disengage. Concurrent treatment removes the gap. |
The signs that this is what you are dealing with
| What you might notice | What it usually means |
|---|---|
| Getting sober and feeling worse rather than better | The condition the substance was masking, now uncovered. It is expected and it is treatable, and it is the most common reason early sobriety fails. |
| Being turned away by one service and told to try the other | The classic dual diagnosis experience, and a service design problem rather than anything about you. |
| Antidepressants that have never quite worked | Very common where drinking has continued alongside them, because alcohol works directly against them. |
| A diagnosis that changes every time you are assessed | Often a sign that assessments happened during intoxication or withdrawal, when the picture is unreliable. |
| Repeated detoxes with no psychological treatment after | Detox removes the substance and leaves the reason. Repeating it does not change the outcome. |
| Using more when the mood dips, and the mood dipping more when you use | The loop, described from the inside. |
If several of those land, our short self-check takes under a minute and stores nothing.
Where the treatment actually happens
People ask for photographs before they ask about therapy, and they are right to. You are deciding whether you could live somewhere for a month. This is the place, not a stock library.
See the full gallery · how people get here.
What we are, and what we are not
Sierra Recovery is entered in the Registro Andaluz de Centros, Servicios y Establecimientos Sanitarios (the Andalusian register of health centres, services and establishments) under N.I.C.A. 67331, authorised by the Junta de Andalucía for the care unit atención sanitaria a drogodependientes (healthcare for drug dependency, authorised care unit U.71). That is a registered health centre with a supervised treatment residence. It is not a psychiatric hospital and it is not an inpatient mental health unit.
What we do is treat the mental health condition and the addiction in one programme, in one house, by one team, with psychiatric care arranged through the appropriate medical route where it is needed. What we do not do is detain anyone, provide intensive psychiatric nursing, or accept someone who is acutely psychotic, acutely suicidal or in psychiatric crisis. Where the assessment shows that, we say so and help you find the right setting instead of admitting you. You can check our registration yourself on the Junta's public register.
Where you are physically dependent, a medically supervised withdrawal is completed in an appropriate medical setting before you arrive and billed separately. With dual diagnosis this sequencing matters more than usual, because a reliable psychiatric picture cannot be taken during withdrawal.
Not sure whether this is the right setting?
The assessment answers that honestly before you commit to anything, and it happens before you travel. A clinician will tell you plainly if a psychiatric service would serve you better.
What a day here looks like
Nobody arrives knowing how twenty eight days are actually spent. This is the real timetable, Monday to Friday.
| Time | What happens |
|---|---|
| 08:00 | Breakfast, cooked by a Michelin-trained chef |
| 09:15 | Planning: the day is set out together |
| 10:30 | Process group, the harder one |
| 12:00 | Therapeutic group |
| 13:15 | Lunch |
| 14:30 | Psychoeducation, working through the curriculum |
| 16:00 | Group activity, often outdoors or with the horses |
| 18:30 | Dinner |
| 20:00 | Day closing, together |
Saturdays turn to holistic and body-based work. Sundays are a supervised excursion, because reconnecting with the world outside a clinic is part of the treatment rather than a break from it.
What the treatment actually involves
There is no separate dual diagnosis track here, and that is the point. One programme treats both, and the curriculum was written that way. Module six is dual diagnosis specifically, covering masking, maladaptive behaviour, attachment and somatisation.
Three group sessions a day, five days a week
The day opens with a process group at 10:30, a second therapeutic group runs at midday, and a psychoeducation session follows lunch. A group activity fills the late afternoon and the day closes together in the evening. That is roughly fifteen structured group contacts a week, which is the part most people underestimate before they arrive and value most afterwards.
Groups are small, in English, and run by the clinical team. Hearing someone else describe your own thinking back to you does something that individual work cannot, and it is the fastest route out of the isolation that substance use builds.
