What are Co-Occurring Disorders?

According to the Diagnostic and Statistical Manual of Mental Disorders (published by the American Medical Association), co-occurring disorders include two or more substance use disorders AND mental health disorders. Any combination of illnesses can be seen as co-occurring disorders.

These conditions include:

  • Anxiety and mood disorders
  • Schizophrenia
  • Bipolar disorders
  • Major depressive disorder
  • Conduct disorder
  • Post-traumatic stress disorder
  • Attention deficit hyperactivity disorder

According to SAMHSA (Substance Abuse and Mental Health Services Administration), substances often used with the disorders mentioned above include:

  • Alcohol
  • Tobacco
  • Opioids
  • Stimulants
  • Marijuana
  • Hallucinogens
  • Prescription drugs

This list will also include many of the street drugs that are illegal and manufactured in illegal drug labs. 

Often a person with an underlying mental health disorder will try to self-medicate to manage the feelings associated with the condition. The term dual diagnosis is often used to describe a person suffering from a mental illness and substance use or abuse simultaneously. “More than half of persons who have a serious mental illness also have a substance use or abuse disorder. Dual diagnosis is sometimes referred to as co-occurring disorders or comorbidity.” The use of substances can sometimes exacerbate an underlying mental health condition, or the drugs can create a mental health condition. Either way, whatever mental health illness is present along with the drug or drugs used requires that both or all conditions be treated simultaneously. It should be noted that drug addiction can occur even if a physician has prescribed a drug. This usually happens when the drug is not taken as directed! But addiction can also happen if the drug is powerful, sometimes the body quickly develops a need for the drug.

“The combination of mental illness and substance abuse is so common that many clinicians who work with the mentally ill now expect to find it. Studies show that 50% of persons with mental illness also have a substance abuse problem. And more than half the persons with a substance abuse diagnosis also have a diagnosable mental illness.”

Before the discussion of dual diagnosis or co-occurring disorders can proceed, we should understand that the medical community, based on years of brain and behavioral research, now considers drug addiction a disease of the brain. And, yes, dual diagnosis or substance addiction and abuse combined with mental health disorders can be treated!

The old approach to solving drug abuse, “Just Say No,” doesn’t work, nor can it be considered a moral flaw. These old perspectives toward substance abuse, addiction, and mental health disorders are harmful and ignore the reality that changes in the brain are caused by drugs. Changes in brain function caused by drugs, including neurotransmitters’ ability to send messages, lead to compulsive drug seeking and use. Compulsive drug seeking occurs despite the harmful consequences that proceed drug use. 

“Addiction affects multiple brain circuits, including those involved in reward and motivation, learning and memory, and inhibitory control over behavior. That is why addiction is a brain disease…[D]rug abuse and addiction increase a person’s risk for a variety of other mental and physical illnesses related to a drug-abusing lifestyle or the toxic effects of the drugs themselves. Additionally, the dysfunctional behaviors that result from drug abuse can interfere with a person’s normal functioning in the family, the workplace, and the broader community.”

According to a National Institute of Drug Addiction research report on comorbidities: 

“Data show high rates of comorbid substance use disorders and anxiety disorders—which include generalized anxiety disorder, panic disorder, and post-traumatic stress disorder. Substance use disorders also co-occur at high prevalence with mental disorders, such as depression and bipolar disorder, attention-deficit hyperactivity disorder (ADHD), psychotic illness, borderline personality disorder, and antisocial personality disorder. Patients with schizophrenia have higher rates of alcohol, tobacco, and drug use disorders than the general population.”

What causes addiction and mental health disorders?

Various aspects contribute to substance abuse and mental illness: Genetics, environment, family dysfunction, trauma (physical, emotional, and cognitive), social pressure to explore drugs, and untreated and undiagnosed mental health issues. There are a host of other influences that can lead to co-occurring disorders. Sometimes the use of drugs can lead to a mental health disorder because drugs, whether prescribed by a physician or taken illegally, can alter the brain’s ability to function correctly.

What treatment is required for dual diagnosis or co-occurring disorders?

The first step toward any treatment is detox. Often, withdrawal can set off more severe mental health issues while also being physically dangerous. A team of addiction specialists and physicians trained in addiction medicine needs to be able to control the withdrawal of a person from multiple drugs or one drug accompanied by a mental health illness. The team must also make a FULL and comprehensive assessment so that proper medication can be administered to ease the withdrawal symptoms. 

Detox is NOT drug treatment; it is the process of ridding the body of the drug. It is a managed process of cleansing the body and brain so that treatment can follow. Detox does not address why a person took drugs, nor does it explore mental illness, etc. 

It is best practice (established after research has shown what works best) for a person going through detox followed immediately by drug treatment. Usually, the easiest transition from detox to treatment is made at a facility that offers the continuation of treatment. Regardless, there should be no time between detox and the start of drug treatment as the likelihood of using again, or relapsing, increases.

Once the detox process is completed, and the person enters drug rehabilitation, another assessment will occur. These assessments should occur regularly throughout treatment. It is in drug rehab that the work of recovery happens. The longer a person has used drugs and has detoxed multiple times, the longer the term of treatment is recommended.

The term now being used to treat co-occurring disorders is integrated interventions. Integrated interventions mean that all disorders receive treatment simultaneously. It also means that treatment plans must address each individual’s needs. One size fits all treatment programs do not work. Quality treatment programs will use a variety of therapies in addressing a person suffering from co-occurring disorders. For example, a person suffering from heroin addiction and psychosis needs to learn how to manage drug triggers and cravings, as well as manage the symptoms of his/her/their mental health disorders. That means that the approach required for that individual will not necessarily work for a person who is suffering from bipolar disorders and cocaine. Without a comprehensive approach to all disorders, a person can go through drug rehabilitation and relapse if his/her/their mental health issues are not addressed and vice versa. 

Qualified, licensed therapists understand the dynamics of mental health disorders and drug addiction. For information on how you or a loved one can gain control over his/her/their life and learn how to live in sobriety and mental health, call one of our trained staff members now. Coastal Detox is dedicated to helping people recover from addiction and mental health disorders.

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