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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.