What Are Co-Occurring Disorders?
When a person is diagnosed with both a mental illness and a substance use disorder, they are said to have co-occurring disorders. Though the disorders can exist separately from one another, when they coexist in the same person, they usually cause the symptoms of both disorders to be amplified. It is common for a person with co-occurring disorders to have more severe symptoms than a person with only one of the disorders.
Co-occurring disorders treatments are defined by the dual diagnosis of a mental health disorder and a substance use disorder in the same person. These diagnoses can be made at the same time, or they can be made one after the other, but the two disorders occur simultaneously in the same person.
Co-Occurring Disorders Symptoms
Only a mental health professional can diagnose a mental health or substance use disorder. However, knowing the common symptoms of co-occurring disorders may help an individual recognize when they need assistance. The symptoms of co-occurring disorders are similar to the symptoms of mental health and substance use disorders, but they occur in the same person. Those symptoms include:
- Using substances under unsafe conditions
- Losing control over substance use
- Developing a high tolerance to a substance or withdrawal symptoms
- Feeling the need to use substances to function normally
- Retreating from relationships with family and friends
- Sudden changes in behavior
- Difficulty managing daily tasks
- Engaging in risky behaviors
- Neglecting health and hygiene
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Mental Disorders that Co-Occur with Substance Abuse
There are several different kinds of mental health disorders that commonly co-occur with substance use disorders. The most common co-occurring disorders with substance abuse fall into five categories:
- Mood disorders
- Anxiety disorders
- Psychotic disorders
- Personality disorders
- Eating disorders
While there are differences among them, many of them have similar attributes as to how they are diagnosed, what causes them to co-occur, and how the two disorders affect one another. Examples of co-occurring disorders include:
Mood disorders are characterized by disruptions in mood that affect a person’s life, such as major depressive disorder and bipolar disorder. Mood disorders and substance abuse disorders are commonly co-diagnosed. It is unclear which disorder is more commonly diagnosed first in patients that have both, but it is clear that one affects the other.
In many cases, patients with co-occurring substance use and mood disorders have more severe symptoms than either disorder alone. It is common to try and treat a substance use disorder first and then address the mood disorder. However, studies have shown that treating both conditions simultaneously improves patient outcomes.
Anxiety disorders include generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. Anxiety and substance abuse are also commonly diagnosed and are among the most common co-occurring disorders.
As is the case with mood disorders, substance abuse and anxiety disorders tend to be more severe in a person that is co-diagnosed than a person that has either one of the disorders alone. However, it is less common for anxiety disorders to be substance-induced than mood disorders. People with anxiety disorders may use substances to self-medicate and relieve their anxiety symptoms, which can lead to substance abuse.
Psychotic disorders involve changes in the way a person thinks and perceives themselves, others, and their environment. Examples of psychotic disorders include schizophrenia, delusional disorder, and schizoaffective disorder. A common symptom among psychotic disorders is psychosis, which is a temporary state where a person experiences hallucinations or delusions.
Psychotic disorders and substance abuse disorders can be hard to co-diagnose because psychosis can sometimes be a symptom of substance abuse. Drug-induced psychosis occurs when a person taking a substance experiences temporary hallucinations or delusions. Withdrawal from certain substances can also have psychotic effects. To be co-diagnosed, psychotic symptoms must also be present in the absence of substance use.
Schizophrenia and substance abuse, in particular, are commonly co-diagnosed. Substance use can make schizophrenia symptoms significantly worse. The underlying genetic conditions that increase a person’s risk of developing schizophrenia can also make a person vulnerable to a substance use disorder. Because of genetic predisposition, substance use may start early in life, causing the person to be more at risk for developing a substance use disorder.
Personality disorders cause people to have unhealthy thoughts and behaviors that affect their everyday life and relationships. Common personality disorders that co-occur with substance use disorders include borderline personality disorder, antisocial personality disorder, and narcissistic personality disorder, with the most common being borderline and antisocial personality disorders.
Personality disorders and substance abuse disorders are more commonly co-diagnosed in people with drug use disorders rather than alcohol use disorders. The high prevalence of co-diagnosis is usually a result of a personality disorder being followed by a substance use disorder.
Eating disorders are characterized by dysfunctional eating habits. Examples of eating disorders include binge eating disorder, anorexia nervosa, and bulimia nervosa. People with bulimia nervosa or anorexia nervosa with binge eating and purging habits tend to be at a higher risk of substance use than individuals with other types of eating disorders.
In general, eating disorders and substance abuse are commonly co-diagnosed. Studies have suggested that a genetic link could be the cause. Genetic factors that make a person more liable to eating disorders are also found among those that make a person liable to substance use disorders.
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Causes of Co-Occurring Disorders
As is true for chemical dependency and psychiatric conditions in general, co-occurring disorders can be fueled by a combination of internal (genetic) and external (environmental) influences. The following factors can significantly increase the likelihood that a person will struggle with the presence of co-occurring disorders:
- Genetic: Decades of research strongly suggest a genetic component to the development of addiction and mental health problems. Having a history of depression or addiction in one’s family increases the odds that a person will also suffer from these problems. Recent scientific inquiries into the genetics of addiction have identified both individual genes and gene networks that appear to function differently in individuals who are struggling with addictions than they do in people who have not struggled with this disease. Also, being exposed to alcohol or another drug – or certain viruses and toxins – while in the womb can increase a person’s odds of facing mental health concerns later in life.
- Environmental: Family history of substance abuse and addiction can also be an environmental influence, as children who grow up in houses where alcohol or other drugs are freely used may believe that this behavior is acceptable. Mental illness can also have several environmental influences, including exposure to certain drugs or chemicals, accidents that involve damage to the brain, traumatic experiences (including combat, severe traffic accidents, and physical or sexual abuse), and stressful events (including financial pressure, death of a loved one, divorce, or similar experiences).
