What Is A Co-Occurring Disorder?
Substance abuse wreaks havoc in the lives of people struggling with addiction. Their dependence on alcohol and other substances makes it difficult to contribute to society, care for themselves and their families, and live healthy lives. To make matters worse, other mental health disorders often accompany substance abuse.
The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that approximately half of people with a substance use disorder also have a mental health disorder. These conditions are referred to as co-occurring disorders, and people who suffer from them are referred to as dual diagnosis patients.
Co-occurring disorders make treatment more complicated and pose an increased risk of negative outcomes for sufferers of substance use disorders. Many individuals with co-occurring disorders go untreated due to a lack of access to services. But there is hope for dual diagnosis patients who struggle with addiction as well as a co-occurring disorder. Read on to learn more about co-occurring disorders and how appropriate treatment can lead to lasting recovery.
Does Mental Illness Cause Substance Abuse?
Researchers have spent a lot of effort to determine why so many people with mental disorders are drawn to drug abuse. One theory that is supported by evidence is the self-medication hypothesis.
The Self-Medication Hypothesis
In the 1980s, researcher Edward Khantzian suggested that many people with mental health disorders use drugs to self-medicate. They “discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states.” They may be trying to cope with trauma or with the symptoms of their illness, and find that alcohol or drug abuse helps them feel better on a short-term basis.
Khantzian believed that the substance used could often be traced to the symptoms the person was trying to relieve. Alcohol and sedatives like benzodiazapenes were used to relieve anxiety. Stimulants like cocaine and methamphetamine were used to compensate for depression or llack of energy. And opioid use disorder can be traced to pain, whether physical or emotional.
Feedback Loops
Unfortunately, self-medication quickly leads to dependence. Their symptoms often recur more strongly after the substances they use wear off, and they use again to cope. This leads to a cycle known as a “feedback loop” in which their mental health disorder causes increased substance use, and their increased substance use leads to worsening symptoms.
People with both a substance use disorder and a mental health condition can enter a feedback loop in which their increased tolerance to their substance of choice necessitates ever-increasing use to achieve the same effect. Meanwhile, this increased use causes increases in the underlying symptoms.
Does Substance Abuse Cause Mental Illness?
While the self-medication hypothesis illustrates the way that mental health disorders cause sufferers to abuse substances, that’s not always the direction of causation. The truth is that while mental illness is a risk factor for substance abuse, the relationship extends the other way as well. Substance abuse can strongly contribute to the development of mental health disorders.
People who abuse substances at an early age are at particular risk for co-occurring disorders as adults. Brain development is ongoing at these early ages, and using drugs can do permanent damage to neural pathways. Some people have genetic factors that predispose them to mental illness, and using drugs can hasten the onset of these conditions.
What Mental Health Disorders Commonly Co-Occur With Substance Use Disorders?
Although any mental health disorder can co-occur with substance use disorder, some disorders are more commonly linked with addiction. This list does not cover all the possible co-occurring disorders, merely a few of the most commonly reported.
Bipolar Disorders
Bipolar disorders have a major overlap with substance use disorders. One study with over 43,000 participants found that 60% of people with Bipolar I (which includes episodes of mania) also had a substance use disorder, and 47% of people with any bipolar spectrum disorder (including Bipolar II and cyclothymia) also had a substance use disorder.
Bipolar disorder causes extreme moods. Sufferers may depend on drug abuse to increase their mood during moments of depression, or to level it out during moments of hypomania or mania.
Additionally, during manic episodes, sufferers of bipolar experience increased impulsivity, one of the common risk factors for drug abuse. They may lose the inhibitions that normally prevent them from using substances. These are a few of the reasons they make up some of the most common dual diagnosis patients.
Depressive Disorders
Because they cause such negative impacts on patients’ moods, depressive disorders often result in self-medication. Major Depressive Disorder is one of the most frequent co-occurring mental disorders. People may abuse drugs or alcohol to numb the pain of their symptoms.
Paradoxically, some sufferers of Major Depressive Disorder cope by drinking excessively. Although it causes exhilaration in the short term, alcohol is ultimately a depressive substance. This means that their mental health condition is worsened by the substance they use to cope with it. This creates a feedback loop, where the more they drink, the worse they feel, and the more they drink to cope with it.
