Individuals who have an addiction experience increased risks of developing a mental health disorder and vice versa. The coexistence of a substance use disorder (SUD) and mental health disorder is known as a co-occurring disorder. Unfortunately, co-occurring disorders appear at alarming rates.
Co-occurring disorders can bring about various uncertainties and unique challenges during treatment. Recovery is possible with the right treatment, though. To effectively heal from co-occurring disorders, treatment programs must utilise an individualised approach to treatment and recovery.
Understanding Co-Occurring Disorders
First, it is important to recognise that there are endless combinations of co-occurring disorders. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “Co-occurring disorders may include any combination of two or more substance use disorders and mental disorders identified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)“.
Learning about some common combinations of co-occurring disorders can help readers recognise whether they or their loved ones may experience an increased risk of developing an additional condition.
Examples of Mental Health Disorders
Mental health disorders are complex. Each category of mental health disorder is marked by unique symptoms. According to SAMHSA, mental health disorders involve “changes in thinking, mood, and/or [behaviour]”. Let’s discuss categories of mental disorders.
Anxiety Disorders
An anxiety disorder involves persistent and chronic symptoms of anxiety, including fear and worry. Common examples of these conditions include generalised anxiety disorder (GAD), social anxiety disorder, panic disorder, and phobia-related disorders.
Mood Disorders
All mood disorders involve marked disruptions in emotional regulation. This can occur in a heightened state called hypomania or mania. Additionally, it can include a lowered state called depression. Examples of mood disorders include major depressive disorder (MDD), persistent depressive disorder (dysthymia), bipolar disorder, and seasonal affective disorder (SAD).
Personality Disorders
A personality disorder falls into one of three clusters based on a collection of symptoms. As stated in the DSM-5, all of them involve “an enduring pattern of inner experience and [behaviour] that deviates markedly from the expectations of the individual’s culture”. Examples of personality disorders include antisocial personality disorder, borderline personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder.
Psychotic Disorders
Psychosis includes symptoms that affect the mind, causing an individual to lose contact with reality. While they can occur as a secondary specification of many disorders, psychotic disorders involve psychosis as the primary symptom. Examples of these disorders include schizophrenia, schizoaffective disorder, and delusional disorders.
Dissociative Disorders
People with dissociative disorders experience an involuntary escape from reality, causing problems with memory, emotion, identity, perception, and sense of self. Examples of dissociative disorders include depersonalisation-derealisation disorder, dissociative amnesia, and dissociative identity disorder (DID)
Trauma-Related Disorders
Traumatic incidents can cause challenging psychological reactions that impair daily functions. In this case, a person will receive a diagnosis of a trauma-related disorder. Examples of trauma-related disorders include post-traumatic stress disorder (PTSD), acute stress disorder (ASD), and reactive attachment disorder (RAD).
Eating Disorders
A person with an eating disorder with experience severe disturbances in their eating patterns and overall body image. Examples of eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder (BED).
Common Misused Substances and Examples of SUD
According to the National Health Service:
Being addicted to something means that not having it causes withdrawal symptoms, or a “come down”. Because this can be unpleasant, it’s easier to carry on having or doing what you crave, and so the cycle continues…The strain of managing an addiction can seriously damage your work life and relationships. In the case of substance misuse (for example, drugs and alcohol), an addiction can have serious psychological and physical effects.
The Adult Substance Misuse Treatment Statistics 2020 to 2021: Report published by the Office for Health Improvement and Disparities (OHID) states that the two largest groups of people in treatment for substance addiction are people abusing opioids and alcohol. Both communities slightly increased in number from the previous year, a trend that has continued for many years.
This only accounts for individuals in treatment, though. Many people haven’t sought treatment for their substance abuse. OHID reports that 81.9% of dependent drinkers and 52.1% of drug users aren’t in treatment.
While an individual can have a general diagnosis of SUD, they can also have a unique type of SUD. Examples of SUDs include:
- Alcohol use disorder (AUD)
- Opiate use disorder (OUD)
- Marijuana use disorder
- Nicotine use disorder
- Stimulant use disorder
- Sedative use disorder
The Prevalence of Co-Occurring Disorders in the UK
According to the National Institute for Health and Care Excellence (NICE), “UK studies have reported dual diagnosis rates of 20-37% across all mental health settings and 6-15% in addiction settings.” Still, SUD and mental health disorders often overlap in symptoms, which can make it challenging for an individual to recognise the presence of a co-occurring disorder in themselves or their loved ones.
Why Do Co-Occurring Disorders Happen?
