Treating Co-Occurring Disorders
When someone is addicted to a substance and also is diagnosed as having one or more mental illnesses, he or she is classified as having a co-occurring disorder. Drug or alcohol abuse combined with a mental disorder creates a new and different set of challenges for treatment as opposed to singularly focusing on one or the other. Whether drug or alcohol dependence is a result of coping with the mental illness, or addiction itself has led to severe mental deterioration, the result is the same, an interdependence of two separate disorders compounding a dangerously precarious health situation.
This disorder can be challenging to diagnose, as symptoms of substance abuse can mask symptoms of a mental disorder, and symptoms of mental illness can sometimes be confused with signs of addiction. There are many common co-occurring disorders that are often tied to one another, which is why it is imperative that you are able to identify when you or a loved one is suffering from this condition.When someone is experiencing a co-occurring disorder, their symptoms are joined, making it impossible to disengage one disorder from the other. Often times people with mental health illness do not address their addiction because they don't see it as relevant to their problems.
When someone is experiencing mental health issues, whether it be anxiety, depression, post-traumatic stress disorder (PTSD) or any other diagnosis, they often turn to prescription pills, illegal substances or alcohol to help relax their symptoms. Unfortunately, forming a dependence on a substance not only fails to repair the mental health disorder, but also hinders the patient from establishing healthy coping skills, satisfying relationships, and confidence in themselves. Most often, drug or alcohol dependence makes the health disorder even worse.
According to a 2014 National Survey on Drug Use and Health, there are about 7.9 million adults in the United States who experience co-occurring disorders. This is much more difficult to diagnose because the symptoms are related, and will vary in severity, chronicity, disability, and degree of impairment. Also, the severity of the disorders may change over time. If untreated, co-occurring disorder patients can rapidly decline in health, leading to homelessness, incarceration, suicide, or early death.
People with co-occurring disorders may experience more serious medical, social, and emotional problems than if they were only dealing with a single disorder, and are more vulnerable to relapse and a worsening of the mental disorder. Because the disorders feed off each other, a relapse of one will trigger a relapse of the other. Therefore, treatment of co-occurring disorders must be specifically designed to address these unique complications and will often require longer treatment, will have more frequent crises, and generally progress more gradually.
Causes of Co-Occurring Disorders
Learning how to treat co-occurring disorders begins with understanding each individual patient and creating a specific integrated approach to treatment. There are several possible factors that could lead to substance abuse and mental illness and are often a result of biological and environmental elements. Some people are naturally susceptible to addiction or mental illness (genetic risk) or could be more likely to develop disorders through their living situation or trauma (environmental risk) or have a dependence on pharmaceutical drugs (pharmacologic risk). Many times, it can be a combination of these factors and will vary by degrees of severity, the rate of progression, and symptom manifestation.
Addiction can best be described as having a physical and psychological dependence on illicit and/or legal drugs, including alcohol. An addict has a physical dependence when they develop a tolerance to the drug and need an increasingly larger dose to experience the desired effect. Psychological dependence is manifested when the addict experiences cravings and an obsession with using the drug.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has established a basis to categorize all forms of substance abuse as well as the severity of the disorder from mild to severe.
There are 11 recognized symptoms that lead to a pattern of substance abuse.
- The inability to carry out obligations at home, work, or school. This includes responsible child care, repeatedly missing work or school, or always showing up late for appointments.
- The use of drugs or alcohol in situations where it becomes physically dangerous, such as operating a vehicle under the influence.
- Repeated or ongoing negative issues with other people as a result of drug or alcohol use, such as fighting with family members or a significant other.
- A tolerance to the drug because of a decreased effect, resulting in a need for an ever-increasing dosage.
- Withdrawal symptoms when the drug of choice is removed.
- Taking more of the substance either in a single session or in a certain period of time.
- The inability to fully stop taking the drug or cutting down on use.
- A large amount of time spent seeking out the drug, being high or drunk and recovering after from it.
- Avoiding family or social activities, or giving up former hobbies due to substance use.
- The continued use of the substance despite recognizing the problems it causes psychologically, physically, or socially.
- Continued cravings for the substance.
DSM-5 also creates the standard for evaluating mental illness. Each disorder is explained, and the diagnostic criteria sets are classified. This includes the symptoms that must be exhibited by the individual -- as well as the symptoms and disorders that must be ruled out -- prior to diagnosing a person with each disorder. Experiencing symptoms that are severe and often enough to interfere with daily life and relationships usually indicates a mental health diagnosis. When treating co-occurring disorders, a specific focus on the designated mental illness is necessary to integrate a successful treatment plan.
20 million Americans are living with some type of depression. Often, symptoms of depression are also linked to other forms of mental illness, and substance abuse is very often a co-occurring disorder, contributing to a co-dependent relationship between the drug and the depression.
Symptoms of depression include:
- Deprival of feelings of joy and hope, leaving a lingering sadness
- Guilt, low self-esteem, and/or worthlessness
- Low energy
- Weight loss or gain
- Erratic sleep patterns
- Lack of interest in old hobbies
- Suicidal thoughts or behaviors
Depression can be caused by many things, and most people feel depression at one time or another, either over the loss of a loved one, a job loss, the end of a relationship. Postpartum Depression may occur after a woman gives birth, and Seasonal Depression may set in when winter seems like it will never end. Only if the depression persists, or can be found to be a symptom of a larger disorder, like bipolar disorder, will treatment be necessary.
