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Tuesday, June 16, 2020

What Is a Co-occurring Disorder?

What is a co-occurring disorder and why should we care? Why should mental health matter when we’re talking about recovery from addiction?
First, a definition: A co-occurring disorder is when an individual with a substance use disorder (drugs or alcohol) also has a mental health disorder (depression, anxiety, bipolar disorder, etc). It doesn’t matter which is the “primary concern” for it to be considered a co-occurring disorder.

For these individuals struggling with both a sense of depression or anxiety as well as an addiction, seeking treatment and recovery is often much more difficult in terms of higher relapse potential, poor psychological wellbeing, and shorter stays at treatment centers (aka leaving before the culture of recovery has cemented).

For these reasons, it absolutely matters that both their mental health as well as their addiction is treated through a specialized program, not one before the other, but at the same time. 

What Causes a Co-occurring Disorder?

There are many potential routes to developing both a mental health and substance use disorder. Individuals may be dealing with the symptoms of mental illness and use substances to self-medicate, or conversely, substance use can sometimes induce psychosis or exacerbate mental illness. 
It can often feel like a “chicken or the egg” dilemma of what came first. Sometimes it can be hard to decipher when there has been a long pattern of substance use, and because often substances will influence mental health and vice versa. 

There are often multiple factors that contribute to a co-occurring disorder including:
  • Genetic predisposition: If someone has a history of addiction or mental health in their family, they are more likely to also have a substance use or mental health disorder.
  • Family of origin: If someone is exposed to close relatives using substances, they are more likely to engage in similar behavior. Similarly, if one grows up with a close family member with a mental health disorder, this can increase the likelihood of developing a mental health disorder themselves.
  • Environmental factors: This refers to the community in which one was raised, especially factors like poverty, community violence, limited access to resources, food insecurity, etc. These are examples of adverse childhood experiences that can increase the chances of co-occurring disorders.
  • Trauma: Whether single incident or over a long period of time, trauma includes verbal, physical, and sexual abuse as well as a near-death experience, witnessing traumatic events, or the loss of a loved one. 

How Common are Co-occurring Disorders?

There is a high prevalence of individuals with a substance use disorder also have a co-occurring mental health diagnosis. Numerous population surveys have shown that 50% of individuals with a mental illness will also have a substance use disorder at some point in their lives. This prevalence rate is even higher for adolescents at 60%. 

Research also indicates that 43% of people in substance use treatment centers have a diagnosis or significant symptoms of mental health disorders. It is important to note that these statistics represent only what is officially diagnosed or reported- it is much more likely that there is a higher rate of comorbidity that is not in treatment or undiagnosed.

What Types of Mental Health Disorders Occur with Substance Use Disorders?

While any mental illness can be comorbid with substance use disorders, the most common are severe mental illnesses, defined by a mental illness that causes significant impairment in functioning. These often include major depression, schizophrenia, and bipolar disorder, though other mental disorders can cause severe impairment. 

Treatment at The Haven for Co-occurring Disorders

When treating individuals with co-occurring substance use and mental health disorders, it is important to understand the nuances to provide the most ethical and effective treatment. Firstly, it is imperative not to assign a mental health diagnosis too soon, as often the effects of substances, detox, and withdrawals can affect one’s mood, thought patterns, and behavior. 

After the effects of substances have subsided, a more thorough assessment can be done to determine cooccurring mental illness. It is then recommended to have a treatment plan designed to treat both substance use and the mental health disorder simultaneously. This allows for monitoring, support, and intervention of mental health symptoms that previously might have led one to use drugs or alcohol. By treating one without the other, the individual is more likely to relapse or develop new maladaptive coping skills as a replacement including a different substance than their drug of addiction, self-harm, disordered eating behaviors, or additional addictions. 

Managing emotions, developing positive coping skills, and establishing a support network are all vital in early recovery, as well as mental wellness. Medication therapy is also thought to be more effective when addressing both substance use and mental health concerns. Group therapy can also provide important skills for this population as well as connectedness and a strong support network. By treating both mental health and substance use disorders, the treatment experience, as well as outcomes, are markedly improved, showing that recovery and building a life worth living is possible.

