NWVCIL Logo
Medically Reviewed Content
Updated: May 2026
Sources: SAMHSA, NIDA

Dual Diagnosis Treatment Centers Near You

Dual diagnosis treatment addresses co-occurring mental health and substance use disorders simultaneously. Find integrated treatment centers providing comprehensive care for lasting mental health and addiction recovery.

Found 8,517 rehab centers specializing in dual diagnosis across the United States.

Need Help Finding the Right Treatment Center?

Speak with a compassionate specialist now - 100% free & confidential

Call +1 (833) 244-3031
Available 24/7
All 50 States

Find Dual Diagnosis Treatment Centers Near You

Browse dual diagnosis treatment centers below. All listed facilities treat co-occurring mental health and substance use disorders with integrated care.

Filters:

Showing 20 of 8517 results

Center
Edmonds, WA

Situated in Edmonds, WA, the Center provides outpatient programs for substance use recovery, catering to adult men and women, including those facing concurrent mental health challenges. The treatment framework incorporates proven methods like anger management, cognitive behavioral therapy, and motivational interviewing. Designed for adults and young adults alike, this center offers tailored support for both sexes. Emphasizing personalized care and high standards, the Center aims to assist clients in their path to recovery. If you are looking for thorough and efficient addiction treatment in a supportive atmosphere, this facility is committed to guiding you towards enduring sobriety and enhanced wellness.

Center for Addiction Treatment

Situated in Cincinnati, OH, the Center for Addiction Treatment delivers an extensive array of services designed to assist individuals on their path to recovery. With a focus on detoxification and treatments for substance use, this center offers a variety of programs, including intensive outpatient, outpatient, and outpatient detox options. Emphasizing methods such as 12-step facilitation, anger management, and brief interventions, the facility customizes its programs to cater to adults and young adults of every gender. A distinguishing feature of this center is its commitment to a personalized care approach, ensuring that each client receives the specific support they need throughout their recovery journey. If you or someone you know is in search of effective addiction treatment, the Center for Addiction Treatment is committed to guiding you toward sustainable recovery.

Center for Behavioral Health

The Center for Behavioral Health, situated in Las Vegas, NV, provides focused outpatient care for adults struggling with addiction and concurrent mental health challenges, as well as children experiencing emotional difficulties. Their services employ a variety of proven methods, such as techniques for managing anger, cognitive behavioral therapy, and motivational incentives. The center caters to specific needs with customized plans for adult men and women, those affected by domestic violence or intimate partner violence, and survivors of such abuse. With a commitment to offering top-tier care in a nurturing setting, the center supports adults and young adults across the gender spectrum. For extensive outpatient support, including medication-assisted treatment like methadone or buprenorphine, the Center for Behavioral Health stands as a reliable source for effective and empathetic healing.

Centennial Mental Health Center Inc

Centennial Mental Health Center Inc in Fort Morgan, CO, specializes in providing outpatient services for individuals dealing with substance use issues, co-occurring disorders, and significant mental health challenges in both adults and children. The center administers outpatient treatments that include methadone, buprenorphine, and naltrexone, emphasizing evidence-based methods like cognitive behavioral therapy, anger management, and motivational incentives. It offers customized programs designed for adolescents, women, and victims of sexual abuse, guaranteeing personalized support for adults and seniors of all genders. Renowned for its high-quality services and extensive assistance, Centennial Mental Health Center Inc is a reliable choice for those in need of effective and empathetic rehabilitation solutions.

Center for Addictions
Springfield, MO

Nestled in Springfield, MO, the Center for Addictions delivers thorough support for those battling addiction. This establishment features hospital-based inpatient detox, continuous hospital inpatient services, and rigorous outpatient options. Employing methods like 12-step encouragement, emotional regulation, and concise counseling, the center supports adults and young people facing concurrent mental health issues. Unique programs are offered for those who have experienced trauma or are dealing with pain alongside substance dependence. Prioritizing individualized attention and scientifically validated methods, this center crafts customized recovery journeys for all clients, regardless of gender, aiming to overcome addiction.