A seventeen-module curriculum, not a rest cure
The psychoeducation strand moves through a fixed seventeen-module curriculum written by our clinical director. It is the core of what we call the Regulation Model, which is our adaptation of the PROMIS Clinics methodology to this centre rather than a model of our own invention. It covers skills training, communication styles, boundaries and decision-making, trigger recognition, self-esteem and self-concept, dual diagnosis, self-care and habits, emotions, crisis identification and management, suicide prevention, goals, grief, values, trauma and relapse, perfectionism, loneliness and isolation, and cross-addiction. Every module runs the same structure: check-in, theory, an experiential dynamic, shared reflection, and a commitment carried into the week.
The cognitive work uses the ABC model, the same structure that underpins cognitive behavioural approaches: the event, the belief you attach to it, and the consequence that follows. It is taught, practised, applied between sessions and reviewed, rather than talked about once.
Individual therapy alongside the group programme
One-to-one sessions run three times a week and are where the material that will not surface in a group gets worked. For most people that is the thing underneath the use rather than the use itself.
You are treated by the same small team throughout, in the same house. Nobody is handed between departments, and there is no rotation of therapists mid-stay.
Yoga, meditation and body-based work
Saturdays turn to holistic and body-based practice: yoga, meditation and mindfulness, breathwork, art, and time outdoors on the land. This is not decoration and it is not a spa timetable. Early recovery is a physiological event as much as a psychological one, and sleep, appetite and the ability to sit still are usually the first things to return.
The self-care and habits module runs alongside it, treating rest as a right rather than a reward and food as connection rather than control.
Equine therapy on working farmland
The horses live here, on the forty hectares around the house, and equine work is part of the working week. Horses respond to what you are actually feeling rather than what you say you are feeling, which is why the work reaches people who have learned to talk their way around a therapy session.
What happens when you go home
Aftercare is planned before you leave rather than mentioned on the last day. For clients returning to the UK, care continues online or in person at the PROMIS clinics in London, with a weekly session for a full year, more than 48 in the twelve months after discharge, and a written handover to your GP so nothing has to be explained from scratch. For clients elsewhere in Europe we arrange continuity online and help find local services.
Alongside that, mutual-aid groups are free, run everywhere, and are worth using whatever else you choose.
Who will actually treat you
A small team, in one house, in English. You are not handed between an addiction service and a mental health service, which is the entire reason this page exists.
Nerea Encinas Sánchez
Director · General Health Psychologist
MSc General Health Psychology. Leads clinical standards, the assessment you have before you travel, and admissions.
Berenice Paramés Jones
General Health Psychologist
Individual and group psychological work inside the house, crisis follow-up and coordination of the group programme.
Marta Leal
Social worker
Family mediation, links to services back home, and preparing for independent life after discharge.
Robin Lefever
Founder of Sierra Recovery; MD, PROMIS Clinics UK
Founder of Sierra Recovery and Managing Director of PROMIS Clinics, whose method this programme adapts. PROMIS has been treating addiction in the United Kingdom since the mid-1980s, and Robin has worked in addiction treatment for around 35 years, with thousands of patients treated with the PROMIS method in the United Kingdom.
Meet the whole clinical team and their qualifications.
The combinations we see most, and how each is worked
| Combination | How it is approached |
|---|---|
| Depression and alcohol | The most common pairing we see. Alcohol is a depressant, so the depression cannot be assessed properly until drinking has stopped. Behavioural activation and the emotions and grief modules run from the first week. See depression. |
| Anxiety and benzodiazepines | A supervised taper first, then the anxiety treated with graded exposure rather than replaced with another chemical. See benzodiazepines and anxiety. |
| Trauma and any substance | The trauma and relapse module runs alongside the addiction work rather than after it, because leaving trauma untreated until someone is stable is what keeps them unstable. See trauma and addiction. |
| ADHD and stimulants | Assessed carefully, because stimulant use both imitates and self-medicates ADHD. Diagnosis and any prescribing are arranged through the appropriate medical route rather than assumed here. |
| Bipolar disorder and substance use | Requires stable psychiatric management and medication continuity. Where the illness is not currently stable, a psychiatric setting is the safer choice and we will say so. |
| Eating difficulties alongside addiction | Assessed honestly. Where an eating disorder is the primary and severe condition, specialist services are the right answer and we will not pretend otherwise. |
Treatment options for a dual diagnosis, and how they compare
Residential rehab is one treatment option among several, and it is not automatically the right one. Being straight about that is more useful to you than a page that pretends otherwise.
