7 Things you Should Know about Co-Occurring Disorders

In recent years co-occurring disorders have been gaining more and more attention. Previously referred to as dual diagnosis, a co-occurring disorder is the presence of a mental health disorder along with substance abuse. This condition often causes immense suffering to an individual and those that care for the person. With the dangers associated with co-occurring disorders and the often underestimated prevalence, it’s important that we as a society understand them a little more deeply.

It’s More Prevalent than You Think

According to SAMHSA’s National Survey on Drug Use and Health, about 7.9 million adults experienced co-occurring disorders in 2014. That’s almost 8 million people struggling with both drug or alcohol addiction and a mental health disorder such as depression, anxiety, bipolar disorder, or schizophrenia. According to the same survey, almost 39% of people with a substance abuse disorder also battle with a mental health disorder. Co-occurring disorders are much more common than many people realize.

Most Don’t Receive Help

Because of the complexity of symptoms, social stigma, and difficulty in dealing with co-occurring disorders, the majority of people don’t receive appropriate help. Some may receive help for their substance abuse issue without addressing the mental health disorder, while others seek treatment for their depression, anxiety, or other disorder without receiving help for their addiction. For those that receive no treatment or treatment for only one of the issues they are facing, recovery rates are low. Adding to this problem is the fact that many people with co-occurring disorders are able to function in their daily lives, which can lead to a sense of wellness and not needing help.

Learn about Co-Occurring Disorders

Misdiagnosis is Common

There are quite a few different ways in which co-occuring disorders can manifest. Consider all the different substances that somebody may be abusing and all of the different mental health disorders that may be present. The possibilities here make it difficult for doctors and clinicians to know exactly what is going on. The symptoms vary greatly from individual to individual, and different disorders cause different warning signs.

Furthermore, people are often under-diagnosed or over-diagnosed. The symptoms of klonopin withdrawal include depression, anxiety, and other experiences similar to mental health disorders. This leads clinicians to sometimes diagnose a co-occurring disorder where there isn’t one. On the other hand, somebody may have their mental health disorder written off as a symptom of their drug abuse. These misdiagnoses can result in the person not receiving appropriate treatment for what they have going on with them.

Certain People are at Higher Risk

Like drug addiction or mental health disorders in general, there are some risk factors. For example, people that have a family history of either addiction or mental health issues are at higher risk. There is a genetic factor in addiction and disorders such as major depressive, generalized anxiety, and schizophrenia. People who show symptoms of drug abuse or a mental disorder in adolescence are also at higher risk than those who develop symptoms later in life. If somebody experiences trauma early in life such as abuse, family dysfunction, or neglect, they also may be more likely to develop a co-occurring disorder.

It’s a Vicious Cycle

Because of the interaction between the two disorders, a vicious cycle is often created. As one’s mental health disorder arises, the person may self-medicate with drugs or alcohol. When a person uses mind-altering substances, it worsens their mental health disorder. Thus a cycle is created, often sending the person spiraling downward. The cycle created can be debilitating and fatal. One condition feeds the other, pulling the individual down further into both of their disorders.

There are Many Treatment Models

As with both disorders individually, co-occurring disorders are treated via a variety of methods. The most common include cognitive behavioral therapy, dialectical behavioral therapy, medication management, motivational interviewing, and EMDR, especially with trauma-based disorders. Most dual diagnosis treatment centers include a strong family program and support groups, as building a support network can be extremely beneficial in one’s recovery. In addition to these traditional therapeutic models, a more holistic approach including relaxation methods, nutritional counseling, and exercise can be greatly beneficial.

Concurrent Treatment Works Best

This is a huge piece of the puzzle. If one is to truly recover, seeking treatment for both conditions works best. If a person stops using drugs or alcohol but is living with an untreated mental health disorder, they are likely to relapse. If somebody gets help for a disorder like major depressive, generalized anxiety, PTSD, or schizophrenia but keeps using mind-altering drugs, their mental health disorder is likely to return. Drugs and alcohol interact with medications in ways that we don’t fully understand, and the mental state rolls downhill quickly. The two must be treated together in order to give the individual the greatest chance at recovery.

If you or somebody you know is struggling with a co-occurring disorder, reach out for help today. Receiving professional help can help you gain a life back.



co-occurring-disorders infographic

Substance Abuse and Mental Health Understanding the Link

When someone suffering from a mental illness is also diagnosed with a substance use disorder, the combination is known as co-occurring disorders or a dual diagnosis. Co-occurring disorders are very common, and understanding the link between substance abuse and mental health is crucial for finding the right treatment program and improving the chances of long-term recovery.