Centennial Mental Health Center Inc

Centennial Mental Health Center Inc. in Sterling, CO, provides targeted outpatient services for individuals of all ages struggling with substance abuse and co-occurring mental health conditions. Their therapeutic approach incorporates anger management, cognitive behavioral therapy, and motivational incentives to create personalized treatment plans. The center distinguishes itself with specialized programs for adolescents, adult women, and survivors of sexual trauma, fostering a holistic recovery journey. Catering to adults and seniors across all gender identities, Centennial Mental Health Center Inc. utilizes research-backed therapies and a committed team to deliver exceptional support for those aiming to conquer addiction and enhance their psychological health.

Center for Alcohol and Drug Services

The Center for Alcohol and Drug Services in Davenport, IA, delivers complete addiction recovery support. This establishment features dedicated services such as detox programs, comprehensive substance abuse therapy, supervised living arrangements, and extended care housing. Employing inpatient hospital treatment models and varied methodologies like 12-step integration and emotional regulation techniques, the center serves adult individuals of all genders, as well as those affected by trauma. Personalized plans for adolescents and adults guarantee unique treatment journeys. The center's dedication to high-standard care and gender-focused programs establishes it as a reliable destination for individuals pursuing freedom from addiction.

Center for Alcohol and Drug Services

The Center for Alcohol and Drug Services, located in Davenport, IA, provides a wide range of treatment options for individuals dealing with substance use issues, including both adults and young adults. The facility features intensive outpatient programs, standard outpatient services, and regular outpatient care. It employs various methodologies, including 12-step support, anger management techniques, and brief interventions, to tailor treatment to each person's unique circumstances. The center is particularly adept at addressing clients who face both mental health and substance use challenges, ensuring a comprehensive approach to recovery. With dedicated programs for men and women, the center fosters a supportive and individualized atmosphere conducive to healing.

Center for Behavioral Emergency and

The Center for Behavioral Emergency in Houston, TX, specializes in outpatient detoxification and substance use disorder treatment. They employ proven methods like cognitive behavioral therapy and contingency management to support those on their path to recovery. The center offers tailored programs for active duty military, teenagers, and adult males, as well as comprehensive care for adults, children, adolescents, and seniors of any gender. Their commitment lies in providing excellent services designed to foster sobriety and enhance mental well-being.

Center for Behavioral Health

The Center for Behavioral Health in Reno, NV, provides outpatient support for adults struggling with addiction, including individuals also managing significant mental health conditions. The center excels in addressing dual diagnoses with targeted strategies like anger management, brief interventions, and cognitive behavioral therapy. Customized treatment plans are developed for adult men, adult women, and young adults facing challenges with both substance use and mental well-being. Committed to high standards of care, the facility offers medication-assisted treatment with methadone, buprenorphine, or naltrexone, integrated with their general outpatient services. Clients receive thorough assistance within a professional and supportive setting.

Centennial Peaks Hospital

Centennial Peaks Hospital located in Louisville, CO, provides an extensive array of rehabilitation services aimed at assisting both adults and children struggling with substance abuse issues alongside accompanying mental health challenges. The center features inpatient detoxification and treatment options, with specific programs developed for active duty military members as well as adult males and females. By utilizing evidence-based methodologies such as cognitive behavioral therapy and motivational interviewing, the center customizes treatment strategies to align with the distinct requirements of each patient. Catering to diverse needs, Centennial Peaks Hospital offers programs for all ages and maintains separate tracks for men and women, promoting a nurturing and inclusive atmosphere for those on the path to recovery.

Center for Addiction and Counseling

The Center for Addiction and Counseling in Salem, OR, provides outpatient services for adults and youth dealing with substance abuse and co-occurring mental health issues. Their approach incorporates scientifically proven methods such as cognitive behavioral therapy and motivational interviewing, emphasizing strategies to avoid future relapses. The center features distinct programs tailored for adult men, adult women, and individuals impacted by intimate partner violence. They extend their comprehensive care to young adults as well, ensuring a personalized and gender-responsive experience for all clients. For those in the Salem area looking for effective and individualized addiction treatment, the Center for Addiction and Counseling is a guiding light toward recovery.

Placeholder image

Centennial Mental Health Center Inc in Holyoke, CO, delivers targeted outpatient services for adults struggling with addiction and dual diagnoses, as well as for children with significant emotional difficulties. Their therapeutic methods are grounded in proven techniques like anger management, cognitive behavioral therapy, and motivational incentives. The center excels in providing personalized treatment plans, with specific programs designed for teens, women, and survivors of sexual abuse, guaranteeing a customized recovery journey. Catering to adults and seniors of all genders, Centennial Mental Health Center Inc is dedicated to providing excellent care and thorough assistance to individuals confronting substance abuse and mental health concerns.