Major Depressive Disorder also causes lethargy and makes it difficult to perform the tasks of daily living. Some sufferers of this serious mental illness cope by using stimulant drugs like methamphetamine or cocaine. This type of use can also worsen their depressive symptoms, as they will feel even less energetic during periods when they are withdrawing from stimulants.
Anxiety Disorders
People with anxiety disorders are likely to self medicate with depressive and sedative substances. Benzodiazapenes are a common prescription for the treatment of anxiety disorders, but they are frequently abused. The National Institute of Health notes that monitoring dosage is one way for health practitioners to prevent abuse of these substances by people with mental disorders.
Alcohol also has anxiolytic qualities, meaning it reduces feelings of anxiety. But it is very easy for sufferers to enter a feedback loop, as they require more and more of the substance to feel calm. Additionally, anxiety is one of the biggest symptoms of withdrawal from alcohol, meaning that the rebound of symptoms is likely to be severe, and that long term users may develop an anxiety disorder that they did not have previously.
Post Traumatic Stress Disorder (PTSD) is another mental disorder with a high prevalence of co-occurring substance use disorders. Research by the National Institute of Health has found that 60% of people with PTSD also have a substance use disorder. They may depend of drug abuse to deal with traumatic memories and hypervigilance.
Personality Disorders
People with this category of mental disorders often do not feel that their thoughts or behavior are incorrect, despite the fact that it differs from cultural norms and negatively impacts their functioning. They are a major risk factor for substance use disorders, and because sufferers may not recognize that they have a mental illness, they may also be resistant to treatment for their substance use disorder. Additionally, people with co-occurring disorders are more likely to experience increased hospitalization rates, further complicating their recovery journey.
Among individuals with borderline personality disorder, who suffer from an inconsistent sense of self, overwhelming emotions, and unstable relationships, National Institute of Health research shows 73% have been reported to have a co-occurring substance use disorder. This may be partially explained by their tendency toward impulsivity.
Individuals with antisocial personality disorder are also at high risk for co-occurring substance use disorders. Research has found that they are thirteen times more likely to develop a substance use disorder than the general population.
Psychotic Disorders
Psychotic mental disorders, the most common of which is schizophrenia, also have a high prevalence of co-occurring substance use disorder. 25-35% of individuals with schizophrenia also suffer from alcoholism. And marijuana, which has developed a reputation as harmless, is linked to earlier onset of schizophrenia and worsening of psychotic symptoms.
Mental Health Treatment for Co-Occurring Disorders
Clinicians who treat co-occurring disorders in dual diagnosis patients use a number of techniques to address the unique needs of these patients and provide appropriate treatment.
Inpatient Detoxification Treatment For Drug Use
A medically supervised detoxification is often necessary for people with co-occurring disorders, both to monitor for the negative health conditions that can result from withdrawal, and to stabilize the symptoms of patient’s mental health disorders.
The National Institute of Health and the National Library of Medicine recommend inpatient detoxification treatment for patients who are unable to abstain from use on their own. Getting patients safely through the initial stages of withdrawal is an important part of treatment. Patients with mental disorders are likely to need inpatient detox before they will be responsive to mental health care.
Recognizing Common Risk Factors
Clinicians who work in dual diagnosis are trained to recognize the risk factors for mental illness. They will screen patients for trauma, ask about their level of social support, and examine whether their drug use could be a way of managing symptoms of mental health conditions or emotional problems. However, about 56.7 percent of adults with any past-year mental illness received no treatment, highlighting the importance of proactive screening and intervention.
Dual diagnosis clinicians often take a holistic view of health, looking at the way environmental factors contribute to a person’s mental health problems as well as their substance use disorder. The Substance Abuse and Mental Health Services Administration notes that environmental factors like a person’s family situation, neighborhood, and educational background play a large role in their mental health as well as their substance use.
For example, a young person who grows up in a household with adults who have mental disorders and substance use disorders is more likely to develop their own mental disorders and substance use disorders later in life. To treat this person and achieve lasting recovery, the clinician must understand how these family members contribute to the problem, and find other sources of social support for the patient. A lack of emotional and social support is a major risk factor for substance abuse.
Accurate Diagnosis of Mental Disorders
Clinicians must be careful to find the correct diagnosis for the co-occurring disorder. If they are off the mark, they may prescribe medications that actually exacerbate the symptoms of the patient. For example, misdiagnosing a person who suffers from Bipolar I with depression can result in prescribing an SSRI, which could trigger a manic episode.