Risk Factors For Co-Occurring Disorders
There are many common risk factors, that may make a person more susceptible to being diagnosed with co-occurring disorders. Some of the underlying conditions that might make a person susceptible to co-occurring disorders include:
- Family history
- Environmental influences
- Stress and response to stress
- History of trauma or adverse childhood experiences
Treatment Options for Co-Occurring Disorders
In Recent Years, Researchers have Found that Integrated therapy is the best method for treating people with co-occurring disorders. Research gathered by the Substance Abuse and Mental Health Services Administration indicates that combining psychiatric and addiction treatment techniques can decrease relapses and reduce suicide attempts in rehab graduates, as well as promote long-term abstinence.
Several Factors Make it Crucial to Treat Co-Occurring Mental Health Disorders and Addictive Disorders Together:
- An Integrated Recovery Plan aims to reduce the negative side effects of mental health disorders, including problems paying attention, feeling depressed, and disinclination to socialize with others.
- You are more likely to be able to treat your substance abuse disorder and mental health dysfunction at the same time when pharmacological therapy addresses both disorders.
- Traditional concerns about psychotherapeutic medication use in co-occurring disorders are no longer a problem.
- Co-occurring disorders patients who undergo group therapy help them strengthen their support network. This training is also useful for combating problems such as substance misuse.
- Treating both addiction and mental disorders simultaneously reduces one’s chances of relapse, such as depression, mood swings, or panic strikes.
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There has been a steady growth in the treatment of co-occurring disorders since the 1990s, and rates are expected to continue to rise as we move into the next decade. One of the pioneers of co-occurring disorders, Dr. Kenneth Minkoff, has written an article in Psychiatric Services containing standards of best practices, including the following:
- Rather than excluding co-occurring individuals because of their mental illness, welcoming them into treatment
- Providing equal attention and care during the rehabilitation process to the addictive and co-occurring psychiatric disorders.
- Both psychiatric and substance addiction disorders may seem to be temporary conditions, but they require long-term assistance
- A treatment team with expertise in treating co-occurring disorders must be working to ensure that treatment is delivered.
- Provide treatment to clients who are suffering from psychiatric disorders early on, which will allow them to be treated more quickly.
- Whether the client is experiencing a mental health crisis or is acutely intoxicated, all clients should be treated with dignity and respect.
A co-occurring treatment program should address the needs of the mentally ill, including the treatment for substance abuse along with addiction treatment. Therapy sessions and group therapy meetings should address the needs of those who are mentally ill.
Co-Occurring Disorders Statistics
Until recently, it was believed that the treatment of drug or alcohol misuse could be separated from the treatment of mental disorders, and care provided at different facilities via significant other healing strategies. Many individuals suffering from substance abuse never receive treatment for despair, schizophrenia, obsessive-compulsive disorder, or other severe psychiatric maladies. Additionally, graduates from drug rehab programs with co-occurring disorders often receive inadequate treatment for their undetected mental health conditions.
In recent years, the field of cognitive-behavioral therapy for addiction has observed an increase in the treatment of co-occurring disorders in patients. It is estimated that the U.S. Department of Health and Human Services predicts up to 5% of Americans suffer from severe mental illnesses such as schizophrenia, bipolar disorder, and schizoaffective disorder and that anywhere from 1 to 5% of the United States population struggles with mental illness.
About 7 million individuals who fall within that group also suffer from substance abuse, thus requiring integrative treatment to protect the group from poverty, illness, isolation, imprisonment, and homelessness, which can adversely affect a Dual Diagnosis individual.
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Dual Diagnosis vs Co-Occurring Disorders
When considering the treatment of co-occurring disorders, it is important to address both disorders. Dual diagnosis treatment will provide the patient with a means to control their substance use disorder while also providing the resources necessary to relieve the symptoms of their mental health disorder.
An integrated treatment program for co-occurring disorders addresses a client’s substance use disorder while providing them with therapy for their mental health conditions. Once the person has control of their substance use disorder, medication may also be added to their treatment program that will help with their mental health condition. It is common to wait for the patient to stop substance use before initiating medication due to the side effects of mixing mental health medication with substances that are commonly abused.
While the co-occurrence of substance use disorders and mental health disorders has long been observed, treatment for the two disorders simultaneously has only more recently been developed. It is still relatively common for the two disorders to be treated separately rather than together. It is also common to address the substance use disorder before treating the mental health disorder. However, dual diagnosis research studies show that there is a benefit to simultaneously treating both disorders to achieve better outcomes for the patient.
Developing treatment plans for co-occurring disorders is challenging for many reasons. The specific type of treatment needed varies depending on the type of mental health disorder and substance use disorder. More individualized research is needed to understand the link between specific mental health conditions and addiction. Dual diagnosis case studies will help to determine treatment outcomes in individuals with specific co-occurring disorders.
Reclaim Your Life With Co-Occurring Disorders Treatment
A co-occurring disorder is defined by the dual diagnosis of a mental health disorder and a substance use disorder in the same person. We Level Up rehab treatment & detox center can provide you, or someone you love, treatment for co-occurring disorders with professional and safe care. Feel free to call us to speak with one of our counselors. We can inform you about this condition by giving you relevant information. Our specialists know what you are going through. Please know that each call is private and confidential.
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 Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013). DSM-5 criteria for substance use disorders: recommendations and rationale. The American journal of psychiatry, 170(8), 834–851.
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 Pettinati, H. M., O’Brien, C. P., & Dundon, W. D. (2013). Current status of co-occurring mood and substance use disorders: a new therapeutic target. The American journal of psychiatry, 170(1), 23–30.