Placeholder image

Centennial Mental Health Center Inc located in Yuma, CO specializes in outpatient services for adults dealing with substance abuse and serious mental health disorders, as well as children facing significant emotional challenges. The center emphasizes personalized treatment plans, offering services such as anger management, cognitive behavioral therapy, and motivational techniques. Programs specifically designed for adolescents, women, and survivors of sexual abuse provide extensive care options. This facility caters to both adult men and women, featuring a variety of treatment approaches, including outpatient methadone, buprenorphine, or naltrexone therapies. Centennial Mental Health Center Inc is committed to delivering exceptional care to assist individuals in their recovery journey.

Placeholder image

Centennial Mental Health Center Inc in Julesburg, CO is dedicated to providing specialized outpatient care for individuals grappling with substance use challenges and co-occurring mental health conditions. Their comprehensive approach encompasses services like anger management, cognitive behavioral therapy, and motivational incentives, all designed to address a wide spectrum of client needs. The center distinguishes itself with distinct programs designed for adolescents, adult women, and survivors of sexual abuse, ensuring a highly personalized recovery journey. Catering to adults and seniors across all gender identities, Centennial Mental Health Center Inc is committed to delivering high-quality, individualized treatment plans. Their reliance on evidence-based methodologies and thorough support systems makes them a reliable resource for those pursuing effective recovery.

Placeholder image

Centennial Mental Health Center Inc, located in Akron, CO, provides outpatient treatment for substance use disorders, catering to both adults and children facing overlapping mental health challenges. The facility features dedicated programs for adolescents, adult females, and individuals with dual diagnoses. Emphasizing approaches such as cognitive behavioral therapy, anger management, and motivational incentives, the center creates personalized treatment plans designed to address specific needs. Offering outpatient alternatives like methadone/buprenorphine and naltrexone, Centennial Mental Health Center Inc serves individuals of all genders, ensuring comprehensive care that promotes recovery and mental well-being.

Placeholder image

Centennial Mental Health Center Inc, located in Elizabeth, CO, delivers extensive outpatient care for adults facing substance use challenges alongside serious mental health disorders, as well as for children dealing with significant emotional issues. The center is adept in anger management, cognitive behavioral therapy, and motivational incentives, offering customized support for adolescents, women, and individuals who have experienced sexual trauma. Catering to adults and seniors of all identities, the center provides outpatient treatment options including methadone, buprenorphine, or naltrexone, alongside standard outpatient services. With an emphasis on personalized, evidence-informed strategies, Centennial Mental Health Center Inc guarantees high-quality support for those in pursuit of recovery.

Placeholder image

Centennial Mental Health Center Inc, located in Wray, CO, specializes in offering outpatient care for adults dealing with substance use issues and significant mental health disorders, as well as addressing severe emotional challenges in children. The center utilizes a variety of evidence-based treatment methods, including cognitive behavioral therapy, anger management, and motivational incentives. Custom programs cater to specific groups such as adolescents, women, and individuals who have faced sexual abuse. This facility is dedicated to providing personalized support for adults and seniors of all genders, ensuring that each client's distinct requirements are met. For those in need of compassionate and effective addiction recovery solutions, Centennial Mental Health Center Inc is recognized as a reliable source of quality rehabilitation services.

Placeholder image

Centennial Mental Health Center Inc, located in Burlington, CO, delivers targeted outpatient services for individuals dealing with substance abuse and dual diagnosis issues, catering to both adults and children. Their offerings encompass anger management programs, cognitive behavioral therapy, and motivational incentives. The center places a strong emphasis on addressing the needs of specific groups, including adolescents, adult women, and survivors of sexual trauma, ensuring that care is customized for a diverse range of clients, including adults and seniors of varying genders. Whether individuals are in need of routine outpatient care or specific treatments such as methadone or buprenorphine, they can anticipate personalized assistance and scientifically-based strategies aimed at achieving sustained recovery. The center's dedication to high-quality rehabilitation makes it a reputable option for those in pursuit of comprehensive mental health services.