Tuesday, June 9, 2020

Are You Creating A Culture of Addiction or Recovery?

All groups and communities have a culture, whether it is innate or something intentionally created. People may be bonded together over shared interests, identity, location, or membership to a particular group.

All this said, there is no one group of people who remains immune to the pull of addiction. It may be easy to dismiss these ideas as ‘only affecting other people’, however, it can be a wake-up call to realize how pervasive these constructs are in our current society. 

Addiction truly does affect a diverse variety of people including all ages, genders, races, and socio-economic statuses. Within each of these sub-groups, active addiction may have a particular culture within that community or identity group. However, there is a pervasive culture of addiction that umbrellas many subcultures that is important to recognize.

The Culture of Addiction

Culture is a significant aspect of addiction that affects the expectations and experiences of individuals using substances. The culture of addiction is a way of life and a way of viewing the world. 

Part of this culture is adopting beliefs and behaviors that encourage excessive drug use. This includes language used, additional hobbies and activities, rituals that are a part of using, and typical relationship patterns with others. While some of these factors may vary slightly depending on the drug of choice, geographical location, or sub-group of identities, the overall culture is similar. 

While there is a very specific negative viewpoint directed towards those in active addiction, some elements of Western culture still glorify and promote substance use. This can contribute to unintended substance misuse, and for some means escalating their use unintentionally into a substance use disorder. 

Elements that can be found in the culture of addiction that can lead to problematic substance use can be identified by the three C’s:

Celebrate - How one celebrates is reflective of their culture. 

For much of American society, personal, work, or community celebrations often involve alcohol. This includes happy hours, sharing a bottle of champagne, or going out with the exclusive purpose of drinking to celebrate. This creates a culture of expecting substances for all celebrations, big and small.

Cope - How one copes with difficult situations. 

This is especially relevant by the phrase often used after a challenging experience of “I need a drink.” Alcohol or other substances are often what individuals turn to after a hard day, a loss, or a stressful situation. Rather than acknowledging or participating in other, more adaptive coping skills, numbing emotion by drinking or using substances has been made to feel normal.

Commiserate - How we commiserate with others when coping with difficult situations. 

When experiencing hardship, often the supportive people in our life seek to offer comfort by providing or gathering around alcohol or substances. After a break-up, “You need to go out”; or when you share that you’ve lost your job or been placed on furlough, “You need a drink.”

It is important to note These aspects of the culture of addiction often contribute to unintentionally developing substance use disorders. 

Other important factors that can lead to problematic substance use include the two S’s:

Sleep - How we sleep. 

If individuals use alcohol or drugs daily in order to fall asleep every night, this can lead to an unhealthy dependence on substances. Additionally, lack of sleep is also an increased risk for mental health and can increase substance use.

Stress - How we handle stress. 

When stressful situations become too difficult for one to cope, often alcohol or substances become an alternative way to deal with stress. When this becomes a regular pattern, it can become harder to deal with everyday stresses, and a dependence on substances to cope with stress can occur.

The Culture of Recovery

Just like addiction, recovery has its own culture. The culture of recovery requires a new worldview and also has group norms that encourage abstinence and recovery behavior. 

When we change our culture from addiction to one that is recovery-focused, our relationships, values, and behaviors change as well. In the same way, we once accepted, adapted, and acclimated to the culture of addiction, we must do so also in the culture of recovery. This includes adopting new behaviors, skills and supports specific to the three C’s and two S’s in order to maintain sobriety.

The Culture of Recovery at The Haven at Pismo

Our culture of recovery looks like:
  • Creating a safe place for an open and honest discussion about the existence of drug cultures, as well as teaching about the cultures of recovery through a holistic perspective.
  • A network of peers supporting one another where longer-term clients can offer support, encouragement, and guidance to newer clients.
  • Including your family (when appropriate) in the treatment process to support your recovery as well as receive information and resources to support their own healing.
  • Encouraging attendance and providing transportation to external recovery networks for you to continue your growth after treatment (12-step meetings, Smart recovery, refuge recovery, etc).

The culture of recovery is one of experience, strength, and hope that changes lives, families, and communities. Contact us to learn more about how you can get started with your recovery today!

