According to the Substance Abuse and Mental Health Service Administration guide on treating concurrent substance abuse, most research and best practices have not been done on treating addiction in a person using more than one substance. Ironically, co-occurring or concurrent substance use is prevalent in society and requires multiple treatment approaches. “Furthermore, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which defines and classifies disorders to improve diagnosis, treatment, and research…does not include a definition for or address concurrent substance use (CSU)…, which complicates diagnosis and treatment.”

How do concurrent SUDs impact treatment? Using multiple substances, which may include alcohol, lead to poorer medical and mental health outcomes, increased risk of suicide, and overdose.

“While studies on the impact of CSU and concurrent SUD are limited, available research demonstrates that when compared to people with a single SUD, CSU and concurrent SUD are associated with higher rates of:

  • Lifetime suicide attempts, arrests, and incarceration
  • Financial and legal problems
  • Increased likelihood of overdose
  • More severe medical and psychiatric comorbidities (e.g., the prevalence of a mental disorder is higher among those dependent on multiple psychoactive substances, such as heroin, alcohol, or cocaine, than those who use one substance).”

A person may fall into using more than one substance for a variety of reasons. He/she/they may be unable to obtain the original drug and will use another; the person may be trying to manage an underlying trauma through self-medicating, trying to manage withdrawal symptoms of another drug. Sometimes people take drugs that have been “cut” with other medications, such as fentanyl, without knowing what they are taking. Indeed, many overdose deaths involve the illicit manufacture of fentanyl.

According to the CDC, in 2019, nearly half of the overdose deaths involved multiple drugs.

Proper Diagnosis

The individual with concurrent SUD who enters treatment presents a more complicated clinical picture than someone who uses only one substance. Combine that with underlying mental health disorders (trauma, PTSD, bipolar disorders, etc.), and the diagnosis becomes that much more complicated.

When entering detox and a treatment facility, it is of the utmost importance that a complete medical/psycho/social workup be performed. If a person abuses multiple drugs, the withdrawal symptoms can mask what is happening. In some instances, withdrawal from some medications can bring on psychotic-like behavior, hallucinations, paranoia, and other mental health issues. Drug use can, and often does, worsen chronic diseases.

A few statistics provide an overview of the situation and why treatment for concurrent SUD is required.

“Among people with heroin use disorder…25 percent have an alcohol use disorder, and over 20 percent have a cocaine use disorder. Among people with a cocaine use disorder, nearly 60 percent have an alcohol use disorder…and over 21 percent have a marijuana use disorder.” People with concurrent SUD often have other problems, which include tobacco use, mental illness, treatment adherence, infectious disease transmission, chronic pain, and involvement in the criminal justice system. “It is estimated that about 45 percent of individuals in state and local prisons and jails have a mental health problem comorbid with substance use or addiction.”

Some questions to ask yourself when evaluating your situation concerning concurrent SUD include:

  • “Have you used drugs other than those required for medical reasons?
  • Do you use more than one drug at a time?
  • Have you had “blackouts” or “flashbacks” from drug use?
  • Do you ever feel bad or guilty about your drug use?
  • Have you engaged in illegal activities to obtain drugs?
  • Have you had medical problems due to drug use (e.g., memory loss, hepatitis, convulsions, bleeding, etc.)?

Suppose you seek help from your physician about not feeling well or chronic pain you are experiencing and are not honest with him/her/them. In such cases, the physician tends to prescribe more opiates and antipsychotic prescriptions at a rate higher than the general population.

The majority, 83.8%, of drug users obtain their drugs from family or friends. That means the person suffering from SUD took, bought, or was given drugs.

The sad reality is that more than half of those with mental illness do not receive care, and 87.9% do not receive treatment for those suffering from SUD. (U.S. statistics)

Types of Treatments Used to treat Concurrent SUDs and Mental Health Disorders (MHD)

When looking for treatment for yourself or a loved one, knowing that the facility is licensed, accredited, and uses best practices (those practices supported by research and approved by the medical association for treating addiction) is essential. Additionally, because of the nature of multiple SUDs, a facility should be able to provide integrated treatment programs. That means a medical and clinical staff team provides interventions to address various drug use and mental health problems. Treatment success is lessened significantly if only one of the multiple problems is addressed, including mental health issues and substance abuse. Those providing care must know the complex relationship and interactions between disorders. Such an approach requires expertise in substance abuse and mental health disorders.

Practice Principles include:

  • Integrated treatment for all SUD and Mental health disorders
  • Trained staff in both SUD and MHD
  • Provide different therapies at different stages of recovery
  • Motivational interventions
  • Substance abuse counseling includes but is not limited to cognitive behavioral therapy.
  • Different therapeutic formats: individual counseling, group counseling, peer groups and family counseling, life skills training, work evaluation, nutritional and physical exercise, meditation, or stress relieving education, and for those who have been involved in the criminal justice system behavior modification
  • Medication education and mental health disorder management counseling
  • Relapse prevention
  • Aftercare plans

If you seek help to address your or your loved one’s SUDs and MHDs, call and speak with one of our staff today. Every conversation is confidential. We can answer all your questions and set your mind at ease, allowing you or your loved one to feel comfortable about entering detox and treatment and get on the road to a healthier, more fulfilled life. Call now.

References:

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