Placeholder image

Centennial Mental Health Center Inc, located in Limon, CO, delivers outpatient services for adults managing substance dependency alongside significant mental health challenges. The center is equipped to provide targeted support for those facing both addiction and emotional difficulties. Their therapeutic methods encompass anger control, cognitive behavioral strategies, and motivational reinforcement. Distinct programs are available for young people, adult women, and survivors of sexual trauma. The center assists adult and senior individuals of all genders. Prioritizing excellent care and personalized recovery paths, Centennial Mental Health Center Inc is committed to fostering enduring sobriety and enhanced psychological health for its clients.

Dual Diagnosis (Co-Occurring Disorders): Key Facts

Classification

Co-occurring mental health + substance use disorders

Prevalence

9.2 million adults in the US (SAMHSA)

Affected

~50% of people with severe mental illness have SUD

Common pairings

Depression+alcohol, Anxiety+benzos, PTSD+opioids, Bipolar+stimulants

Treatment model

Integrated (simultaneous), NOT sequential

Why it matters

Treating one without the other = high relapse rate for both

Key credential

CARF or Joint Commission dual diagnosis accreditation

Insurance

Covered under Mental Health Parity and Addiction Equity Act

What Is Dual Diagnosis?

Definition of dual diagnosis

Dual diagnosis — also called co-occurring disorders — refers to the presence of both a mental health disorder and a substance use disorder (SUD) in the same person at the same time. This is not two separate problems that happen to overlap. The mental health condition and the addiction interact with and reinforce each other, making both harder to treat in isolation.

More common than most people realize

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 9.2 million adults in the United States have co-occurring mental health and substance use disorders. Roughly half of all people with a severe mental illness also struggle with substance abuse, and about one-third of all people with any mental illness also have a substance use disorder. Despite how common this is, fewer than 10% of people with co-occurring disorders receive treatment for both conditions.

Why dual diagnosis is often missed

Many people with co-occurring disorders are only diagnosed with one condition. Substance use can mask or mimic mental health symptoms, and mental health symptoms can be dismissed as consequences of substance use. This is why comprehensive assessment by professionals trained in both mental health and addiction is essential for accurate diagnosis and effective treatment planning.

Common Co-Occurring Disorder Combinations

Depression + Alcohol

Depression and alcohol use disorder is one of the most common co-occurring combinations. People with depression often drink to numb emotional pain, but alcohol is a central nervous system depressant that worsens depression over time. This creates a self-reinforcing cycle where each condition drives the other.

Anxiety Disorders + Benzodiazepines or Alcohol

People with generalized anxiety, social anxiety, or panic disorder frequently turn to benzodiazepines or alcohol for relief. While these substances reduce anxiety temporarily, they cause rebound anxiety that is often worse than the original symptoms, leading to escalating use and physical dependence.

PTSD + Opioids

Post-traumatic stress disorder and opioid use disorder frequently co-occur. Opioids blunt the emotional pain, hyperarousal, and intrusive memories associated with PTSD. However, opioid dependence adds a second layer of suffering and makes trauma processing in therapy far more difficult.

Bipolar Disorder + Stimulants

People with bipolar disorder have some of the highest rates of co-occurring substance use. During depressive episodes, stimulants like cocaine or methamphetamine may be used to elevate mood. During manic episodes, stimulants can intensify risky behavior. Substance use also destabilizes mood cycling and interferes with medication effectiveness.

Eating Disorders + Various Substances

Eating disorders like anorexia, bulimia, and binge eating disorder frequently co-occur with alcohol, stimulants, laxatives, or diet pills. Both conditions involve compulsive behavior patterns and distorted self-perception. Treatment must address the shared psychological roots rather than treating each behavior in isolation.

Why Integrated Treatment Is Essential

The failure of the sequential model

For decades, the standard approach was sequential treatment: address the addiction first, then treat the mental health condition (or vice versa). This approach consistently produced poor outcomes. A person who achieves sobriety but still has untreated depression, anxiety, or PTSD is at extremely high risk for relapse. Likewise, stabilizing someone's mental health while ignoring active substance use undermines psychiatric treatment effectiveness.

