Treating Co-Occurring Disorders

Approximately 27 million American adults used an illicit drug in the month leading up to the 2014 National Survey on Drug Use and Health (NSDUH) while nearly 140 million people drank alcohol. Substance use is not necessarily always problematic, but chronic abuse can lead to drug dependence and addiction. The NSDUH reports that over 20 million adults in the United States battled the brain disease of addiction in 2014.

The presence of a mental health disorder can increase the risk for addiction. The National Institute of Mental Health (NIMH) publishes that more than 43 million American adults struggled with some form of mental illness in 2015. Both mental illness and substance abuse can contribute to and complicate each other. When a person battles both a mental health disorder and addiction at the same time, the disorders are considered to be co-occurring. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that almost 8 million adults in the United States struggled with co-occurring disorders in 2014.

Common Co-Occurring Disorders

Half of those who struggle with serious mental illness, and one-third who battle any form of mental illness, abuse substances, the National Alliance on Mental Illness (NAMI) publishes, and the reverse is also true, as over half of those who abuse drugs also suffer from mental illness and one-third of individuals who abuse alcohol do as well. Mood and anxiety disorders are some of the most common mental health issues to co-occur with substance abuse and addiction, the journal Addiction Science & Clinical Practice reports. Drug and alcohol use may seem to blunt the symptoms of an anxiety or mood disorder at the time; however, the “crash” from these mind-altering substances can be more significant and end up making the side effects worse.

Addiction can also lead to more issues socially, emotionally, physically, and behaviorally, increasing the odds for more physical health problems, higher stress and emotional strain, worsening mental illness, complications with treatment and compliance, a higher risk for suicidal thoughts or actions, and a decreased quality of life in general.

Highlighted below are specific mental health disorders that regularly co-occur with substance use and addiction:

  • Depression: Low energy, activity levels, and moods are signs of depression, and drugs and alcohol may commonly be used to try and boost these. The National Institute on Drug Abuse (NIDA) reports that around 40 percent of those suffering from a mood disorder abuse drugs, and that those battling a mood disorder are more likely to struggle with addiction than those who are not.
  • Bipolar disorder: A severe mood disorder characterized by extreme swings in mood, energy, and activity levels, bipolar disorder is indicated by episodes of mania and depression that may include psychotic symptoms. Individuals battling bipolar disorder abuse drugs and alcohol at very high rates. The journal Substance Abuse Treatment, Prevention, and Policy reports that at least 40 percent of adults battling bipolar I disorder also suffer from addiction.
  • Anxiety disorders: Examples include generalized anxiety disorder (GAD) and social anxiety disorder. Anxiety can induce a person to want to take drugs or drink alcohol to alleviate the symptoms. The Anxiety and Depression Association of America (ADAA) estimates that 20 percent of those battling an anxiety (or mood) disorder also suffer from addiction and vice versa.
  • PTSD (post-traumatic stress disorder): A type of anxiety disorder involving a previous trauma or life-threatening event, PTSD and addiction commonly co-occur, as individuals may drink alcohol or do drugs to try and self-medicate. The S. Department of Veterans Affairs (VA) publishes that one out of every three veterans who seek out treatment for addiction also suffers from PTSD and 20 percent of those battling PTSD also struggle with addiction.
  • Schizophrenia: A serious and complex mental illness that involves disorganized thoughts, emotional responses, and perceptions, individuals battling schizophrenia commonly resort to alcohol and drug abuse. According to Psych Central, those suffering from schizophrenia smoke cigarettes at rates as much as three times those of the general population in the United States.
  • Personality disorders: Examples include antisocial personality disorder and borderline personality disorder (BPD). Personality disorders involve difficulties relating to others and behavior patterns that are often extreme and problematic. Drugs and alcohol may seem to help these individuals to fit in socially. Studies published by SAMHSA found that over half of those who struggled with BPD also battled addiction at some point in their lives.
  • AHDH (attention deficit hyperactivity disorder): Impulsivity, an inability to focus, disorganized thoughts, and restlessness are all common signs of ADHD. The journal ADDitude reports that adults suffering from ADHD also abused or were dependent on alcohol or drugs three times as much as the general population who didn’t struggle with the mental health disorder.

