Co-Occurring Disorders

If you drink heavily or abuse drugs and you also live with mental illness, you can get better and greatly improve your quality of life. Treatment works best when it’s integrated – that is, when addiction treatment and mental health treatments are delivered at the same time, by a team of caregivers working together.

Definitions - Dual Diagnosis – Concurring Disorders – Co-occurring Disorders

In general, all of these terms refer to the co-presence of addiction or substance abuse and a mental health disorder. They can be used interchangeably.

Why Mental Illness and Addiction Co-occur

Unfortunately, if you’ve got a drinking or drug problem, you also raise your risks of mental illness – and if you’ve got a mental illness, you’re at much greater risk of drinking or drugging to excess.

People with a mental health disorder are far more likely to experience substance abuse or addiction. There are a number of reasons for this, such as:

• A common event or genetic history can trigger both mental illness and substance abuse (A very traumatic experience, for example)

• The symptoms of mental illness can lead to substance abuse, for self medication and other reasons (and substance abuse can easily lead to addiction). Additionally, people with certain mental illnesses are more vulnerable to substance abuse problems (they develop abuse or addiction problems more quickly)

• Substance abuse can trigger mental illness. Taking certain drugs, such as methamphetamine or cocaine, can cause psychotic symptoms directly and such drugs can also trigger depression during drug withdrawal. Drug and alcohol abuse can also lead to work, relationship or health problems that can also trigger mental health disorders, such as depression or anxiety

Substance abuse and addiction can cause mental health problems and mental health problems can spark abusive drinking or drug taking – and once a person has a dual diagnosis of addiction/substance abuse and a mental health disorder, both disorders continue to interact.

• Substance abuse frequently causes an intensification of mental heath symptoms, for example, by worsening depression or hallucinations

• Mental health disorders can intensify the effects of drugs and alcohol

• People who abuse drugs or alcohol are less likely to adhere to treatment recommendations and so tend to benefit less from mental health treatments (they are less likely to take their medications correctly, for example)

• People with co-occurring disorders may be more likely to get involved in confrontations or be aggressive and are more likely to get arrested and possibly incarcerated for their behaviors

• Co-occurring disorders can lead to greater negative behaviors – which can lead to relationship problems. People with a dual diagnosis are at greater risk of losing their social (family) support system

• People with co-occurring disorders may be less able to manage finances and may wind up homeless or in unsafe living environments

Because the use of drugs and alcohol and the symptoms of mental illness interact greatly, treatment for those with a dual diagnosis must attempt to better the symptoms of mental illness and the substance abuse/addiction at the same time. Treatment must be integrated to be effective.

The statistics listed below show just how commonly mental illness is linked with substance abuse.

• A person with a mental health disorder is 3 times more likely to experience a substance abuse problem over a lifetime – and a person with a drug abuse problem is 4.5 times as likely as a non drug abuser to experience a mental health disorder over the course of a lifetime.

• 24% of people who have had an anxiety disorder at some point will experience a substance abuse disorder at some point over a lifetime – for depression, that percentage rises to 27%

• Nearly half – 47% - of those that experience schizophrenia over a lifetime will also experience a substance abuse disorder at some point – for those with bipolar disorder, that percentage rises to 56% ¹

People with mental illness will sometimes self medicate – by taking drugs or alcohol to temporarily reduce negative symptoms of mental illness:

• A person with depression might use something to feel happier or euphoric, such as cocaine or alcohol

• A person with mania might use alcohol, to slow down a racing train of thought

Although self medication works in the short term, over the long run, it just makes things worse.

• In the immediate withdrawal period after use, drugs like cocaine or alcohol can increase feelings of depression and despair, or increase manic thought processes. During this ‘morning after’ stage, people will often turn to alcohol or drugs once again, to start feeling better.

• The repeated use of alcohol or drugs can easily lead to addiction and a whole new set of problems, and the repeated use of alcohol or drugs also interferes with the effectiveness or medications used to treat mental illness.