| Option | What it involves, and who it suits |
|---|---|
| Medical detox | Required wherever there is physical dependence, and it must come first because a psychiatric assessment taken during withdrawal is unreliable. |
| Residential rehab inpatient treatment | Living at the centre for the whole programme. It suits people who have been passed between an addiction service and a mental health service without either treating the whole picture. |
| Outpatient treatment day programmes and therapy sessions | Attending sessions and going home between them. Works where both conditions are mild to moderate and one service is willing to hold the whole case. |
| Community and NHS services | Free local drug and alcohol treatment services, reached through your GP or by self-referral. Waiting times vary and residential placements are rationed, but the support is real and it costs nothing. For many people this is the right first step rather than a lesser one. |
| Mutual aid and support groups | Free peer support meeting in person and online, everywhere, with no waiting list and no cost. Worth using alongside whatever else you choose rather than instead of it. |
A treatment plan should be built around your circumstances. If an outpatient or community route fits you better, we will say so at assessment and we will not charge you for the conversation.
The therapies used, in plain terms
Every centre lists the same acronyms, so here is what each one actually is and where it appears in the week.
| Therapy | What it is, and when you would meet it here |
|---|---|
| Cognitive behavioural therapy CBT, and the related REBT | Evidence-based work on the link between an event, the belief you attach to it and what you then do. Taught through the ABC model in psychoeducation, practised in group therapy and applied between sessions. It is the backbone of the cognitive work rather than an optional extra. |
| Acceptance and commitment therapy ACT | Learning to have a difficult feeling without having to act on it, and choosing behaviour by your values instead. Module eight, on emotions, is built on it. |
| Dialectical behaviour therapy DBT | Distress tolerance, emotional regulation and interpersonal skills, used where emotions arrive faster and larger than they can be managed. See DBT. |
| EMDR | A structured trauma therapy, used where trauma is driving the use and always after stabilisation rather than before it. See EMDR. |
| Group therapy | Three group sessions a day, five days a week: a process group, a therapeutic group and psychoeducation. It is the largest single component of the treatment programme. See group therapy. |
| Individual therapy one-to-one counselling | Three therapy sessions a week with the same clinician throughout, where material that will not surface in a group gets worked. |
| Family therapy | Offered where it is wanted, in person or online, because the people around you are part of what happens next. See the family programme. |
| Motivational interviewing | Used throughout rather than booked as a session. It is the stance the team takes: working with your reasons for change rather than arguing you into someone else’s. |
| Holistic therapies | Yoga, mindfulness and meditation, breathwork, art and equine work, on Saturdays and through the week. See equine therapy and all our therapies. |
Every element above is delivered by the clinical team as part of the residential programme. Your treatment plan sets out which of them apply to you, and it is reviewed during the stay rather than fixed on day one.
Where else to get help, free
Not everyone needs residential rehab, and nobody should be waiting on a private programme before they get any support at all. Everything below is free, and none of these organisations pays or receives a fee from us.
| Organisation | What they do |
|---|---|
| NHS talking therapies | Free psychological therapy for anxiety and depression in England, available by self-referral without going through your GP first. |
| Mind | Mental health information, advocacy and local services across England and Wales. |
| Samaritans | Free and confidential, 24 hours a day on 116 123, for anyone struggling to cope or having thoughts of suicide. |
| NHS drug and alcohol services | Free local treatment services, reached through your GP or by self-referral. The usual starting point for community-based drug and alcohol treatment. |
| We Are With You | Free, confidential support for drug, alcohol and mental health problems, in person in many areas and by webchat. |
| Adfam | Support and information for families and friends affected by someone else’s drug, alcohol or gambling use. |
Sierra Recovery neither pays nor accepts referral fees, so nothing on this list depends on where you go. If a free or community service is the right fit for you, use it.