Defining Mental Illness

A mental illness is any condition that affects thought processes, feelings or mood, according to the National Alliance on Mental Illness.1 People who have a mental illness may be unable to relate well to others, and the mental condition may affect overall feelings of good health and well-being. This can interfere with healthy social functioning.

Mood disorders like anxiety and depression are the most common mental illnesses that co-occur with substance abuse.

Mood disorders like anxiety and depression are the most common mental illnesses that co-occur with substance abuse.

Anxiety disorders include generalized anxiety disorder, panic disorder, social anxiety disorder and agoraphobia. Obsessive-compulsive disorder and post-traumatic stress disorder are closely related to anxiety disorders and also commonly co-occur with substance use disorders. Around 40 million American adults, or 18 percent of the adult population, suffer from an anxiety disorder, according to the Anxiety Disorders Association of America.2

Depressive disorders include major depression, dysthymic disorder, postpartum depression, seasonal affective disorder and bipolar disorder. Major depression alone affects around 14.8 million adults in a given year, according to the Depression and Bipolar Support Alliance, and nearly six million people are diagnosed with bipolar disorder each year.3

Defining Substance Abuse

The World Health Organization defines substance abuse as the harmful use of a psychoactive substance, including alcohol, prescription medications and both legal and illegal drugs.4 “Harmful” can mean any negative consequence of using drugs or alcohol, including:

  • Relationship problems with family, friends or co-workers
  • Neglecting responsibilities at home, work or school
  • Physical or mental health problems, including hangovers
  • Legal troubles, such as charges of possession, DUI, public intoxication or domestic violence
  • Financial problems resulting from buying drugs or alcohol, missing work or losing a job due to using them

People who abuse substances may do so once in a while, or they may do it frequently. Chronic substance abuse is a substance use disorder, and it can lead to worse substance use disorders like addiction and dependence.

Addiction is characterized as being unable to stop using a substance despite negative consequences. Dependence is characterized by changes in brain function that lead to the brain operating more “normally” when a substance is present than when it’s not. If dependence has developed, withdrawal symptoms will set in when the substance is withheld.

The Link Between Substance Abuse and Mental Health

According to the National Institute on Drug Abuse, mental illness and substance use disorders commonly co-occur for three reasons:5

  • Drug or alcohol abuse can lead to the onset of a mental illness, and it almost always worsens symptoms of an existing mental illness.
  • Mental illness can lead to self-medicating with drugs or alcohol, which can lead to addiction and dependence.
  • Risk factors for substance use disorders and mental illness may overlap, leaving some people more susceptible to co-occurring disorders.

Overlapping Factors for Mental Illness and Substance Use Disorders

Three important factors influence the development of mental illness and substance use.

Overlapping genetic vulnerabilities. Researchers have identified several regions of the human genome that are linked to an increased risk of developing both a substance use disorder and a mental illness. Genetic factors may be direct, such as controlling how substances are metabolized, or they may have an indirect influence, such as predisposing someone to engage in risky behaviors that may include abusing drugs or alcohol.

Involvement of similar brain regions. Certain regions of the brain are involved in the development of both mental illness and substance use disorders. For instance, the dopamine system is affected by psychoactive substances, and it’s also a factor in depression and other mental illnesses.

Environment. Environmental factors can influence both substance abuse and mental illness. For example, high stress can cause anxiety, and since many people medicate stress with drugs or alcohol, it can also lead to a substance use disorder.

The Prevalence of Co-Occurring Disorders

According to the National Institute on Drug Abuse, people who have a mood or anxiety disorder are two times more likely than those who don’t to develop a substance use disorder, and vice versa.6

People who have a mood or anxiety disorder are two times more likely than those who don’t to develop a substance use disorder, and vice versa.

Nearly eight million American adults have co-occurring disorders, according to the Substance Abuse and Mental Health Services Administration.7 The National Alliance on Mental Illness points out that around one-third of people who have any type of mental illness and half of those with a serious mental illness like schizophrenia or bipolar disorder also suffer from a substance use disorder.8 Conversely, around one-third of those who abuse alcohol and over half of those who abuse drugs also have a mental illness.

Common Co-Occurring Mental Illnesses

While any mental illness can co-occur with a substance use disorder, some more commonly do so than others.

Anxiety. People who have an anxiety disorder often self-medicate with alcohol and drugs, and while it may seem to help initially, using psychoactive substances nearly always makes the mental illness worse.

Depressive disorders. Major depression and bipolar are associated with a higher risk of substance abuse. People suffering from depression may use drugs and alcohol to feel better, but this usually makes the condition worse in the long run. Those who have bipolar disorder may tend to engage in high-risk behaviors during a manic episode, increasing the risk of substance abuse and developing a substance use disorder.

