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Substance use disorders (SUDs) including alcoholism and drug addiction are all too common, affecting more than 48 million people in the United States. Mental health disorders are also common, with nearly one in four people suffering from some type of mental illness.
A co-occurring disorder, also known as a dual diagnosis, occurs when a person has both an SUD and a mental health disorder at the same time. This has implications in both diagnosing and treating people who are seeking help for an SUD or a mental illness.
Co-occurring disorders affect about 21.5 million people in the United States, and roughly half of all people who have a serious mental health disorder struggle with substance abuse. This is in part due to people with mental health disorders “self-medicating” to relieve their mental health disorder symptoms. However, some people with SUDs develop mental health disorder symptoms during active substance use, but symptoms go away when they become abstinent.
The symptoms of co-occurring disorders vary based on the type of underlying mental health disorder. The most common disorders associated with substance abuse include anxiety, depression, bipolar disorder, ADHD, schizophrenia, and personal disorders.
Common symptoms of mental health disorders include:
Substance abuse disorders are characterized by seeking and using the substance regardless of consequences, withdrawal from normal activities, risky behavior, and withdrawal symptoms when substance use stops.
The causes of co-occurring disorders depend to a certain extent on which disorder came first. However, both separately and together, the causes may be genetic or environmental.
Genetically, some people may have a defect in how the brain processes dopamine or serotonin, or they may react differently to the abused substances.
Environmentally speaking, people who suffer childhood trauma may have a higher risk of mental health disorders. People who grow up with access to drugs or alcohol may be more likely to develop an SUD.
Often, it’s a combination of both genetic and environmental factors that lead to the co-occurring disorder.
In some cases, the underlying mental health disorder leads to substance abuse. For example, someone with severe anxiety may turn to alcohol to ease their anxiety symptoms. While this may ease symptoms in the short term, substance abuse often makes mental health disorder symptoms progressively worse.
In other cases, the substance abuse leads to mental health disorder symptoms. For example, a person with an alcohol use disorder may develop feelings of depression when they drink or after they drink.
It can be difficult to diagnose co-occurring disorders because many of the symptoms of SUDs and mental health disorders overlap. The question that must be answered is whether the mental health disorder existed prior to the SUD.
To determine if the disorder was preexisting, the patient will generally go through an extensive evaluation which involves questions about their history. At HSA, we do a multi-level assessment of patients to come to a diagnosis before any treatment is started.
Sometimes, family input regarding the patient’s history is also useful in diagnosing a co-occurring disorder.
The treatment of co-occurring disorders involves an integrated approach to treating the SUD and the mental health disorder at the same time. This may include both medications for the mental health disorder, such as anti-depressants, as well as different types of therapy to treat both disorders.
Cognitive behavioral therapy (CBT) is commonly used to treat co-occurring disorders and has proven to be quite successful. In CBT, patients learn ways to cope with their mental health disorder without abusing substances as well as strategies to control their negative or harmful thoughts and emotions.
Dialectical behavior therapy (DBT) uses some of the same techniques as CBT, but with a focus on mindfulness and challenging intense emotions with rational thoughts. It also involves strategies for patients to better manage interpersonal relationships.
Group therapy is an important part of SUD treatment, and can also be effective for the underlying mental health disorder. Peers in treatment are often suffering from the same or similar mental health issues, and can offer empathetic support to each other that medical professionals cannot. With regular group interaction, patients feel less isolated and can develop and practice personal relationships.
All of these therapies are employed in comprehensive treatment programs that consist of inpatient treatment, followed by a partial hospitalization program (PHP), and an intensive outpatient program (IOP). During the treatment program, medications may be used for the mental health disorder and adjusted based on their effectiveness.
After the treatment program, ongoing regular individual therapy for the co-occurring disorder should continue. Many people also find SUD support groups, such as Alcoholics Anonymous or Narcotics Anonymous, helpful in maintaining abstinence.
If you are struggling with substance abuse and mental health issues, help is available. Going through an extensive treatment program may seem daunting, but consider the potential reward of living a more productive and fulfilling life. Making the first call for help is the first step on a journey to a better future.
