As described by Psychology Today, co-occurring disorders are simply defined as two or more mental health disorders that are present in an individual at the same time. Usually, the term refers to an addiction that co-occurs alongside another mental health issue, such as anxiety, depression, or a personality disorder.
The process of addiction treatment can become complicated when another mental health disorder is part of the picture. Sometimes, a mental health condition may occur before the substance abuse started and contribute to the formation of addiction. It is even possible for addiction to cause some mental health disorders, based on the way the substance of abuse acts on the brain.
In many cases, the co-occurring disorder can affect treatment of the substance use disorder because the symptoms of the co-occurring disorder contribute to triggers and cravings that lead the individual to relapse into substance abuse. Similarly, substance abuse can often worsen a co-occurring mental health disorder. This results in a feedback pattern that can cause both conditions to spiral, unless care is taken to treat and manage both conditions.
Types of Co-occurring Disorders
Any mental health disorder can co-occur with substance abuse; however, there are some mental illnesses that are more commonly seen with substance abuse issues. As described by the National Institute on Drug Abuse, mood and anxiety disorders are the ones that are most frequently seen in people being treated for addiction. Other conditions that frequently co-occur with addiction include:
- Post-traumatic stress disorder (PTSD)
- Anti-social personality disorder
- Obsessive-compulsive disorder (OCD)
- Conduct disorders like attention deficit hyperactivity disorder (ADHD)
In many cases, these mental health disorders come first, before the addiction, and contribute to the development of substance abuse.
The Relationship between Co-occurring Disorders and Substance Abuse
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), about 7.9 million people who have mental illnesses are also dealing with substance abuse issues. Why this relationship is so common is a subject of study by researchers and addiction professionals, and there are a few hypotheses about it. However, the idea with a great deal of research and evidence behind it seems to be the concept of self-medication, as described by the Harvard Review of Psychiatry.
When a person is experiencing the symptoms of a mental health disorder, it can be very frustrating, upsetting, and frightening. For example, a person who is dealing with an anxiety disorder may feel continually alert and nervous, unable to concentrate on anything other than the source of anxiety. That person might start drinking alcohol or using a sedative drug like Valium to calm those feelings. However, over time, the substance may not work as well as it used to, and the person might use more or use it more often.
Addiction treatment professionals refer to this as tolerance. As the individual uses the drug more and more, the effects seem to decrease, resulting in the person craving more of the drug. Tolerance and dependence can quickly lead to addiction. The challenge then becomes how to help the person manage the addiction when the co-occurring mental health disorder can be such a strong trigger for substance use.
When Addiction Comes First
While it is less common, it is possible for the addiction to come first and cause the symptoms of a mental health disorder. A common example occurs when people who abuse alcohol seem to become depressed or anxious. In many of these cases, if the addiction is managed, the symptoms of the co-occurring disorder will tend to fade. Nevertheless, it is still important during rehab for the individual to be treated for both disorders to ensure complete recovery.
Other cases may result in a more lasting mental effect, such as the psychosis that has been observed in some who abuse marijuana, according to the National Institute on Drug Abuse. Again, research is still being done to understand how this happens, but there is some indication that the individuals may have an existing vulnerability that enables the disorder to develop.
Treating Co-occurring Disorders
The key to treating co-occurring disorder is integrated care – that is, treating both conditions at the same time, in a way that acknowledges the effect that each condition has on the other. Whether the addiction came first, or the co-occurring disorder is an underlying factor, making sure that treatment supports the management of both disorders is important to helping the person achieve abstinence and recovery.
The process for treating the two disorders together can be similar to treating a substance abuse disorder alone. The difference is in adding treatment and support for the other mental health condition. Though specifics will vary according to individual needs, a general treatment plan might include the following:
- Medical detox: Medically supported detox can help to manage cravings and withdrawal symptoms, including those that might have to do with the other disorder. In addition, medical detox ensures client safety and wellbeing throughout the process.
- Behavioral therapy: Sessions that approach the addiction might be paired with one-on-one therapy for the co-existing condition. In this case, if there are multiple treatment personnel, therapies are coordinated to make sure that each treatment addresses the other in an integrated manner. Therapy addresses the entire individual, and all existing issues, rather than only focusing on one disorder.
- Medical treatment: If medicines are necessary to help the individual manage the co-occurring disorder or the addiction issue, they must be carefully coordinated by treatment personnel to make sure that the medicines do not have the potential to lead to further substance abuse.
- Group therapy and peer support groups: Working in a group where others are dealing with similar co-occurring issues can provide additional information from those who have experience managing co-occurring mental health conditions and substance abuse.
Treatment works best when it is customized to meet the individual’s needs. As described in an article from Alcohol and Alcoholism, the treatment of substance abuse cannot take the form of a one-size-fits-all approach, because the results of each person’s experience with substance abuse, triggers, and mental health issues are different. This is extremely apparent in those who have co-occurring disorders, which may affect each person and how substance abuse develops in a different way. Therefore, customizing treatment can be the difference between relapse and recovery for those dealing substance abuse as well as other mental illnesses.
Finding Appropriate Treatment
As described by SAMHSA, sometimes an individual may seek care from a primary care physician before seeking mental health or addiction treatment in the case of co-occurring disorders. In this case, it can be helpful for the physician to recognize symptoms, make diagnoses as appropriate, and recommend treatment.
For a person dealing with potential co-occurring disorders, working with a treatment center experienced in treating these types of conditions is vital. When seeking out a treatment program, ask about the center’s ability to treat these additional issues and their experience treating the specific combination in question. This will help to identify whether the program is prepared to effectively address the issue as well as the type of program that is needed to manage the specific conditions involved.
Through an experienced, research-based program that works to create individualized treatment plans for people with co-occurring disorders, an individual dealing with these issues has greater potential to move forward into recovery and a future of abstinence and management of the mental illness.