A study published in the journal Psychiatric Clinics of North America found that around half of all people with bipolar disorder have a lifetime history of a substance use disorder.9

Schizophrenia. People with schizophrenia may experience delusions, hallucinations and psychotic episodes, and many use nicotine to help compensate for cognitive deficits. Marijuana is also commonly used by those suffering from schizophrenia in an attempt to manage stress.

These and other psychoactive substances can lessen the effects of medications that interfere with dopamine production and make it difficult to feel joy, but they almost always worsen schizophrenia in the long-term.

Obsessive-compulsive disorder (OCD). An article published in the Journal of Anxiety Disorders found that 27 percent of people suffering from obsessive-compulsive disorder had a lifetime history of a substance use disorder.10 Those with OCD may use drugs or alcohol to relieve symptoms like intrusive thoughts and repetitive behaviors, but due to the nature of the disorder, substance abuse may also become compulsive and lead to addiction.

Post-Traumatic Stress Disorder (PTSD). Post-traumatic stress disorder develops after being a witness to or victim of a traumatic event. Those with PTSD often use alcohol to combat symptoms like insomnia, nightmares, flashbacks and intrusive memories of the event.

An article published in the journal Alcohol Research & Health cites a study that found that 40 percent of people seeking inpatient treatment for a substance use disorder suffer from PTSD, and another study found that over half of combat veterans with PTSD subsequently developed an alcohol addiction.11

Eating disorders. People with eating disorders often abuse drugs or alcohol in an attempt to control their appetite or alleviate psychological symptoms like depression and low self-esteem. An article in the journal Social Work Today points out that up to 50 percent of those with an eating disorder abuse alcohol or drugs, compared to just nine percent of the general population.12

Diagnosing Co-Occurring Disorders: Integrated Screening and Assessment

Diagnosing co-occurring disorders can be problematic. It’s often difficult to determine which symptoms are associated with substance abuse and which are associated with mental illness. This is particularly true in a treatment detox setting, and it’s typical for healthcare professionals to wait until withdrawal symptoms subside before making a diagnosis.

It’s often difficult to determine which symptoms are associated with substance abuse and which are associated with mental illness.

Due to the high prevalence of co-occurring disorders, a comprehensive and integrated screening and assessment protocol is in place within the mental healthcare and substance abuse treatment communities to ensure a proactive approach to diagnosing co-occurring disorders.

Integrated screenings take place upon admission for those seeking help for a mental illness or treatment for a substance use disorder. In a mental health setting, a patient is screened for a substance use disorder, and vice versa. The screening is short and simple and involves a series of questions that are scored to indicate whether a more comprehensive assessment is in order.

Integrated assessments begin with gathering information from a patient or client. The assessing therapist and the individual form a partnership and move through a defined, 12-step process to evaluate a substance use disorder in the context of a mental illness or vice versa. At the end of the assessment, a diagnosis is made one way or the other.

Integrated Treatment is Essential for Co-Occurring Disorders

Since mental illness often leads to substance abuse and substance abuse can cause or worsen a mental illness, treating both conditions at the same time, each in the context of the other, is absolutely essential for successful long-term recovery.

Treating both conditions at the same time, each in the context of the other, is absolutely essential for successful long-term recovery.

The Substance Abuse and Mental Health Services Administration notes that integrated treatment is associated with better outcomes, including:13

  • A reduction in substance abuse
  • Improved mental illness symptoms
  • Improved mental functioning
  • Decreased hospitalization
  • Increased housing stability
  • Fewer legal problems
  • A higher overall quality of life

Some recovery programs offer dual diagnosis treatment in addition to standard treatment services, while others specialize solely in treating co-occurring disorders.

Six Principles of Dual Diagnosis Treatment

The Substance Abuse and Mental Health Services Administration has identified a number of principles that should guide treatment for co-occurring disorders.14

Employ a recovery perspective. Recovery is a process of change from the inside out, and change occurs in predictable stages. Everyone’s path of recovery is different, but all high-quality, successful treatment programs will ensure continuity of care by developing and putting into place an individualized aftercare plan to address the post-treatment stages of recovery and improve the outcome of treatment.

Address multiple problems. Treatment for substance use disorders and mental health conditions requires addressing more than root causes and symptoms. Issues like legal, financial and housing problems, physical health conditions, relationship troubles and employment needs must all be addressed for the best possible outcome.

Use a phased approach. Treatment plans should be dynamic and continually assessed and amended based on an individual’s specific needs and issues at each stage of recovery.