Self medication can feel good at first, but it can cost you in the end. ¹

The first thing to remember when considering treatment is hope.

Treatment works. It helps people gain control over the symptoms of mental illness and it helps people stop drinking or using drugs. People that get the right treatment can and do make great progress, improve health and live happier more fulfilling lives. It sometimes takes a bit longer – but people with dual diagnosis can and do recover everyday.

It is important, however, that a person with a dual diagnosis get the kind of treatment that is most likely to help.

Literally millions of Americans live with co-occurring disorders. Some have severe addictions with relatively minor mental health challenges and some have serious mental illness with some degree of alcohol or drug abuse – there is no one face of dual diagnosis and as such there is no ‘one treatment’ that fits the needs of all those seeking help.

What treatment you need depends on such factors as:

• The type of mental illness
• The severity of your mental illness
• The severity of your substance abuse/addiction
• Your age
• Your physical health
• Your history of treatment
• Any physical danger to yourself and/or others
• Many other factors

While treatment plans need be as unique as the people that require them, there are some general guiding principles for effective dual diagnosis treatments.

• Most importantly, treatment needs to be integrated. When you treat only the mental health disorder, the drug or alcohol use continues to worsen mental health symptoms and affects compliance with treatments. When you treat only the substance abuse – the symptoms of mental illness make compliance with recovery exercises difficult (or impossible). By treating only one of the conditions the untreated one just drags you back down!

Getting integrated treatment means getting help for the mental health condition and the substance abuse at the same time, under the care of a team of professionals who are working together and in concert on your case file. At its best, this type of treatment occurs in a single facility where doctors and other staff can meet to discuss your care and stay fully informed on developments.

Some of the techniques/treatments used by effective dual diagnosis treatment programs include:

• Using motivational interviewing and other evidence based motivational techniques to help dual diagnosis clients internalize a desire for change and willingness to work for it

• Programs that offer long lasting treatment that occurs in progress based stages

• Using outreach programs to help clients stay engaged in treatment (One of the best indicators of long term success is simply sticking with treatment – and for dual diagnosis populations, outreach programs, like visiting the home, can help a lot to lengthen treatment stays)

• Using counseling in treatment

• Helping the person improve their social environment - Helping them find safe living and social environments and avoid risky environments and people

• Helping the person improve in comprehensive ways - This can mean helping with housing, employment, relationships and in other ways. ¹
  

Talk to your doctor or primary mental health caregiver about your desire for dual diagnosis treatment, and get her recommendations for effective programs that meet your needs, in your area.

There are some treatment programs or support groups that do not believe in the use of medication for any reasons – claiming, amongst other things, that people on medication are not sober…or, ‘you can’t take drugs to beat a drug problem’.

These statements are false, and dangerous.

Doctor prescribed medications, used according to a treatment plan, do not get you high. They control brain chemistry to stabilize symptoms of mental illness.

Just as a person who takes a medication for heart disease or diabetes is still sober, so too is a person who takes medication prescribed to control mental illness.

Treatment programs that do not allow the use of medications may not have medical staff available that can understand these drugs, or they may object to them on misguided philosophical grounds. Whatever the reason – if you need medication to control your mental illness, you are far better off finding a treatment program or support group that understands and respects this need.

Who Is Most at Risk of Dual Diagnosis?

Although anyone can succumb to mental illness and substance abuse/addiction, people in some situations are at greater risk. In general, the more risk factors a person has, the greater their likelihood of dual diagnosis.

Risk factors include:

• Poor academic or employment performance
• Poverty
• Having few social relationships
• Unstable or unsafe housing – or a lack of housing
• Having a family history of mental illness or addiction
• Family problems
• Suffering trauma or abuse, whether today or from the past

Although some people are at greater risk, many people living with significant risk factors never experience addiction or mental illness. ¹