In the past, co-occurring disorders were either called dual diagnoses or dual disorder. Regardless of the term used, all three refer to the same thing; a person who is affected by both a substance abuse disorder and a mental illness at the same time. According to SAMHSA’s 2018 National Survey on Drug Use and Health, approximately 9.2 million adults in the United States have a co-occurring disorder. This is an increase of 1.2 million from a similar survey in 2014. These studies have shown that people with mental health disorders are significantly more likely to succumb to alcohol or substance abuse disorder than people without any mental health issues.
What makes co-occuring disorders more difficult is that they are extremely hard to diagnose since symptoms of both issues are complex, and many times, may overlap. A person’s alcoholism may get noticed and addressed, while their bipolar disorder goes undiagnosed and treated. These medical conditions become even more complex due to co-occurring disorders typically do not abide by a strict set of classifications. Although in many cases certain drugs pair well with and can alleviate symptoms of particular mental illnesses – anxiety disorders with alcohol or benzodiazepine (Xanax) addiction; depression with meth, Adderall, and cocaine addiction; schizophrenia and alcohol – there is not a one to one correlation. What we have found though is that mental illness often goes hand in hand with substance abuse disorder, and often though not always, there is a push and pull link between the specific substance and the mental illness. People who feel down in the dumps, take uppers to try and pull them up. People with schizophrenia drink to quell the voices in their head or alleviate the feeling of bewilderment. People who are anxious, often turn to weed, alcohol, and benzos to calm the turbulent inner feelings. And still, any combination of co-occurring disorders can ensue.
Co-occurring disorders can have psychological, social, and biological aspects, which make detection and diagnoses an even difficult diagnosis and treatment. Additionally, due to overlapping symptoms, improper screening, or other social or health problems that must be handled first, co-occurring disorders often don’t get resolved properly or in the correct order. The results of an untreated, undiagnosed co-occurring disorder are quite severe. Those with co-occurring disorders are likelier to be jailed, fall into joblessness and homelessness, have higher rates of suicidality and fatality. Below, we will discuss the symptoms of a co-occurring disorder, the signs, and treatment options.
What Comes First?
One of the biggest failures in treating co-occuring disorders is the order of treatment. We all deal with and experience mental illness or addiction differently. For some, mental health issues first develop during childhood or the teenage years, which are soon followed up with experimentation with drugs and alcohol, which leads to both substance abuse disorder and mental health problems. For a small percentage of others, their mental illness may lie dormant for years until being unlocked by drugs during their early adulthood. And yet others will look to drugs and alcohol to alleviate the pains of mental health issues that developed in their teens and twenties. Co-occurring disorders generally can be divided into two separate categories: those disorders that developed before substance abuse, and those that develop as a result of heavy substance abuse. Regardless of what type they have, both the mental health issues and the substance abuse issues must be fixed in order to recover.
Studies have shown that nearly one in two people suffering from severe mental disorders also deals with substance abuse issues. One in three of those simply diagnosed with any type of mental health issue, report alcohol or substance abuse problems. It is easy to understand why this occurs, why people whose mental illnesses go untreated will wind up self-medicating as a form of coping mechanism. They know that something is wrong in their head and they just want to feel better, to temporarily escape or numb the pain. Sadly, we know that this does not solve the issue, it only kicks the problem down the road, exacerbating the issue until it festers and requires redress.
Common Co-Occurring Disorders
Co-occurring disorders frequently go unnoticed in people who abuse substances or alcohol since several symptoms of mental disorders imitate those of substance abuse. Issues such as anxiety, insomnia, mania, depression, paranoia, violent behavior and visual and auditory hallucination all can be found in heavy substance abusers.
The most common co-occurring disorders found among people dealing with substance abuse include:
- Generalized Anxiety Disorder
- Obsessive Compulsive Disorder
- Panic Disorder
- Post-Traumatic Stress Disorder (PTSD)
- Social Anxiety
- Bipolar Disorder
- Major Depression
Thought-Related Disorders (Severe)
- Schizoaffective Disorder
Of these disorders, the mental health issues that will most likely lead to substance abuse issues are as follows:
- Antisocial personality disorder: 15.5%
- Manic disorder: 14.5%
- Schizophrenia: 10.1%
- Panic disorder: 4.3%
- Major depressive disorder: 4.1%
- Obsessive-compulsive disorder (OCD): 3.4%
- Phobias: 2.4%
People who deal with such disorders will regularly find that their mental issues will only get worse in the long term as a result of their substance abuse and that their substance abuse worsens due to their mental health issues.
Signs Of Co-Occurring Disorder
The specific signs of the various co-occurring disorder will vary on a case by case basis depending upon the mental health issue and the particular drug of choice. The symptoms of a schizophrenic alcoholic will be very different than a bipolar meth addict. However, there are general signs to look for since people with the co-occurring disorder have a tough time fitting in with everyday society. Merely acting normally and by society’s standards can be insanely hard, if not wholly unmanageable, especially for those with severe mental health issues.