Further Reading


Diagnosing Co-Occurring Disorders

There are several factors that can contribute to the onset of both a mental health disorder and addiction, and many of these aspects are overlapping. For example, co-occurring disorders may involve similar regions in the brain or have biological or genetic vulnerabilities that make a person more prone to suffer from them. Mental health disorders often involve dysfunctions in brain chemistry or certain regions of the brain that can also contribute to substance abuse and addiction, as drugs and alcohol interfere with these same chemicals and brain areas. Environmental factors like chronic stress, trauma, or childhood neglect or abuse can also make a person more likely to struggle with addiction and potentially develop a mental health disorder as well.

Using drugs or drinking alcohol before the brain is completely developed (usually in early adulthood) can contribute to both the onset of mental issues as well as potential problems with substance abuse as an adult. Many mental health disorders can be triggered by substance abuse, and drug and alcohol use can definitely exacerbate symptoms of a mental health disorder. Marijuana use at a young age, for instance, may lead to worsening or earlier onset of schizophrenia in individuals who are vulnerable to the disorder, NIDA warns. Drug use can induce psychotic symptoms, and if there is an underlying mental disorder, it may bring it to the surface.

Alcohol and drugs are often used as a form of self-medicating mental health disorder symptoms. This can actually make the side effects of both the substances involved and the mental illness worse.

Substance abuse can make it potentially more difficult to diagnose a mental illness, and the reverse is also true. Medical and mental health assessments should be thorough and involve both mental health screening and an evaluation of drug and alcohol use in order to properly diagnose co-occurring disorders. A detailed medical and mental health history is needed to paint a clear picture of the individual’s situation, and individuals are also asked about the role alcohol and drugs play in their lives.

When disorders are undiagnosed, they are also left untreated. Proper assessment by trained professionals can help to determine what disorders are present, so they can then design a specialized care plan to attend to them.

Treatment Options for Co-Occurring Addiction and Mental Health Disorders

Over the years, co-occurring disorders have been treated in many ways. They may have been treated one disorder at a time with whichever one was considered more severe attended to first and then the other one addressed second. Integrated treatment that manages both disorders simultaneously is generally thought to be the most effective method today. Since symptoms and side effects of addiction and mental illness may be difficult to untangle from each other, treating them at the same time can be extremely beneficial.

It is also helpful to have medical, mental health, and substance abuse treatment providers all working together toward the same goals. This way, medications and treatment protocols can be properly managed to ensure optimal results and fewer potential pitfalls. Each disorder makes the other inherently worse. With oversight from a team of treatment providers, compliance can be closely monitored, and the plan can be adjusted when needed.

Pharmacological management is often necessary to manage symptoms of a mental health disorder, and these medications will need to be carefully supervised and controlled when a history of substance abuse is also present. Certain types of drugs (those that are habit-forming) may need to be replaced with those with less potential for abuse and diversion.

When someone suffers from significant drug dependence, a medical detox program may be the first stage of a treatment program after the detailed evaluation. Some drugs, such as opioids and benzodiazepines (and also alcohol), should never be stopped suddenly as severe withdrawal side effects can occur. Instead, medical detox programs can help to safely taper these substances out of the body, often with the help of other medications.

Moods are drastically affected by drug withdrawal, and when a mental health disorder is also diagnosed, detox will need to be closely monitored and managed through a specialized around-the-clock program to manage the side effects. Holistic measures, such as balanced nutritional plans, massage therapy, yoga, chiropractic care, mindfulness meditation, and more, can be helpful adjunctive therapies to promote healing during treatment and detox as well.

Treatment for co-occurring disorders is individual, and no two plans will be exactly the same. That being said, most will include group and individual therapy. Contingency Management (CM), Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI), and relapse prevention programs are commonly used to treat co-occurring disorders as part of an integrated care plan, Psychology Today reports. CM offers small incentives and rewards for clean drug tests and the achievement of attainable goals while MI is a non-confrontational approach that helps individuals find the motivation within themselves to want to make positive changes. CBT addresses negative thinking patterns and works to help people develop new and healthier coping strategies and mechanisms for managing stressors and behaving in more positive ways. Learning how to deal with possible triggers, cravings, and stress are important aspects of relapse prevention programs that can provide tools a person can use to promote and sustain their recovery. Family involvement and peer support groups can help with this as well.

The main goal of treatment for co-occurring disorders is to help individuals lead healthy, meaningful, and productive lives. A complete treatment program will assist people in developing new and useful life skills, help them to form better communication and stress management tools, and provide support, encouragement, and hope. Treatment consultants can help families and loved ones to find a program that will be a good fit for a lasting recovery.


Further Reading