Address real-life problems early on. Working through personal and social problems from the start of treatment increases engagement and helps individuals identify and improve on their various roles in life, such as employee, parent or student. Learning the necessary skills to support these roles is central to successful recovery.

Address cognitive and functional impairments. An individual in treatment should fully understand how treatment works and be able to perform the necessary tasks at each stage of recovery. Addressing cognitive and functional impairments ensures that this happens to the best of a person’s ability.

Institute an aftercare plan. Aftercare is a critical component of any quality treatment program. Once treatment ends and an individual returns to the community, various supports and a comprehensive plan for continued recovery should be in place. The aftercare plan typically includes ongoing therapy, monitoring of the mental illness, support group participation and other components based on need, such as vocational therapy or legal services.

Treatments for Co-Occurring Disorders

A high-quality, holistic dual diagnosis treatment program improves the chances of successful recovery and will employ a number of therapies to treat both the mental illness and the substance use disorder.

  • Pharmacotherapy, or the administering of medication, is often essential for getting symptoms of mental illness under control. During the detox phase, medications may help reduce the severity of withdrawal symptoms.
  • Behavioral therapies, including cognitive-behavioral therapy, help individuals identify harmful ways of thinking and behaving and replace them with healthier thoughts and behaviors.
  • Group therapy helps clients work through various issues with the support and input of peers.
  • Family therapy helps to restore function to the household and improve communication among family members.
  • Psychoeducational classes help those in treatment better understand both their mental illness and their substance use disorder and how each affects the other.
  • Alternative therapies are an essential part of a holistic treatment program and include acupuncture, meditation, biofeedback and art and music therapy.
  • Didactical therapy, exposure therapy and other specialized therapies help individuals with severe mental illness reduce dangerous behaviors and improve symptoms that are otherwise difficult to treat.

Choosing a Treatment Program for a Dual Diagnosis

For those who have co-occurring disorders, a treatment program that specializes in dual diagnosis is essential for successful long-term recovery. Treating just the substance use disorder but not the mental illness or vice versa is associated with poor outcomes and high relapse rates.

For those who have co-occurring disorders, a treatment program that specializes in dual diagnosis is essential for successful long-term recovery.

A dual diagnosis program is based on integrated treatment as a collaboration among the members of each treatment team. The mental illness is treated in the context of the substance use disorder, and the substance use disorder is treated in the context of the mental illness.

A holistic approach to treatment is essential for addressing the range of highly complex issues that underlie mental health issues and substance use disorders.

According to the Substance Abuse and Mental Health Services Administration, there is no single pathway to recovery.15 Every individual has different issues and needs, and using a range of both traditional and alternative therapies helps to ensure that all of the various issues are addressed in a variety of ways that promote better overall physical and mental health and a higher sense of well-being.

A high-quality, holistic dual diagnosis treatment program will:

  • Employ experienced and licensed healthcare and mental health professionals
  • Have state accreditation
  • Adhere to research-based protocol and treatment therapies
  • Offer medical detox, which involves administering medications to alleviate the severity of withdrawal symptoms
  • Offer services in a culturally aware environment that takes into consideration a client’s cultural background, such as age, gender, sexual orientation, gender identity and values
  • Adhere to the Principles of Effective Treatment as set forth by the National Institute on Drug Abuse16
  • Offer coordinated care across treatment teams
  • Offer a comprehensive aftercare plan once treatment is complete
  • Provide a wide range of community supports, such as child care, financial counseling, legal services and peer support groups

The Substance Abuse and Mental Health Services Administration has several excellent resources for helping individuals find a high quality and effective treatment program:

  • The National Registry of Evidence-Based Programs and Practices offers information and expert ratings for a large number of programs across the country.17
  • The Behavioral Health Treatment Services Locator is a searchable database of treatment programs across the country to help individuals find a high-quality program that suits their needs.18

There is Hope

Hope is the foundation of recovery, driving the motivation to recover and keeping people engaged in treatment despite setbacks and difficult challenges. With the right dual diagnosis treatment program, individuals develop the skills, strategies and knowledge upon which successful recovery is based. No matter how dire things may seem to be, recovery from a substance use disorder and a mental health condition is always possible.

Taking the first step and entering treatment is often the most difficult part of treatment for many, but doing so can restore good physical and mental health and lead to a vastly higher quality of life for those with an addiction and the ones who love them.