Although co-occurring disorders are common, it does not mean that one condition necessarily caused another. The Common Comorbidities with Substance Use Disorders Research Report suggests three possibilities as to why SUDs and mental health disorders co-occur.
#1. Co-Occurring Disorders Develop From Shared Risk Factors
Contrary to what one may believe, the same risk factors that contribute to SUD also contribute to mental health disorders. In general, these risk factors can be separated into two categories: genetic and environmental.
Genetic risk factors take into account how certain biological and gene traits can influence the development of addiction and mental illness. Examples of genetic risk factors include a family history of substance abuse and a high genetic propensity for addiction.
Environmental risk factors acknowledge that exposures and experiences can increase an individual’s risk for addiction and mental health disorders. According to the Centers for Disease Control and Prevention (CDC), some risk factors include, but are not limited to:
- Childhood trauma, including abuse and neglect
- Family normalisation of substance use
- Association with delinquent or substance-using peers
- Low academic achievement
#2. Mental Health Disorders Increase the Risk of Self-Medicating
Another explanation for the high prevalence of co-occurring disorders is efforts to self-medicate mental health disorders. Self-medication occurs when an individual uses alcohol or other drugs in an attempt to treat, manage, or numb difficult symptoms and emotions.
Some people may engage in self-medicating practices unconsciously. Reaching for a beer when arriving home after work can easily become a habit. This can be especially true for those that have undiagnosed mental health disorders. On the other hand, many people who recognise their struggles with mental health may consciously use alcohol and other drugs to cope with their symptoms.
Alcohol and other drug use can produce pleasurable responses in the brain. For an individual with a mental health disorder, substance use may seem to provide temporary relief from uncomfortable symptoms of their condition.
It is important to understand that self-medicating practices of any kind can be detrimental to an individual’s health and well-being. Not only can using alcohol and other drugs as a coping mechanism worsen already present mental health symptoms, but it can also trigger the development of SUD.
#3. Substance Use Can Trigger Mental Health Problems
Brain structure and chemistry impact the likelihood of developing different illnesses. Substance use – even in moderation –can alter important brain areas that are commonly disrupted in other mental health disorders. The change can impair associated functioning. This can make an individual more vulnerable to developing a mental health disorder, even after using a substance one time.
Treatment Challenges for Co-Occurring Disorders
Co-occurring disorders are comorbid, which means that illnesses not only interact but they also affect the course and prognosis of each other. According to a publication by the U.S. National Institutes on Drug Abuse (NIDA), “Patients who have both a drug use disorder and another mental illness often exhibit symptoms that are more persistent, severe, and resistant to treatment compared with patients who have either disorder alone”. For this reason and more, effective treatment must address all co-occurring conditions simultaneously.
Remember that treatment involves more than just ceasing problematic alcohol and drug use and mental health symptoms. To ensure lasting recovery, treatment must help individuals work through the root causes of their substance abuse and mental health challenges. Additionally, individuals must gain knowledge of healthy and useful coping mechanisms that can be utilised during times of high stress and emotional discomfort.
Examples of Improper Treatment of Co-Occurring Disorders
Improper treatment of co-occurring disorders prioritises one condition over the other. To understand why it is crucial to treat both conditions simultaneously, consider two examples.
Example #1: Treating Addiction Without Treating a Co-Occurring Mental Health Disorder
Consider an individual who enters addiction treatment for AUD. The treatment centre helps the individual establish initial sobriety by aiding in initial detox. They supply healthier coping mechanisms for managing alcohol triggers. However, professionals do not address any underlying mental health conditions or potential causes for why this individual developed AUD.
For this example, the individual with AUD also has co-occurring depression. However, their depression has not been diagnosed, which means that they are unaware of it. When treatment only works to address problematic substance abuse, the symptoms of the undiagnosed depression can become more prevalent as a result. In other words, treatment is only fixing half of the problem.
The chances that this individual developed AUD in an attempt to self-medicate their depressive symptoms are high. However, without conscious knowledge of self-medication or professional treatment addressing their depressive symptoms, this individual is much more likely to return to substance use once they leave the treatment setting.
Example #2: Treating a Mental Health Disorder Without Treating Problematic Substance Abuse
On the other hand, often, an individual enters treatment for a mental health disorder, but treatment does not address any co-occurring substance abuse problems. In this example, an individual has GAD and also struggles with problematic marijuana use.
Similar to the previous example, this individual may have begun using marijuana to self-medicate. However, it is also likely that their marijuana use could have triggered their anxiety disorder.
