Posted On : December 29, 2022
Co-occurring disorders treatment is an important part of helping individuals who struggle with mental health and substance abuse issues. Addiction of any kind can be taxing and daunting for the patient as well as his/her loved ones and family. The situation becomes worse if the patient is diagnosed with co-occurring disorders. As the name suggest, a co-occurring condition is when a substance abuse exists alongside a mental illness. A person with co-occurring disorders may have any combination of mental health issues, such as a mood disorder and an addiction, or a mood disorder and an eating disorder. These disorders can happen at the same time or one after another. The dual existence consequently enhances the necessity to seek proper medical treatment to return to sober and pre-condition lifestyle.
As mentioned above, a co-occurring disorder is a condition in which two or more disorders coexist. People suffering from co-occurring disorders often struggle with both mental illness and substance abuse or addiction. This is also known as Dual Diagnosis.There can be many causes of co-occurring disorders, such as trauma, genetics, and brain chemistry. Co-occurring disorders are often difficult to diagnose because the symptoms of one disorder can mask the other, thereby making the diagnosis of the condition difficult. For example, a person with schizophrenia may not have any psychotic symptoms for weeks at a time but still have delusions that they can’t shake off; this would be difficult to diagnose without knowing about the schizophrenia diagnosis.
In general, patients who are pursuing treatment for mental illness have high chances of developing dependence on drugs, resulting in co-occurring disorders. It develops because patients diagnosed with a mental disorder often start using substances to feel better and alleviate the discomfort. They feel that the drugs are helping them to fight the negative feelings of anxiety, depression, fear or even to numb their pain. Notably, the other way round situation is also true and equally concerning. Researches have shown that almost 50% of all people with a substance use disorder or drug addiction end up having some kind of mental health disorder, most common being depression. In either of the cases, when the intake of these drugs exceeds a limit, it can hinder the overall treatment. Substance abuse can lead to failure of the ongoing mental disorder treatment, making it difficult for the patient to develop coping skills, thereby pushing sobriety and balanced life to the back burner. Additionally, substances might also interfere with the medications prescribed which prevents the intended impact of the treatment and further worsening the mental health.
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With so many types of substance abuse and mental illness, there can be numerous combinations and permutations of co-occurring disorders that can exist. Below are a few commonly diagnosed co-occurring disorders are:
While both the disorders are common when occurring in isolation, their co-existence is equally common. According to a research, nearly 10% of the US population has been diagnosed with depression, of which around one-third of them suffer from a substance abuse such as cocaine. People often abuse cocaine to stimulate their neurotransmitter and experience temporary euphoria. However, constant and over use of the substance alters the brain chemistry and prevents it from producing dopamine naturally. Also, it regular use can impair the function of brain cells by up to 20%. Notably cocaine abuse and its withdrawal can cause mental illness like depression, which can further lead to overuse of cocaine. Although, this co-occurring disorder treatment usually involves medication with antidepressants, however, the suitable treatment method should be decided by a certified medical professional.
ADHD is defined by hyperactivity and chronic inattention. People suffering from the condition are often diagnosed to have low levels of naturally produced dopamine. Therefore, they start using alcohol to experience the otherwise natural dopamine levels. Also, the fact that alcohol is depressant makes it a common amongst the people suffering ADHD to calm their symptoms. However, it should be noted that regular use of alcohol does the opposite and affects the thinking capabilities and exhibits wild, uncontrollable and erratic behaviour, thereby worsening the already existing mental illness. The frequent use of alcohol soon turns into regular use and further develops into addiction. Similarly, the reverse is equally common. A person can end up developing ADHD with frequent abuse of alcohol.
PTSD commonly occurs in patients who have experienced a trauma such as a sexual abuse, military combat, life-threatening accidents or likewise. The condition is defined as severe anxiety disorder with symptoms such as extreme nervousness, constant fear, startling flashbacks and scary thought. Many also experience symptoms of depression. As these patients are prescribed heavy opioids to keep their symptoms under control, they frequently end up developing opioid abuse.
Co-occurring disorders can cause a large number of symptoms in patients. Some of the common ones symptoms other than poor mental and physical health are:
- Significant changes in behavior
- Marked changes in physical appearance
- Extreme mood swings
- Extended periods of sadness or hopelessness
- Impulsive and risky behavior
- Changed eating patterns – both are possible, eating more or less than usual
- Weight gain/ weight loss
- Sleeping in for long hours or not sleeping at all
- Constant state of Mental confusion or erratic thoughts
- Problems in relationships
- Distancing from friends and family members
- Degrading performance at work or school
- Increased levels of tolerance for alcohol or drugs
- Having to use drugs or alcohol confront stressful events
- Constantly thinking about the next drink or use of drugs
- Thoughts and ideation of suicide
- Frequent flashbacks of traumatic events
- Risk of unemployment or even becoming homeless
In a situation where one of the condition increases the risk of developing another condition, the significance of treatment rises exponentially. Furthermore, it is only important to treat either of the condition but demanded an integrated treatment that would treat both the conditions equally.
Integrated co-occurring disorder treatment is when the same medical team attends the patients while taking care of both the issues at the same time. An integrated approach for co-occurring disorder treatment addresses and takes care of an individual and their unique physical and emotional needs caused by their specific combination of mental and substance use disorders.
Mental disorder and substance use disorder both affect the brain, hence a dual disorder gives rise to a very delicate situation and must be handled with professional care. However, it’s easier said than done. In case of co-occurring disorders, there could be a possibility of the patient being suffering from multiple mental disorders. Since, many mental disorders share similar symptoms and impacts, their co-existence can often go untraceable. Similarly, there are also possibilities for a patient to suffer from dependence on more than one substance which can go undiagnosed due to exhibiting similar symptoms and effects. Such complications and scenario can make a dual disorder can be difficult to diagnose and requires professional training and expertise in both psychiatry and addiction.