Sources:

  1. Mental Health Conditions. (n.d.). Retrieved from https://www.nami.org/Learn-More/Mental-Health-Conditions
  2. Facts & Statistics. (2014, September). Retrieved from http://www.adaa.org/about-adaa/press-room/facts-statistics
  3. Depression Statistics. (n.d.). Retrieved from http://www.dbsalliance.org/site/PageServer?pagename=education_statistics_depression
  4. Substance Abuse. (n.d.). Retrieved from http://www.who.int/topics/substance_abuse/en/
  5. Why Do Drug Use Disorders Often Co-Occur with Other Mental Illnesses? (2010, September). Retrieved from https://www.drugabuse.gov/publications/comorbidity-addiction-other-mental-illnesses/why-do-drug-use-disorders-often-co-occur-other-mental-illnesses
  6. Comorbidity: Addiction and Other Mental Illnesses. (2010, September). Retrieved from https://www.drugabuse.gov/sites/default/files/rrcomorbidity.pdf
  7. Mental and Substance Use Disorders. (2016, March 8). Retrieved from http://www.samhsa.gov/disorders
  8. Dual Diagnosis. (n.d.). Retrieved from https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Dual-Diagnosis
  9. Sonne, S. C. & Brady, K. T. (1999, September). Substance Abuse and Bipolar Comorbidity. Psychiatric Clinics of North America, 22(3), 609-627. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10550858
  10. Mancebo, M. C., Grant, J. E., Pinto, A., Eisen, J. L., & Rasmussen, S. A. (2009, May). Substance Use Disorders in an Obsessive Compulsive Disorder Clinical Sample. Journal of Anxiety Disorders, 23(4), 429-435. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2705178/#R6
  11. Volpicelli, J., Balaraman, G., Hahn, J., Wallace, H., & Bux, D. (1999). The Role of Uncontrollable Trauma in the Development of PTSD and Alcohol Addiction. Alcohol Research & Health, 23(4), 256-262. Retrieved from http://pubs.niaaa.nih.gov/publications/arh23-4/256-262.pdf
  12. Ressler, A. (2008, July). Insatiable Hungers: Eating Disorders and Substance Abuse. Social Work Today, 8(4), 30. Retrieved from http://www.socialworktoday.com/archive/070708p30.shtml
  13. Behavioral Health Treatments and Services. (2015, October 19). Retrieved from http://www.samhsa.gov/treatment
  14. Overarching Principles to Address the Needs of Persons with Co-Occurring Disorders. (2006). Retrieved from http://store.samhsa.gov/shin/content//PHD1132/PHD1132.pdf
  15. Recovery and Recovery Support. (2015, October 5). Retrieved from http://www.samhsa.gov/recovery
  16. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). (2012, December). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment
  17. Resource: http://www.samhsa.gov/nrepp
  18. Resource: https://findtreatment.samhsa.gov/
Dual Diagnosis: The Connection Between Mental Health & Addiction

The National Alliance on Mental Illness defines mental illness as a condition that affects an individual’s thoughts, feelings or mood and which may impact the ability to relate to other people.1 Genetics, environment and lifestyle are all factors that determine whether someone will develop a mental disorder.

The 2014 National Survey on Drug Use and Health revealed that more than 43 million Americans over the age of 18 had some form of mental illness, and over 20 million suffered from a substance use disorder.2 Nearly eight million people had both a mental disorder and a substance use disorder, known as a dual diagnosis or co-occurring disorders.

The Prevalence of Co-Occurring Disorders

People who have a mood or anxiety disorder are twice as likely as the general population to suffer from a substance use disorder.3 Conversely, people who have a substance use disorder are twice as likely as the general population to suffer from a mood or anxiety disorder.

People who have a mood or anxiety disorder are twice as likely as the general population to suffer from a substance use disorder.

All told, around a third of people who have any type of mental condition and half of those with a serious mental illness also have a substance use disorder. Around a third of people who abuse alcohol and more than half of those who abuse drugs also report having a mental illness.4

Why Addiction and Mental Illness Commonly Co-Occur

Three scenarios help explain why so many people suffer from both a mental illness and an addiction.5

  • Abusing drugs can cause the onset of a mental illness or worsen an existing mental condition.
  • People who have a mental illness may self-medicate with drugs or alcohol to alleviate certain symptoms, and this can lead to addiction.
  • Overlapping factors for both substance use disorders and other mental illnesses can leave certain individuals more vulnerable to developing co-occurring disorders.

Overlapping Factors for Mental Illness & Addiction

Overlapping genetic vulnerabilities, the involvement of similar brain regions and environmental considerations are the three most prevalent factors that influence whether someone will develop a co-occurring disorder.

Overlapping Genetic Vulnerabilities

Scientists have linked several areas of the human genome to an increased risk of both substance use disorders and mental illness. Between 40 and 60 percent of your risk of developing an addiction is genetic.