If an individual receives treatment that only addresses their anxiety disorder, they are missing a huge piece of treatment that would otherwise work to reverse the brain changes that may have resulted from marijuana use.
As mentioned before, solely ceasing substance use is not enough to establish long-lasting sobriety. This individual requires professional care to understand how their thoughts, emotions, and addictive behaviours all intersect.
Additionally, if an individual hides their substance abuse during treatment, it will only reduce their ability to maintain lasting recovery from their anxiety disorder in the long run. Even moderate substance use can lead to long-term changes in brain structure and associated functioning. Chances are very high that this individual will experience perpetuating anxiety symptoms, even after receiving treatment, as a result of untreated, co-occurring substance abuse.
Treatment for Co-Occurring Disorders Involving SUD
As shown in these examples, treatment for co-occurring disorders can be complicated. The most effective treatment approaches utilise both integrated and individualised care throughout recovery.
First, this requires treatment centres to identify and evaluate each disorder as accurately as possible. Secondly, it requires that treatment plans utilise interventions to appropriately fit the individual’s wellness needs, in addition to their diagnoses. Lastly, comprehensive assessment tools must be used during an individual’s initial evaluation to ensure that there are no missed diagnoses.
The First Stage: Detox
Individuals seeking recovery from co-occurring disorders that involve SUD or addiction must, first, utilise professional detox. Guided by health care professionals, detox is a process that helps individuals rid their bodies of the remnants of alcohol and other drugs.
Many may wonder if it is safe to detox from alcohol and other drugs at home. Simply put, the detox process can surface various withdrawal symptoms. They can be severe — and potentially fatal — if an individual chooses to not utilise professional support. Because professional detox can provide both physical and psychological support to individuals, it is significantly safer and more effective than detoxing at home.
Often, medications are administered during detox to make the process as manageable as possible. When medication is used in tandem with behavioural therapies, it is known as medication-assisted treatment (MAT). Detox MAT drugs can decrease cravings and ease withdrawal.
Beginning Rehab for Co-Occurring Disorders
Following detox, an individual will work with mental health professionals to determine the underlying causes of their mental health disorder and co-occurring SUD. Becoming educated on personal motives for substance abuse and understanding why certain symptoms of a mental health disorder surface from time to time is instrumental for lasting recovery success. Likewise, doing so actively prevents a return to substance use in the future, as an individual will learn healthier coping mechanisms for managing symptoms when these issues come to light.
Inpatient vs. Outpatient
It is essential to understand that there are many avenues of treatment for co-occurring disorders. For those that require flexible scheduling and the ability to attend to personal responsibilities throughout the week, outpatient treatment is a great option. If someone’s struggling with severe symptoms of SUD and mental health issues and can put outside responsibilities on hold, inpatient rehabilitation (also known as residential rehab) can be paramount.
Therapy for Co-Occurring Disorders
Regardless of the type of program an individual utilises, they will likely participate in several different types of therapies. Common behavioural therapies for co-occurring disorders include:
- Cognitive-behavioural therapy (CBT)
- Dialectical behavior therapy (DBT)
- Contingency management (CM)
- Family therapy
Treatment will, most likely, involve a combination of individual and group therapies. Additionally, in many cases, medication may be used to help reduce distressing symptoms that may accompany SUD and other mental health disorders.
The Value of Social Support
In addition to participating in treatment, it is essential to understand the value that social support can play in treatment and recovery outcomes. According to Substance Abuse: Official Publication of the Association for Medical Education and Research in Substance Abuse, “Social factors have been found to be important in influencing entry into drug-addiction treatment, as well as for retention in treatment and ultimate recovery”.
Engaging with other peers in treatment through support groups and group therapy interventions is instrumental for healing. When working to recover from co-occurring disorders, it is important to connect with others that may be experiencing similar struggles. Social support can be vital for achieving initial sobriety as well as maintaining long-lasting recovery from SUD and mental health disorders.
Co-occurring disorders are characterised by one or more substance use disorder and mental health disorder that occur simultaneously. These conditions are comorbid, which means that they interact and worsen the course of each other. Effective treatment for co-occurring disorders must utilise both individualised and integrated care. This often includes a combination of individual and group therapies. The Perry Clayman Project (PCP) has a number of quality rehabilitation clinics across the UK. We are dedicated to providing treatment and support to individuals seeking recovery from substance addictions and other addictive behaviours, such as gaming. Whether you require detox, treatment, aftercare, or general support, PCP is here to help. Call us today at 08000 380 480.