The evidence for integrated care

Research consistently shows that integrated treatment — addressing both conditions simultaneously with a coordinated team — produces significantly better outcomes than sequential or parallel treatment. SAMHSA has identified integrated dual diagnosis treatment as an evidence-based practice and recommends it as the standard of care for co-occurring disorders. Integrated programs reduce hospitalization rates, improve treatment retention, decrease substance use, and improve mental health symptoms.

What integrated means in practice

In an integrated program, the same treatment team addresses both conditions together. A psychiatrist manages medication for both the mental health disorder and any medication-assisted addiction treatment. Therapists are trained in both mental health and substance use counseling. Treatment plans account for how the two conditions interact, and progress is measured across both domains simultaneously.

What Happens in Dual Diagnosis Treatment

Comprehensive assessment

Treatment begins with a thorough evaluation by professionals trained in both mental health and addiction. This assessment identifies all co-occurring conditions, determines the severity of each, evaluates how the conditions interact, screens for medical complications, and establishes a baseline for measuring progress.

Medication evaluation and management

A psychiatrist evaluates medication needs for both conditions. This may include antidepressants, mood stabilizers, anti-anxiety medications (non-addictive options), antipsychotics, and addiction-specific medications like buprenorphine, naltrexone, or acamprosate. Medication management is ongoing throughout treatment, with adjustments as symptoms change.

Individual and group therapy

Individual therapy uses evidence-based approaches like Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) to address thought patterns, emotional regulation, trauma, and coping skills. Group therapy provides peer support from others with co-occurring disorders, reduces isolation, and builds interpersonal skills. Specialized groups may focus on relapse prevention, emotion management, or specific conditions like trauma or anxiety.

Family education and involvement

Co-occurring disorders affect the entire family. Family education helps loved ones understand both conditions, learn how to provide effective support without enabling, establish healthy boundaries, and participate constructively in the recovery process. Family therapy sessions address relationship dynamics that may contribute to or result from the conditions.

Aftercare planning

Before discharge, the treatment team develops a detailed aftercare plan that includes ongoing psychiatric care, continued therapy, support group participation, medication management, relapse prevention strategies, and crisis planning. Aftercare is especially important for dual diagnosis because both conditions are chronic and require ongoing management.

Typical program timeline

Dual diagnosis programs are often longer than single-condition treatment. Residential programs typically last 30 to 90 days, though some extend to 6 months for complex cases. Intensive outpatient programs run 8 to 12 weeks. Step-down to standard outpatient therapy and psychiatric follow-up usually continues for 6 to 12 months or longer, depending on individual progress and needs.

How to Choose a Dual Diagnosis Treatment Center

Licensed MH + addiction staff

Verify the center has both licensed mental health professionals (psychiatrists, psychologists) and certified addiction specialists working together.

Psychiatric services on-site

On-site psychiatric care is essential for medication evaluation, prescribing, and ongoing management of both psychiatric and addiction medications.

Medication management

Look for programs that coordinate psychiatric medications with addiction treatment medications, monitoring for interactions and adjusting as needed.

Accreditation (CARF, Joint Commission)

CARF or Joint Commission accreditation with a specific dual diagnosis designation indicates the program meets rigorous quality standards for co-occurring care.

Evidence-based therapies

The center should offer CBT, DBT, trauma-focused therapy, motivational interviewing, and other proven approaches tailored to co-occurring disorders.

Individualized treatment plans

Every dual diagnosis presentation is different. The center should create personalized plans based on your specific conditions, severity, history, and goals.

Insurance Coverage for Dual Diagnosis Treatment

The Mental Health Parity and Addiction Equity Act

The Mental Health Parity and Addiction Equity Act (MHPAEA) requires health insurance plans that offer mental health and substance use coverage to provide benefits that are comparable to medical and surgical coverage. This means your insurer cannot impose stricter limits on dual diagnosis treatment than it would on treatment for a physical health condition like diabetes or heart disease.

ACA essential health benefits

Under the Affordable Care Act, mental health and substance use disorder services are classified as essential health benefits. All ACA-compliant marketplace plans must cover these services, including dual diagnosis treatment. This applies to individual and small group plans purchased through the Health Insurance Marketplace.

Medicaid coverage

Medicaid covers mental health and substance use treatment in all states, though the specific services covered and provider networks vary by state. Many states have expanded Medicaid under the ACA, broadening access to dual diagnosis treatment for low-income adults. Contact your state Medicaid office or a treatment center's admissions team to verify your specific coverage.

