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What Are Co-Occurring Disorders?

Comorbidity is often used to describe a situation where an individual is diagnosed with more than one disorder at the same time.1 Individuals who simultaneously struggle with both a mental health and substance use disorder are said to have co-occurring disorders—also referred to as a dual diagnosis.2 However, a person with co-occurring disorders can actually have two or more disorders at once.

Here we’ll focus on the notion of a co-occurring disorder being defined as the presence of a mental disorder and a substance use disorder in the same person. Read on to learn more about common co-occurring disorders and treatment options available for the diagnosis.

Common Co-Occurring Disorders­

According to the 2014 National Survey of Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration, nearly 8 million people have both a substance use disorder and mental disorder in the U.S.3 More than half of those with co-occurring disorders are men.

Several mental health conditions may co-occur with substance use disorders, including:

Some common co-occurring disorders include:

Because substance use and mental health issues are prevalently encountered in connection with each other, screening for either a mental health disorder or for a substance use disorder will commonly include a thorough assessment for the other as well.

Frequently co-occurring with other mental health disorders are alcohol use disorder and tobacco use disorder: This is because alcohol and tobacco can be easily and legally obtained by adults, and relatively easily, albeit illegally, obtained by minors.

However, recent trends have indicated that prescription medications such as narcotic pain medications and benzodiazepines are becoming increasingly more prevalent forms of substance use disorders in dual diagnoses, and co-occurring alcohol uses disorder rates are declining.3

Which Came First?

two head silhouettes symbolizing co-occurring disordersIt is not always easy to answer the question: “Did the substance abuse problem or the mental health disorder occur first?” In some cases, it appears that the substance abuse issue predated the mental illness; in other cases, it appears that the mental illness predated the substance use disorder. In many cases, it can’t be determined.

Some drugs are thought to potentially elicit or mimic symptoms of certain mental illnesses which might, in some cases with chronic use, lead to the development of more lasting mental conditions. An example of this is cannabis and cannabis-related psychosis. Research indicating that heavy users of marijuana are at a significantly higher risk to later develop psychosis has been used to support the idea that substance use itself may predate the arrival of mental health issues.9

In the other direction, some posit that unmanaged mental health issues might drive the initiation and eventual compulsive use of certain substances. In lay circles, and even in some clinical circles, this is the very popular notion of self-medication, where an individual who has symptoms of a mental health disorder begins to use drugs or alcohol to cope with the stress of those symptoms, such as with schizophrenia and tobacco use disorder.10

In this example, it appears that nicotine may have a mild therapeutic effect on some of the symptoms of schizophrenia, and individuals diagnosed with schizophrenia are very likely to have tobacco use disorders. However, it should also be noted that tobacco use disorder commonly co-occurs with other mental health disorders, such as anxiety disorders and mood disorders.

A third perspective notes that substance use disorders and other mental health disorders share many similar risk factors, and are often associated with specific environmental events, such as physical or emotional abuse.11 Thus, the development of both a mental health disorder and a substance use disorder simply reflects a shared vulnerability to developing a co-occurring disorder.

Who Is at Risk?

There are several risk factors that increase the probability you will develop a substance use disorder and a co-occurring mental health issue, including:12

  • Gender: Males are more likely to develop substance use disorders than females.
  • Family history: Having a first-degree relative (e.g., parent or sibling) who has a substance use disorder will increase a person’s risk to develop a substance use disorder.
  • Lack of social support: Having a lack of family support or perceiving that one does not have a supportive environment increases the risk of developing a substance use disorder.
  • Peer associations: Peer pressure is often a significant factor in drug abuse, particularly in adolescents and young adults.
  • A history of trauma or abuse: Having a childhood history of emotional trauma or abuse of any type is a risk factor for the development of a substance use disorder.
  • Having a diagnosis of a mental health disorder: Individuals diagnosed with any mental health disorder have a higher risk of developing a substance use disorder.

Treatment for Co-Occurring Disorders

Interestingly, a large percentage of people who have co-occurring disorders are not thoroughly assessed or diagnosed properly. Often, many individuals are only diagnosed with one of their co-occurring disorders. This can result in a number of difficulties with treatment.

man sitting being comfortedHaving both depression and alcohol use disorder, for example, and only treating depression might not significantly affect the alcohol use disorder. Therefore, individuals who have co-occurring diagnoses should have both issues treated concurrently. The suggested approach to treating co-occurring diagnoses is known as an integrated approach.