A gene may impact your risk directly, such as by controlling how you metabolize a certain substance, or it may act indirectly, such as by determining whether you tend to engage in risk-taking behaviors. Likewise, these and other genetic factors can help determine whether you’ll develop a mental illness.

Involvement of Similar Brain Regions

A mental illness and addiction often involve the same or similar brain regions. For example, psychoactive substances affect circuits in the brain that involve the neurotransmitter dopamine, and abnormal dopamine activity is also a factor in the development of mental illnesses such as schizophrenia and depression.

Environment

Certain environmental factors, such as a high stress level, a dysfunctional household or trauma can lead to substance abuse and the development of certain mental illnesses like anxiety, depression and post-traumatic stress disorder.

Six Common Mental Illnesses that Co-Occur with Addiction

Any mental illness can lead to self-medication with drugs or alcohol and increase the risk that someone will develop a substance use disorder. Likewise, drug abuse can lead to any number of mental conditions. Still, some mental illnesses co-occur with addiction more frequently than others.

Any mental illness can lead to self-medication with drugs or alcohol and increase the risk that someone will develop a substance use disorder.

Anxiety

Anxiety is the most common mental illness in the U.S., with around 40 million American suffering from one of a number of anxiety disorders.6 People with anxiety disorders often self-medicate their anxiety with drugs or alcohol, but doing so almost always makes the anxiety worse in the long run.

Mood Disorders

Mood disorders include bipolar and major depressive disorder, both of which often co-occur with substance use disorders. Around 20 percent of Americans with a mood disorder also have a substance use disorder.7

Bipolar disorder is characterized by alternating “mood episodes.” During a manic episode, an individual will have extremely high energy, and during a depressive episode, that same individual will sink into a deep depression.

A characteristic of manic episodes is the tendency to behave impulsively and engage in high-risk, pleasurable behaviors, which often leads to substance abuse. During depressive episodes, individuals may abuse substances to alleviate symptoms of depression or increase their energy levels. According to a study published in the journal Psychiatric Clinics of North America, up to half of all people with bipolar disorder also have a lifetime history of a substance use disorder.8

Major depressive disorder affects around 14.8 million American adults, or about 6.7 percent of the U.S. adult population.6 People with depression are likely to self-medicate with drugs or alcohol to relieve feelings of sadness or hopelessness, inevitably worsening the condition over time.

Major depressive disorder affects around 14.8 million American adults, or about 6.7 percent of the U.S. adult population.

Schizophrenia

Around 2.4 million American adults suffer from schizophrenia, a severe mental illness that affects how someone feels, thinks and behaves. Those who suffer from schizophrenia often lose touch with reality and experience hallucinations, delusions and problems with attention and memory. According to an article published in the American Journal of Drug and Alcohol Abuse, nearly half of those with schizophrenia have a lifetime history of a substance use disorder.9

People with schizophrenia commonly use nicotine and marijuana to alleviate some of the effects of this disorder. Nicotine helps to compensate for the cognitive deficits commonly seen with this disorder, and many patients use marijuana to cope with stress.

Since these and other drugs increase dopamine production, they may be used to combat the effects of antipsychotic medications, which interfere with dopamine activity and leave patients feeling joyless, according to an article published in the journal Schizophrenia Bulletin.10 In the vast majority of cases, illicit drugs worsen symptoms of schizophrenia over time.

Obsessive-Compulsive Disorder

According to an article published in the Journal of Anxiety Disorders, a study of a clinical sample of people with obsessive compulsive disorder, or OCD, found that 27 percent of the sample had a lifetime history of a substance use disorder.11 People with OCD may use opiates like percocet, alcohol or marijuana to relieve their symptoms, which include intrusive thoughts and compulsive, repetitive behaviors. Additionally, the very nature of OCD can lead to obsessive drug abuse that may in turn lead to an addiction.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder, or PTSD, results from experiencing or witnessing a traumatic event, such as a natural disaster, accident or act of violence.

Symptoms of PTSD include:

  • Insomnia
  • Nightmares
  • Anxiety
  • Depression
  • Flashbacks

People with PTSD commonly self-medicate with alcohol to relieve these and other symptoms, because alcohol helps to compensate for reduced endorphin activity that often follows a traumatic experience. Alcohol can also help suppress memories and dreams.

According to an article published in the journal Alcohol Research & Health, PTSD is strongly associated with alcohol abuse.12 For example, a study of combat veterans with PTSD found that over half suffered from subsequent alcohol addiction, and a 1997 study found that 40 percent of people receiving inpatient treatment for a substance use disorder met the clinical criteria for a PTSD diagnosis.