Often depression is treated with tricyclic antidepressant medication like Prozac or Zoloft, but more effectively, a comprehensive approach is used to combat the mental disorder. Cognitive behavior therapy is often recommended, and holistic treatments to lower stress and increase an overall positive perspective have also proven to be effective.
Twice as prevalent as depression, an estimated 40 million Americans are living with any of a variety of anxiety disorders. Post-Traumatic Stress Disorder (PTSD), phobias, obsessive-compulsive disorder (OCD), panic disorder, generalized anxiety disorder (GAD) and others affect the lives of people every day.
Symptoms will depend on the specific disorder, but may include:
- Flashbacks of trauma or abuse
- Rapid heart rate
- Rapid breathing
- Obsessive thoughts
- Repetitive behavior
- Irrational fears or overwhelming panic
The cause of an anxiety disorder can be traced genetically or can be the result of a traumatic event, such as someone who lives through a sexual or physical assault, or a soldier suffering from the combat in war.
Exposure therapy is a form of Cognitive Behavioral Therapy that has proven to be successful when treating this disorder. Encouraging patients to “face their fear” allows them to learn how to manage the anxiety and the fear that triggers it.
Holistic treatments also work well, as deep breathing, meditation, and yoga can all help manage anxiety. If medication is prescribed, Benzodiazepines such as Klonopin or Xanax, antidepressants, or beta-blockers like Inderol may all be useful depending on the diagnosis.
A bipolar disorder is characterized by extreme mood swings, from a very high "high" called mania to very low "low" which brings on a deep depression. About 2.6 million people are affected with this disorder, and it is usually exhibited by jumping from one extreme emotion to another, from excitable, chatty, and busy to morose, hostile, and lethargic. The mood might last a few days or even months before it drastically shifts to the other extreme, and it can lead to erratic behavior and can make keeping personal and professional relationships a challenge. Sleeping and eating patterns are also commonly affected. Genetics may be a reason for bipolar development, or it may be as a result of abnormal brain function.
Treatment for a bipolar disorder is primarily done through medication, as antipsychotic meds, mood stabilizers, and antidepressants may be prescribed. Cognitive Behavioral Therapy, holistic treatment, family therapy and others will continue to be needed to manage the symptoms as bipolar disorder is unfortunately lifelong in most cases.
Other Classified Disorders
There are many other mental disorders that affect people all over the world, and there are specific plans to treat each one. A strong support network and ongoing treatment give patients the greatest chance for successfully managing their symptoms.
Some other mental disorders include but are not limited to:
- Personality disorders
- Eating disorders
- Autism spectrum disorder (ASD)
- Psychotic disorders such as schizophrenia, postpartum psychosis, delusional disorder, etc.
- Attention deficit hyperactivity disorder (ADHD)
When these and the many other afflictions people experience are combined with an addiction to drugs or alcohol, the chance of recovery lessens and the risks of homelessness, crime, and death increase. Efforts must be compounded to properly administer the treatment for co-occurring disorders.
As outlined above, medication is often prescribed to patients with mental illness, but an addiction can be developed to those same meds that are intended to provide the patient relief from pain, anxiety, or other ailments. The administration needs to be monitored, and a dependence on any substance should be addressed. Integrated treatment programs can direct their services to manage medication to avoid dependence or addiction. Co-occurring disorders treatment centers can offer alternatives to addictive medication, provide therapy that addresses the urge to compulsively abuse medication or other substances, and facilitate support groups to address the underlying disorder and prevent relapse.
There are a variety of therapy types for people suffering from one or more disorders, or the combination of co-occurring disorders. Some are designed to be completed in a certain amount of time; some are goal-oriented, some are open-ended and allow patients to attend as needed.
Some common therapies include:
- Cognitive and behavioral therapies focus on the patient’s perspective, especially when it comes to making self-harming decisions. Insight into the assumptions that drive the patient’s perspective can help in the healing process. Also, focusing on the behaviors that may seem automatic for an addict can help them make changes in their life to improve their quality of life, better manage their mental health disorder, and avoid relapse.
- Dialectical Behavior Therapy (DBT) is designed to help patients with suicidal tendencies to accept the reality of what is, rather than placing judgment on themselves as good or bad.
- Interpersonal therapy is intended to improve the patient’s ability to communicate with others. This works to limit the misunderstandings (which can be a source of difficulty to the patient and a huge barrier to seeking help), lower stress, and increase the patient’s ability to successfully manage their mental health symptoms and avoid relapse.
- Family therapy can be very effective as the support of the primary relationships in a patient’s life can foster recovery.
An Integrated Approach
When treating co-occurring disorders, great care must be taken to properly diagnose the patient’s complex condition and the equally demanding recovery. There are numerous therapies based on solid research that has proven to be effective in treating those with mental illness as well as an addiction. A steady balance of an integrated treatment plan focused on all facets of a patient’s co-occurring disorders is necessary to generate progress. Personalized care and long-term support are the keys to managing symptoms for a healthy recovery.