Determining whether substance abuse or the mental disorder occurred is similar to chicken or egg situation. A person having some mental health issue might find drugs helpful in coping up which can lead to being addicted or someone with a substance use disorder might develop a mental disorder because of the change in the way their brain works which stops them from behaving normally. Amidst, co-occurring disorder treatment play a crucial role in identifying the root cause of the problem and then coming up with a treatment plan that suits the individual needs the best.
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Integrated co-occurring disorders treatment can be provided with various levels of care.
Detox
The first step of any kind of addiction treatment is often Detox. In this process the patients try to get rid of the toxins and harmful chemicals accumulated in their bodies during addiction. One of the common outcomes of detoxification is having withdrawal symptoms, which means the body finds it hard to deal with the lack of supply of substance and responds in forms of nausea, cold sweats and other painful experiences. This can also impact one’s mental health adversely. Skilled professionals at a treatment center are able to manage these severe symptoms and help to advance the treatment.
Therapy
Depending on an individual, one or more of the various types of therapy listed below can be integrated into a co-occurring disorder treatment plan.
Behavioral Therapy
- Cognitive behavioral therapy(CBT) – analyses a patient’s thoughts and beliefs to bring gradual changes in their behaviors for the better. CBT helps patients to identify risky situations and develop coping skills while prevengting relapse.
- Dialectical behavioral therapy(DBT)- used to treat borderline personality disorder. This therapy focuses on reducing negative actions like self-harm, substance use, and suicidal behavior. This approach focuses mainly on 4 skill sets namely distress tolerance, emotion regulation, mindfulness, and interpersonal effectiveness.
- Contingency management(CM)- encourages patients towards recovery by providing sm, avoiding self-harm or any other desirable action. A major benefit of CM is that it can result in reduction of the two of the biggest treatment-related issues namely dropping out and relapse.
- Motivational enhancement- – using various methods to motivate patients to make positive changes in the treatment process. It aims to strengthen a patient’s self-motivation and reinforce their commitment to change for better in a consistent manner.
Patients can participate in peer support groups during therapy. The relationships forged during these group meetings of people with similar issues can offer guidance and support in difficult times.
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An ideal treatment center offering co-occurring disorder treatment should be equipped to provide care for both, mental disorder and substance use disorder, simultaneiously or in appropriate stages, as per the individual’s needs.
An integrated co-occurring disorder treatment typically means that the entire treatment process takes place in the same space with no division between mental health and substance misuse. There is, however, not one specific approach that can be adopted by all for treatment of co-occurring disorders.
Below are some factors to check while deciding on a treatment facility to treat co-occurring disorders :
- Specific services for co-occurring mental health disorders and SUDs: Ideally, the facility should have physicians, therapists, counselors, psychologists, and other clinicians experienced in evaluating, assessing, and treating various mental health conditions as well as SUD
- A variety of therapy modalities: : it is important to receive counseling, behavioral therapies, motivational interventions, and ongoing support as these can be effective in treating certain mental illnesses and SUDs concurrently.
- Various options for inpatient and outpatient treatment: Though duration of rehab varies for each individual, try to find out about all the different programs, such as 30-, 60-, and 90-day programs. Consult a professional before choosing one as the decision is based on multiple factors, including the severity of the disorder, symptoms of withdrawal, and more.
- Aftercare support: Does the facility offer ongoing services and social support to help manage both disorders beyond treatment? Connecting people by forming groups for social support after a structured treatment program is vital to maintain the final results and continued recovery. Developing positive relationships with people who have had similar issues helps the patients to stay engaged in treatment and keep a check on themselves.
- Multicultural or population-specific programming (if desired): sometimes, some specific population groups such as women, veterans, first responders, or members of the LGBTQ community might require different care than the others. An ideal treatment center should be able to take care of this aspect.
- Insurance coverage: familiarise yourself with what all your insurance provider covers in the course of treatment of co-occurring disorders and make an informed decision.
Whether its addiction or mental illness, both the conditions continue to be taboo even in the most developed society or country. Amidst, suffering from a co-occurring disorder entails more adversities and backlash from the society, which discourage the patient from seeking medical help and consultancy. Below are some common barriers:
Social Stigma
For someone who is struggling with a mental health condition or substance addiction, it is not always easy to seek help because of the stigma related to these. One might worry about things like social image, job security etc. and hence may hesitate in asking for any kind of medical or social help.
Finances and Costs
Financial barriers are one significant problem. Even if insurance companies provide coverage for mental health and addiction treatment needs, there is often an out-of-pocket cost that remains, which can be a lot for some.
Access
The mental health system in many places struggle to provide access to care because they face a lack of facilities or staffing. This makes the waitlists for mental health treatment long, which discourages people. Many give up before they have the opportunity to begin treatment.
The relationship between mental illness and substance abuse is often complex and complicated. One doesn’t necessarily cause the other, but they can be closely linked. For example, individuals with a mental illness are more likely to abuse substances such as marijuana and methamphetamine, while individuals abusing substances like alcohol are more likely to experience a mental illness such as depression and anxiety symptoms. In other words, substance abuse can exacerbate symptoms of mental illnesses such as depression or anxiety, which can lead to relapse in sobriety for those recovering from addiction. Conversely, untreated mental illnesses can lead to substance abuse as an attempt at self-medicating symptoms such as feelings of hopelessness or social isolation.
Therefore, only an integrated treatment plan for co-occurring disorders that focuses equally on the substance abuse as well as the underlying mental illness can lead to better results and desired sobriety. An integrated treatment promises reduction/ discontinuation of substance use, improve psychiatric condition, more chances of successful recovery of both disorders and decreased hospitalization and medications.