Eating Disorders

Up to half of all people with an eating disorder abuse drugs or alcohol, compared with nine percent of the general population, according to an article in the journal Social Work Today.13 People with eating disorders may abuse stimulant drugs for weight loss and appetite control. They may use alcohol and other drugs to reduce the intensity of negative psychological symptoms resulting from the eating disorder.

Diagnosing Co-Occurring Disorders

Because many of the symptoms of addiction and mental illness overlap, it can be difficult to diagnose co-occurring disorders. To complicate matters, some withdrawal symptoms associated with various drugs of abuse mimic the symptoms of mental illness. In an addiction treatment setting, it’s often necessary to wait until the withdrawal symptoms have subsided and a period of abstinence has been observed before making a formal diagnosis.

Due to the high prevalence of co-occurring disorders, a universal and comprehensive approach has been developed to screen and assess for mental illness and substance use disorders in both psychiatric and addiction treatment settings. Those who seek psychiatric services are screened for a substance use disorder, and those who seek treatment for a substance use disorder are screened for mental illness.

Integrated Screening and Assessment

Screening for co-occurring disorders is usually part of the intake process in a psychiatric or treatment setting. The process is short and succinct. Patients answer a series of prescribed questions, which are then scored. The score determines whether sufficient evidence of a substance use disorder or mental illness is present. If it is, an in-depth assessment will be conducted.

During an integrated assessment, information is gathered to help a practitioner establish or rule out the presence of a co-occurring disorder. The integrated assessment is a 12-step process designed to evaluate a mental disorder in the context of the substance use disorder or vice versa.

During an integrated assessment, information is gathered to help a practitioner establish or rule out the presence of a co-occurring disorder.

The Substance Abuse and Mental Health Services Administration stresses the importance of the partnership between the individual being assessed and the assessing therapist.14 The assessment process is most successful when the patient is engaged in working to understand existing issues and develop treatment goals based on the formal diagnosis.

Integrated Treatment

A large body of research led to the practice of integrated treatment for co-occurring disorders in 1984. Prior to that, a patient was first treated for one disorder and then treated for the other. With integrated treatment came a higher level of success in treating both disorders, and the integrated model became the standard, best-practices method of treatment.

The integrated model of treatment ensures that each disorder is treated at the same time and in the context of the other disorder. Since having a substance use disorder increases the risk of mental illness and vice versa, integrated treatment dramatically improves the outcome for both the mental illness and the addiction.

Dual Diagnosis Treatment: Six Principles

The Substance Abuse and Mental Health Services Administration has developed six guiding principles for the treatment of co-occurring disorders:

  • Employ a recovery perspective to acknowledge that recovery from an addiction and mental illness is a process of change, and it occurs in stages. A successful dual diagnosis treatment plan will offer long-term continuity of care through an aftercare plan once treatment is complete.
  • Address multiple problems, such as medical issues, the need for housing or employment and dysfunction in the household. This is central to successful treatment and to overall good health and well-being.
  • Use a phased approach to treatment so that at each stage—engagement, stabilization, treatment and continuing care—the treatment addresses the recovery goals and meets the unique challenges of the stage.
  • Address real-life problems early to ensure that the co-occurring disorders are treated in the context of personal and social problems. By addressing issues like money management, social skills and skills related to an individual’s various roles in life, such as parent, student or employee, individuals are more likely to stay engaged in treatment and enjoy successful long-term recovery.
  • Address cognitive and functional impairments to ensure the individual being treated fully comprehends the implications of treatment and is able to adequately perform various tasks.
  • Institute an aftercare plan to ensure the individual has support at home and in the community once treatment is complete. The aftercare plan will include participation in a self-help group, ongoing therapy, continued monitoring of the mental illness and medications used to treat it and other supports that have been shown to help reduce the risk of relapse.

Dual Diagnosis Treatment Protocol

A wide range of therapies are employed in treating co-occurring disorders:15

  • Psychoeducational classes focus on helping individuals understand their mental illness and its relationship to and impact on the substance use disorder, and vice versa.
  • Pharmacotherapy is the practice of using medications to treat a mental illness or an addiction, or both. Medications are typically used during the detox phase of treatment to alleviate withdrawal symptoms, and they’re used to effectively treat the mental illness.
  • Behavioral therapies like cognitive-behavioral therapy help individuals learn to evaluate their thoughts, ideas, attitudes and behaviors and replace unhealthy ways of thinking and behaving with healthier ways.
  • Group therapy enables those in treatment to draw on the experiences and support of peers and work through their various issues with the help of others in similar situations.
  • Family therapy helps improve functioning within the family system to reduce stress and improve communication for better overall health and well-being of family members.
  • Alternative therapies like yoga, biofeedback and art therapy are designed to enrich treatment through a holistic approach that addresses issues of body, mind and spirit. Alternative therapies help reduce stress, and they offer a wide variety of ways to approach a problem for a better outcome. They also tend to lead to overall healthier lifestyle choices.
  • Specialized therapies for serious mental illnesses are employed as needed and include dialectical behavioral therapy to reduce self-harm behaviors and exposure therapy to help desensitize those with serious anxiety disorders.