Tuesday, June 2, 2020

How Does Our Environment Have an Impact on Addiction?

At a time such as this, in the face of this global pandemic, many are asking the age-old question: “Is it nature or nurture that leads to addiction?” 

Given our current environment, and the shocking statistics that alcohol sales across the board have increased by 58%, it is difficult to avoid drawing conclusions about how this will affect individuals who perhaps were already struggling with their use. 

So, which is it, Nature or Nurture?

In this great debate about whether it is environmental or biological risk factors that play a more significant role in developing a substance use disorder or addiction, most researchers actually believe that it is often a combination of both.

Broken down by category, these contributing factors include: 

Biological Risk Factors

  • Genetic predisposition (if the biological family have/had substance use disorders and their genes are passed on)
  • Age of first use
  • Presence of mental health disorders or other brain characteristics like impulsivity, sensation seeking, etc.

Environmental Risk Factors:

  • Whether a parent or caregiver used substances around or with the child
  • Peer influences
  • Cultural and societal attitudes towards substances
  • Exposure to physical, emotional, or sexual abuse
  • Exposure to traumatic events

In an earlier blog, we explored the impact that one notable biological factor, the brain, has on addictive patterns. Today, we’ll explore its counterpart, the role that the environment has to play, and especially the intersection between these two important factors.

If my parents abused substances or had a mental health condition, does that mean I will too?

Not necessarily. Biological factors are important in that they ‘set the scene’ for the potential of addictive patterns to take root, but they do not cause addiction outright. They cause certain genes to be more likely to ‘turn on’ if certain environmental factors occur. 

For example, an individual whose parents had substance use disorders will likely be genetically predisposed to addiction, but that does not guarantee they will develop a substance use disorder. This is where the environmental factors play a role: if
the child grows up in a safe, loving environment and is not exposed to many of the environmental risks, they would be less likely to develop an addiction. On the other hand, exposure to some of the environmental risk factors would increase their likelihood of developing an addiction.

So there’s little hope I won’t turn to addiction if I’ve been exposed to both biological and environmental factors?

Again, not necessarily. If you have grown up in an addiction-riddled household but are aware of the precursors to addiction, and are able to effectively process the hurt you may feel by perceived or actual abandonment, there is a greater chance to avoid walking down the same path as your parents. In these cases, your sobriety is dependent on your ability to be resilient in the face of each adversity that life has thrown your way. 

For others who do not have a genetic predisposition, the same environmental factors may not trigger substance misuse. Ultimately, substance use disorders are complex and nuanced in their etiology and cannot be traced to a singular incident or gene.

What about our current cultural environment?

It is important to consider, however, whether if a national pandemic such as the one our country currently faces is experienced as ‘traumatic’ by countless individuals, how this will impact those among us who are genetically predisposed to turn to unhealthy means of coping. 

What we know about times of stress is that unless people are actively working to respond in a new way to the added stress, they will rely on their ‘old habits’ to carry them through a difficult time. As the saying goes, the best predictor of future behavior is past behavior. This of course is in reference to those who live their lives on autopilot, not necessarily those who are actively seeking change. In fact, this is the biggest difference between these two groups of people- their goals and what sort of life they want for themselves. 

A recovery mindset

Someone with a goal of recovery in mind will recognize this disease as cunning, baffling, and powerful, and can see through the mind games and deceit. Even still, they are wise to set up and remain connected with their system of support and to hold onto the truths they learned in recovery. 

In this way, it is still not necessarily biological factors or environmental factors that guarantee that someone will fall into the trap of addiction. Both of these factors will absolutely need to be understood, processed, and overcome, but once someone has learned a new way of being through treatment and recovery, it is their dedication to the recovery lifestyle that will continue to carry them through. 

Transitional Living at The Haven

The sort of accountability available to recovery-seekers through The Haven’s Transitional Living Program is exactly the sort of opportunity that would help them to feel confident testing their recovery practices in a real-world environment. With more independence and autonomy, those in transitional living can practice facing stress and still making the choice that is going to support their recovery. Get connected with us today to learn how we can be supportive to you or your loved one in any stage of recovery!