How to verify your benefits

Call the member services number on the back of your insurance card and ask specifically about coverage for co-occurring mental health and substance use treatment. Request details on in-network providers, deductibles, copays, prior authorization requirements, and any limits on residential or outpatient days. Most treatment centers also offer free insurance verification — call their admissions line and provide your insurance information for a benefits check before committing to a program.

If you've tried treatment for addiction OR mental health alone and relapsed, you may need integrated dual diagnosis care. This is not a failure — it means both conditions need to be addressed together.

Frequently Asked Questions About Dual Diagnosis

What exactly is dual diagnosis?

Dual diagnosis refers to having both a mental health disorder (like depression, anxiety, PTSD, or bipolar disorder) and a substance use disorder simultaneously. Also called co-occurring disorders, this condition affects approximately 9.2 million adults in the United States and nearly 50% of people with severe mental illness. Integrated treatment that addresses both issues together — rather than separately — produces significantly better outcomes.

Why is integrated treatment important for dual diagnosis?

Integrated treatment is crucial because mental health and addiction affect each other directly. Treating only one condition while ignoring the other typically leads to relapse in both. For example, getting sober without addressing underlying depression or PTSD leaves the person vulnerable to self-medicating with substances again. Integrated programs provide coordinated care where mental health professionals and addiction specialists work together on a unified treatment plan.

How do I know if I have dual diagnosis?

Signs that you may have co-occurring disorders include: experiencing mental health symptoms (depression, anxiety, mood swings, paranoia) alongside substance use problems; using substances to cope with emotional pain or mental health symptoms; difficulty controlling substance use despite consequences; mental health symptoms that persist or worsen even during periods of sobriety; or previous treatment failure for either addiction or mental health alone. A comprehensive assessment by a qualified professional can confirm a dual diagnosis.

What makes a treatment center qualified for dual diagnosis?

Look for programs that have both licensed mental health professionals (psychiatrists, psychologists, licensed clinical social workers) and certified addiction specialists on staff. The center should offer on-site psychiatric services, medication management, evidence-based therapies for both conditions (CBT, DBT, trauma-focused therapy), and individualized treatment plans. CARF or Joint Commission accreditation with a dual diagnosis designation is a strong indicator of quality.

Does insurance cover dual diagnosis treatment?

Yes, most health insurance plans cover dual diagnosis treatment. The Mental Health Parity and Addiction Equity Act requires insurers to cover mental health and substance use treatment at levels comparable to medical and surgical coverage. ACA-compliant plans include these as essential health benefits. Medicaid also covers co-occurring disorder treatment in all states. Contact your insurance provider or a treatment center's admissions team to verify your specific benefits and out-of-pocket costs.

What if I was only diagnosed with addiction but think I have a mental health condition too?

This is very common — many people enter addiction treatment without a formal mental health diagnosis. If you experience persistent sadness, anxiety, mood swings, flashbacks, difficulty concentrating, or other symptoms beyond your substance use, tell your treatment team. Request a comprehensive psychiatric evaluation. A qualified dual diagnosis program will screen for co-occurring mental health conditions and adjust your treatment plan accordingly. Getting the right diagnosis is essential for lasting recovery.

Can I take psychiatric medications while in addiction treatment?

Yes, and in many cases it is essential. Proper psychiatric medication management is a critical part of dual diagnosis treatment. Non-addictive medications like SSRIs, SNRIs, mood stabilizers, and certain anti-anxiety medications (such as buspirone or hydroxyzine) are safe and effective during addiction recovery. Dual diagnosis programs have psychiatrists who specialize in prescribing medications that treat mental health conditions without interfering with sobriety or creating new dependencies. Never stop taking prescribed psychiatric medications without consulting your doctor.

Medical Review and Sources

Medically Reviewed Updated April 10, 2026

Reviewed by licensed addiction specialists. Information reflects current clinical guidance.

Sources:SAMHSA·NIDA·CDC

Need Help Finding Dual Diagnosis Treatment?

Speak with a compassionate specialist who can help you find the right integrated treatment program for co-occurring mental health and substance use disorders — 100% free and confidential, available 24/7.

Find Dual Diagnosis by State

Browse dual diagnosis programs in states with the most treatment options.