Choosing a Dual Diagnosis Treatment Program

A treatment program that specializes in treating a dual diagnosis is absolutely essential for the successful treatment of co-occurring disorders. Some programs aren’t staffed, trained or otherwise equipped to offer integrated treatment, which is critical for successful recovery from a dual diagnosis.

A treatment program that specializes in treating a dual diagnosis is absolutely essential for the successful treatment of co-occurring disorders.

It’s important to choose a treatment program that either specifically includes integrated treatment in its programming or that specializes entirely in treating co-occurring disorders. Both types of programs focus on treatment as a collaboration among various treatment teams, and they have far better outcomes than programs that only address and treat an addiction.15

There is Hope

If you’re suffering from a mental illness and a substance use disorder, you may feel like there’s no hope for recovery due to the highly complex issues and interconnectedness between the disorders. But nothing could be farther from the truth. Integrated treatment works, and it vastly improves your physical and mental health and restores your sense of well-being.

Integrated treatment works, and it vastly improves your physical and mental health and restores your sense of well-being.

Taking the first step and entering treatment is often the most difficult part of recovery, but the sooner you acknowledge your need for help in sorting through the complicated issues surrounding your disorders and make the decision to enter treatment, the sooner you will see dramatic improvements in your overall quality of life.

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  3. Comorbidity: Addiction and Other Mental Illnesses. (2010, September). Retrieved from https://www.drugabuse.gov/sites/default/files/rrcomorbidity.pdf
  4. Dual Diagnosis. (n.d.). Retrieved from https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Dual-Diagnosis
  5. Why Do Drug Use Disorders Often Co-Occur with Other Mental Illnesses? (2010, September). Retrieved from https://www.drugabuse.gov/publications/comorbidity-addiction-other-mental-illnesses/why-do-drug-use-disorders-often-co-occur-other-mental-illnesses
  6. Facts and Statistics. (2014, September). Retrieved from http://www.adaa.org/about-adaa/press-room/facts-statistics
  7. Substance Use Disorders. (n.d.). Retrieved from http://www.adaa.org/understanding-anxiety/related-illnesses/substance-abuse
  8. Sonne, S. C., and Brady, K. T. (1999, September). Psychiatric Clinics of North America, 22(3), 609-627. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10550858
  9. Swofford, C. D., Scheller-Gilkey, G., Miller, A. H., Woolwine, B., and Mance, R. (2000, August). Double Jeopardy: Schizophrenia and Substance Use. American Journal of Drug and Alcohol Abuse, 26(3), 343-353. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10976661
  10. Volkow, N. D. (2009, May). Substance Use Disorders in Schizohrenia: Clinical Implications of Comorbidity. Schizophrenia Bulletin, 35(3), 469-472. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669586/
  11. Mancebo, M. C., Grant, J. E., Pinto, A., Eisen, J. L., and Rasmussen, S. A. (2009, May). Substance Use Disorders in an Obsessive Compulsive Disorder Clinical Sample. Journal of Anxiety Disorders, 23(4), 429-435. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2705178/#R6
  12. Volpicelli, J., Balaraman, G., Hahn, J., Wallace, H., and Bux, D. (1999). The Role of Uncontrollable Trauma in the Development of PTSD and Alcohol Addiction. Alcohol Research & Health, 23(4), 256-262. Retrieved from http://pubs.niaaa.nih.gov/publications/arh23-4/256-262.pdf
  13. Ressler, A. (2008, July). Insatiable Hungers: Eating Disorders and Substance Abuse. Social Work Today, 8(4), 30. Retrieved from http://www.socialworktoday.com/archive/070708p30.shtml
  14. Co-Occurring Disorders Screening and Assessment: Integrated Screening. (2016, March 8). Retrieved from http://media.samhsa.gov/co-occurring/topics/screening-and-assessment/integrated-screening.aspx
  15. Substance Abuse Treatment for Persons with Co-Occurring Disorders (2013). Retrieved from http://store.samhsa.gov/shin/content/SMA13-3992/SMA13-3992.pdf