Common signs include:
- Extreme mood swings – A person with a co-occurring disorder has difficulty staying even-keeled. Their moods are all over the place, swinging wildly and rapidly. At one moment they are elated, the next depressed. This is especially true for people who suffer from mood disorders such as bipolar disorder. Such issues are often only heightened by their substance abuse and the mood swings that go hand in hand with always chasing the next high and the irritable moments that are a part of the comedown and withdrawal from the high.
- Unable to hold down a job – Those with a co-occurring disorder have trouble following a strict routine, dealing with the pressure, the people, the obligations that all come with a 9-5 job. Their mental health issues make it difficult to socialize or act normally; their substance abuse makes them want to be anywhere else or to be under the influence at work. As a result, people with co-occurring disorders have great difficulty holding down a corporate job, let alone a part-time job. If someone you know has exhibited a pattern of being fired from every job they have, and if it’s always their boss’ or coworkers’ fault for them being let go, there is a good chance that there are underlying issues.
- Financial issues – People with co-occurring disorders regularly struggle with their finances. Not only is it hard for them to hold down a job, but it’s also hard for them to think long-term and save. Those with severe substance abuse issues often spend every second of free time and every extra dollar on getting their drugs and using. Substances such as cocaine and opioids are exorbitantly expensive habits, that can cost thousands per month to maintain. If someone you know is always borrowing money, or needing a loan, or struggling to pay their bills, they may be blowing all of their finances on their substance abuse.
- Inability to maintain functional relationships – Those with co-occurring disorders have trouble keeping healthy relationships, especially with people who do not use drugs. Relationships take time, effort, communication, honesty, and all of these things are quite hard for someone who is so unstable to manage. Their mood swings, substance abuse, and inward focus regularly take precedence over their loved ones wants and needs. On top of that, a cycle of substance abuse is typically filled with deceit, lies, and guilt. It is an issue of shame that is often kept quiet or hidden, at least initially, for fear of hurting or disappointing their loved ones. Some addicts reach the point where they simply no longer care about anything or anyone besides getting their next high. They will say and do terrible things, they will push others away, or take actions that can instantly wreck relationships.
- Legal Problems – People with co-occurring disorders often have brushes or trouble with the law. Their inability to conform to everyday society and their drug-seeking habits can lead them astray. Drug addicts have been known to steal or break into houses in order to get more drugs or money for drugs.
- Inability to control their emotions – Those dealing with both mental health issues and substance abuse issues have difficulty handling their emotional ups and downs. They lash out, say or do things that they usually wouldn’t, and are often times irritable or flat out angry. Their equilibrium is nearly constantly out of whack, and this manifests in their lack of control over the emotions.
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.
Causes Of Co-Occurring Disorders
While there does seem to be a genetic link between substance abuse and particular mental health disorders, it is not a one-to-one correlation and scientists are unable to say why a person might develop either one of these issues, both of them, or none at all. A prevailing theory that the medical community holds is related to the stress-vulnerability model, which states that stress and biological vulnerability are linked and tend to turn into a condition. Such people are either born or develop this sensitivity to stress early in life. This can occur from a virus in the womb, or environmental factors that trigger symptoms. Medical specialist postulate that people with mental health disorders might be more biologically sensitive to the effects of substances, which is why there is a higher risk of having a substance abuse issue if you already have a mental health issue.
What Is Co-Occurring Disorders Treatment
In traditional care, addiction issues and mental health disorders are generally treated separately, or one is treated, and the other is left to fester. Medical experts have learned that co-occurring substance abuse and mental health disorders require simultaneous treatment in order for that treatment to be effective. This treating of both disorders at the same time, in the same place and by the same team, is known as an integrated treatment. This is a comprehensive rehabilitation program that provides all of the medical, holistic, therapeutic, resources required to help cleanse a client of substance addiction and address their mental health problems. It is an attempt to create a mental, physical and spiritual equilibrium. If diagnosed with co-occurring disorders, integrated care is necessary for dealing with both problems.
The steps include:
- Evaluation – Doctor speaks with the patient and evaluates their mental and substance issues.
- Diagnosis – Doctor diagnoses the patient with either a substance abuse issue, a mental health issue, or a dual diagnosis of a co-occurring disorder.
- Treatment Plan – Doctor creates an integrated treatment plan for dealing with both issues.
- Medical Detox at an inpatient or outpatient medical facility – Patient goes to rehab in order to clean their body of physical addiction to their substance of choice.
- Group Therapy – Patient speaks with groups of people dealing with similar issues.
- Personal Therapy – Patient speaks to experts on the root causes of their mental and substance abuse issues, and helps them prepare a plan to combat these problems.
- A medication treatment plan – Use of stimulants, opiates, sedatives, antidepressants, antipsychotics, beta blockers and mood stabilizers in order to alleviate withdrawal or mental health issues.
- Aftercare plan – Doctor and patient create a plan for dealing with their co-occurring disorders once they are out of detox and released back into society.
If you believe that you or a loved one have remained undiagnosed and untreated for a co-occurring disorder with substance abuse, speak with a medical professional at once so that you can prevent your life from slipping away. At Peaks Recovery rehab center, we want to help you find the right treatment for co-occurring disorders. Give us a call today.