How to get ready
- Compare on licence, not on photographsAsk any centre abroad for its registration number and the register it sits on, then look it up yourself. Ours is N.I.C.A. 67331 on the Junta de Andalucía register.
- Get the medical picture togetherCurrent medications, any previous withdrawal, and any diagnosed conditions. This is what the pre-travel assessment needs, and it is what decides whether a detox is required first.
- Ask what the price actually includesOurs is published: private room, meals, the core therapy programme, and a year of weekly UK aftercare, with medical, psychiatric, laboratory and hospital costs quoted separately. You get an itemised written quotation before admission.
- Bring both histories, not oneEvery psychiatric diagnosis, every medication and dose, every therapy, alongside the substance history. Dual diagnosis assessment is only as good as the information it starts from.
- Do not stop psychiatric medication to look betterStopping antidepressants or mood stabilisers before assessment is both risky and counterproductive. Continuity is arranged through the appropriate medical route.
How Sierra compares with treating each separately at home
| What you get | Sierra Recovery | Typical private residential clinic |
|---|---|---|
| Addiction and mental health treated together | One programme, one team, one house | Usually two services, two waiting lists, two thresholds |
| 28-day residential programme | GBP 9,900, published in full | UK GBP 12,000–GBP 40,000 · Australia A$30,000–A$50,000 |
| Being told to come back once you are clean | Does not happen here | Common |
| Your own private room | Included as standard | Often an upgrade |
| Referral fees paid to third parties | None | Common |
| Psychiatric care and prescribing | Arranged through the appropriate medical route | Varies |
| Written itemised quotation before admission | Yes | Varies |
Comparison figures are the published ranges collected on our cost calculator: the United Kingdom at roughly £12,000 to £40,000 a month, Australia at roughly A$30,000 to A$50,000, and the United States at roughly $20,000 to $40,000 for a 30-day programme. New Zealand, South African and Canadian ranges are set out on the country cost guides. Indicative, not a quotation. Every clinic sets its own fees.
What happens after
Dual diagnosis is the situation in which discharge planning matters most, because two things have to continue rather than one. Aftercare is planned before you leave: continuing therapy online or in person at the PROMIS clinics in London for clients returning to the UK, a weekly group, and a written handover to your GP covering both the addiction work and the psychiatric picture, so that prescribing afterwards is managed rather than reconstructed. For clients elsewhere in Europe we arrange continuity online and help find local services.
When is it time?
If you have been passed between services, if getting sober made your mental health worse, or if you have been treated for one while the other went unmentioned, that is enough. The most useful thing about a dual diagnosis is that it explains why the previous attempts did not work, and that is not the same as saying you failed them.
Talk to a clinician today
You will speak to our admissions team, all of them clinicians. Confidential, no obligation, and we will tell you honestly whether this programme fits or whether something closer to home would serve you better.
Questions people actually ask
What is a dual diagnosis?
A dual diagnosis, or co-occurring disorder, is an addiction and a mental health condition present at the same time. Depression and alcohol, anxiety and benzodiazepines, trauma and opioids, ADHD and stimulants are the combinations we see most. It is closer to the rule than the exception in treatment populations, and it needs both conditions treated together rather than in sequence.
Which is treated first, the addiction or the mental health condition?
Both, concurrently, which is the whole argument for this kind of programme. The one thing that has to come first is any medically supervised withdrawal, partly for safety and partly because a psychiatric assessment taken during withdrawal is unreliable: stimulant withdrawal imitates depression and benzodiazepine withdrawal imitates severe anxiety.