The goal of an integrated treatment program is to help the individual manage their mental health issues, become abstinent from drugs, and reach their highest possible level of independence. An integrated treatment program uses a multidimensional team approach to address an individual diagnosed with co-occurring disorders in 4 stages, including:13

  • Engagement: Develop a relationship between the client and the treatment team. It’s crucial that the client fully trusts the team.
  • Persuasion: Motivate the client to become as involved in treatment as possible.
  • Active treatment: Teach skills that the client lacks, which will help the client better manage both disorders.
  • Relapse prevention: Help the client develop long-term strategies to maintain improvements, reach future goals, and avoid relapse.

Because there are so many different combinations of co-occurring disorders, and because every person is different when it comes to recovery, treatment for co-occurring disorders can vary drastically from person to person. This is why tailoring the treatment program to the individual’s needs along the way is so important.

Oxford Treatment Center can take an integrated treatment approach with co-occurring disorders and has a team of experienced addiction treatment professionals to customize the correct treatment plan depending on the person and the co-occurring diagnosis.

An integrated treatment program for co-occurring conditions might involve:14

  • A multidisciplinary team that will address your diagnoses from a number of different angles. Typically, this will include a psychiatrist and/or addiction medicine physician, a psychologist, social worker, case managers, and support from family and other individuals with similar diagnoses.
  • A comprehensive treatment program that will address your needs. This can include medical detox, residential treatment, outpatient treatment, support group treatment, etc.
  • Individual and/or group therapy/counseling
  • Specific treatment for the mental health disorder.
  • Specific treatment for the substance use disorder.
  • Medically assisted treatment for the mental health disorder, substance use disorder, and any other medical issues.
  • Lifestyle counseling to help you make healthy lifestyle changes.
  • Assistance with placement if you need housing.
  • Family support.
  • Specialized supports and treatments for specific situations.

Regardless of where you choose to receive treatment for your co-occurring disorder, integrated treatment is designed to be as comprehensive and supportive as possible. The treatment team will set realistic goals for the program and adjust the goals accordingly as you progress in care.

 

References

  1. National Institute of Drug Abuse. (2012). Comorbidity.
  2. Substance Abuse and Mental Health Services Administration. (2019). Mental Health and Substance Use Disorders.
  3. Hedden, S.L., Kennet, J., Lipari, R., Medley, G. Tice, P. Copello, E.A.P., & Kroutil, L.A. (2015). Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health.
  4. Davis, L., Uezato, A., Newell, J.M., & Frazier, E. (2008). Major depression and comorbid substance use disorders. Current Opinion in Psychiatry, 21(1),14-8.
  5. Back, S.E. & Brady, K.T. (2010). Anxiety Disorders with Comorbid Substance Use Disorders: Diagnostic and Treatment Considerations. Psychiatric Annals, 38(11), 724-729.
  6. Brière, F.N., Rohde, P., Seeley, J.R., Klein, D., & Lewinsohn, P.M. (2015). Comorbidity Between Major Depression and Alcohol Use Disorder From Adolescence to Adulthood. Comprehensive Psychiatry, 55(3), 526-533.
  7. Trull, T.J., Freeman, L.K., Vebares, T.J., Choate, A.M., Helle, A.C., & Wycoff, A.M. (2018). Borderline personality disorder and substance use disorders: an updated review. Borderline Personal Disorder and Emotion Dysregulation, 5, 15.
  8. Drake, R.E. & Mueser, K.T. (2002). Co-Occurring Alcohol Use Disorder and Schizophrenia. Alcohol Research & Health, 26(2), 99-102.
  9. Wilkinson, S.T., Radhakrishnan, R., & D’Souza, D.C. (2014). Impact of Cannabis Use on the Development of Psychotic Disorders. Current Addiction Reports 1(2): 115-128.
  10. Manzella, F., Maloney, S.E., & Taylor, G.T. (2015). Smoking in schizophrenic patients: A critique of the self-medication hypothesis. World Journal of Psychiatry 5(1): 35-46.
  11. National Institute on Drug Abuse. (2018). Part 1: The Connection Between Substance Use Disorders and Mental Illness.
  12. National Institute on Drug Abuse. (2018). Why is there comorbidity between substance use disorders and mental illnesses?
  13. Substance Abuse and Mental Health Services Administration. (2009) Building Your Program: Integrated Treatment for Co-Occurring Disorders.
  14. Murthy, P., & Chand, P. (2012). Treatment of dual diagnosis disorders. Current Opinion in Psychiatry, 25(3), 194-200.
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