Clinicans use the Diagnostic and Statistical Manual (the DSM) to evaluate a person’s current and prior symptoms, and will also examine their substance use to see if they have one of the other conditions that commonly co-occur. As noted above, a person’s choice of substance can provide a clue as to their underlying mental health condition.
Integrated Treatment for Dual Diagnosis Patients
The National Institute of Health’s National Library of Medicine notes that people who are dependent on alcohol or other substances and also have a mental disorder are likely to need integrated treatment. This means that their mental disorders and substance use disorders are treated simultaneously, rather than separately. Despite this, about 30.5 percent of adults with serious mental illness and co-occurring SUDs received no treatment, underscoring the need for accessible and integrated care.
To treat co-occurring disorders, clinicians must recognize the way that addiction can contribute to the development of mental disorders, and vice versa. Working in silos for the treatment of each issue is unlikely to yield lasting results.
For example, a patient who receives treatment for their addiction to opiates, but does not receive a diagnosis and treatment for their co-occurring depression, is likely to relapse when the symptoms of their depression re-occur. Mental health treatment that addresses both the substance use disorder and the mental disorder has been recognized by the National Institute of Health as more effective.
Behavioral Therapy
Behavioral therapy focuses on identifying and changing negative patterns of action. While psychoanalysis and other forms of mental health treatment delve deeply into the origins of a person’s mental disorder, behavioral therapy focuses on the present.
Patients with dual diagnosis and serious substance use disorders often do not have time to investigate the deep psychological roots of their addiction. Behavioral therapy’s focus on modifying observable actions makes it an effective way to treat adults with a substance use disorder and a co-occurring mental health disorder. There are a few types of behavioral therapy that may be used.
Cognitive Behavioral Therapy
Cognitive behavioral therapy focuses on changing negative thought patterns. In dual diagnosis patients, these thought patterns contribute to their struggles with substance use. For example, a person might identify triggers that lead them to use or drink. By becoming aware of these triggers and planning for how to react to them, a person can develop new ways of responding. The Substance Abuse and Mental Health Services Administration has found that CBT is effective for anger management in dual diagnosis patients with co-occurring mental disorders.
Dialectical Behavioral Therapy
Dialectical behavioral therapy, or DBT, was developed to treat Borderline Personality Disorder and similar mental disorders. It has shown promise for dual diagnosis patients. It helps people with mental disorders and substance use disorders to regulate their emotions, tolerate distress, and manage their relationships with other people. The National institute of Health has noted that DBT is effectve
Support Groups
Following or during integrated treatment, many clinicians recommend that dual diagnosis patients join support groups. These groups provide emotional and social support to people struggling with mental disorders and substance use disorders.
Alcoholics Anonymous and Narcotics Anonymous are among the most popular support groups, but there are others that are specific to other substances or challenges. There are even support groups for codependency and mental health conditions. Research has shown that dual diagnosis patients who attend support groups after treatment are likely to experience longer abstinence from substance use.
Integrated Treatment at Turning Point of Tampa
Turning Point of Tampa offers a fully integrated treatment model for dual diagnosis patients. Their clinical staff is equipped to treat both substance use problems and mental disorders. Dual diagnosis clients are given a unique case plan to help them achieve lasting recovery.
Frequently Asked Questions
Will Recovery from Substance Use Cure a Mental Health Disorder?
While effective treatment can lead a dual diagnosis patient to lasting recovery, it may not completely alleviate a mental disorder. Many mental health conditions are not fully curable.
Does Dual Diagnosis Treatment Work for Physical Health Conditions?
Dual diagnosis treatment specifically refers to co-occurring mental health disorders. Physical health problems are likely to require treatment at another facility.
Sources:
Harvard Review of Psychiatry: The Self-Medication Hypothesis of Substance Use Disorders
SAMHSA: Co-Occurring Disorders and Other Health Conditions
NIH: The Adolescent Brain and Substance Use
NIH: Common Comorbidities with Substance Use Disorders Research Report
Current Status of Co-Occurring Mood and Substance Use Disorders: A New Therapeutic Target
NIH: 2 Settings, Levels of Care, and Patient Placement
NIH: Integrated Treatment of Substance Use and Psychiatric Disorders