Is Sierra a psychiatric hospital?
No. Sierra is a registered health centre authorised for addiction healthcare, not a psychiatric hospital or an inpatient mental health unit. We do not detain anyone and we do not provide intensive psychiatric nursing. Where psychiatric care or medication is part of your treatment, it is arranged through the appropriate medical route, and if you are acutely unwell we will say so rather than admit you.
Can I keep taking my psychiatric medication?
Yes, and you should not stop it to come here. Medication is reviewed and continued through the appropriate medical route, coordinated with whoever prescribes it. We do not start, stop or adjust psychiatric medication ourselves, and a written handover to your GP is part of standard aftercare.
I was told to get clean before my mental health team would see me. Is that normal?
It is extremely common, and it is a consequence of how services are organised rather than a clinical judgement about you. It is also the single most cited reason people with a dual diagnosis give up on treatment. A programme that treats both at once exists precisely to close that gap.
How long is the programme and what does it cost?
It is a 28-day residential programme, published in full at GBP 9,900. That covers a private room, meals, the core therapy programme, and a year of weekly UK aftercare. Psychiatric, medical, laboratory and hospital detox costs are quoted separately. You get an itemised written quotation before admission.
How do I get help for a dual diagnosis?
The first step towards recovery is an assessment, and ours is free and carries no obligation. You can also seek help through your GP, through a free local drug and alcohol treatment service, or through a mutual aid group, and none of those routes costs anything. If you want to talk it through with a clinician, call +44 1202 653136 and you will reach our admissions team.
What does a dual diagnosis treatment involve, from start to finish?
The course of treatment runs in four stages. An assessment before you travel, which decides whether a medically supervised detox is needed first. Any detox, completed in an appropriate medical setting and billed separately. Then the 28-day residential treatment programme itself: three group therapy sessions a day, individual therapy three times a week and the seventeen-module curriculum. Then aftercare, agreed before you leave and continuing online or in person in London.
How much does dual diagnosis rehab cost, and what affects the price?
Sierra publishes a single figure: GBP 9,900 for the 28-day residential programme, with a private room included. What changes the total is whether you need a medically supervised detox, which is arranged and billed separately, and any medical, psychiatric or laboratory costs. Private residential rehab elsewhere commonly runs from around GBP 12,000 to GBP 40,000 a month in the United Kingdom and from roughly A$30,000 to A$50,000 in Australia. You get an itemised written quotation before admission, and we neither pay nor accept referral fees.
What are the signs and symptoms of a dual diagnosis?
The marker of a dual diagnosis is that getting sober makes the mental health condition more visible rather than less. Depression that lifts and returns with drinking, anxiety that is worse between benzodiazepine doses, or a diagnosis that changes every time you are assessed, usually because assessments happened during intoxication or withdrawal.
Is lasting recovery from a dual diagnosis actually possible?
Yes, and the evidence is better than the public conversation suggests. What predicts long-term recovery is not willpower but what is in place afterwards: continuing therapy, a treated mental health condition, a support network and a relapse plan that was written before it was needed. That is why completing dual diagnosis rehab matters less on its own than what follows it, and why aftercare is planned during the stay, so it is in place before you leave.
How can I help someone with a dual diagnosis?
Start by getting support for yourself, because living alongside someone with an addiction is its own burden and Adfam and Al-Anon exist for exactly that. Beyond that: raise it when they are not intoxicated, be specific about what you have seen rather than general about what they are, and offer a concrete next step such as an assessment or a call to a free service. Ultimatums delivered in anger rarely work. We speak to families every day and that conversation costs nothing.
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Talk to a clinician today
You will speak to our admissions team, English-speaking clinicians who know the programme and the people in it. Callback within 24 hours.
Registered health centre. Authorised by the Junta de Andalucía, N.I.C.A. 67331.
