How common are co-occurring disorders?
According to statistics, approximately 8 million individuals in the United States have co-occurring disorders. Those with a mental health disorder such as depression or anxiety are more likely than those without one to also have a substance abuse disorder. Co-occurring disorders can be difficult to diagnose as many individuals have an array of symptoms, and often only one disorder is diagnosed and treated. As a result, the individual may not experience much improvement in their symptoms.
It may take some time for mental health professionals and substance abuse counselors to properly diagnose each co-occurring disorder in the individual client. According to statistics, individuals have an increased risk for developing a substance abuse disorder if diagnosed with the following mental health disorders:
- Antisocial personality disorder: 15.5 percent
- Manic disorder: 14.5 percent
- Schizophrenia: 10.1 percent
- Panic disorder: 4.3 percent
- Major depressive disorder: 4.1 percent
- Obsessive-compulsive disorder (OCD): 3.4 percent
- Phobias: 2.4 percent
These numbers show that an individual who has been diagnosed with antisocial personality disorder is 15.5 percent more likely to have a substance abuse disorder than someone who has no mental health issues.
Signs and symptoms of co-occurring disorders
The signs and symptoms of co-occurring disorders will vary depending upon the specific mental health disorder and drug of choice. For example, if an individual is struggling with marijuana abuse and schizophrenia, the signs and symptoms of these disorders will be drastically different than those of an individual who is struggling with a cocaine addiction and bipolar disorder. In general, individuals who are living with co-occurring disorders find functioning on a day-to-day basis to be significantly difficult, if not impossible. Many will struggle with the following:
- An inability to maintain employment
- An inability to maintain functional relationships
- Legal problems
- Financial issues
- Extreme mood swings or an inability to control their emotions
- Violent behavior
- Suicidal ideation
- Prostitution or unsafe sexual behavior
- Hygiene and health problems
Common examples of co-occurring disorders
There is no single combination of co-occurring disorders. Common co-occurrences include the following:
- Alcohol addiction and panic disorder
- Major depression and alcohol abuse disorder
- Marijuana addiction and schizophrenia
- Cocaine addiction and anxiety disorders
- Trauma and substance abuse
- Obsessive-compulsive disorder and anorexia nervosa
- Self-harm behavior and opioid abuse
- Binge eating disorder and alcohol abuse disorder
Additionally any specific personality disorder can co-occur with a substance abuse disorder.
Co-occurrence of eating disorders and substance abuse disorders
Eating disorders are also deeply connected with substance use disorders. According to The National Center on Addiction and Substance Abuse (CASA) at Columbia University, up to one-half of individuals with eating disorders abuse alcohol or drugs, compared to 9 percent of the general population. Up to 35 percent of drug abusers have eating disorders, compared to 3 percent of the general population. Both eating disorders and substance abuse disorders have a similar underlying mechanism, the obsessive preoccupation with control. Both are often linked to psychiatric disorders such as depression.
According to the CASA report: “Bulimic women who are alcohol dependent report a higher rate of suicide attempts, anxiety, personality and conduct disorders, and other drug dependence than bulimic women who are not alcohol dependent.” There is a strong link between eating disorders, substance abuse, and other mental health disorders. Eating disorders and substance abuse disorders often develop as a means to cope with an underlying mental health issue such as depression or anxiety.
Complications associated with co-occurring disorders
Individuals with co-occurring disorders are more likely to have impairments in daily functioning and within their relationships and work life compared to individuals with either condition alone. Having co-occurring disorders also increases the likelihood of relapse in these individuals. A worsening mental health condition can result in increased substance abuse and vice versa. The following are complications associated with co-occurring disorders:
- Financial problems
- Social isolation
- Family problems
- Sexual and physical victimization
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What are the causes of co-occurring disorders?
The causes of co-occurring disorders depend on the many factors. However, general causes of mental health disorders and substance abuse include:
- Past history of abuse or trauma
- The loss of a job
- The loss of a loved one
- Abnormalities in brain chemistry
- Disruptions in prenatal brain development
- Poor nutrition
- Exposure to environmental toxins
- Low self-esteem
- Dysfunctional family relations
- Dysfunctional intimate relationships
Treatment for co-occurring disorders
Treatment for co-occurring disorders aims at treating both the mental health disorder and the substance abuse disorder with an integrative approach, including:
- Medical detoxification
- Family therapy
- Social support groups
- Medications to treat mental health disorders
- Aftercare treatment
- Cognitive behavioral therapy: A therapy that concentrates on patterns of abnormal thinking and distorted beliefs that are the underlying causes for irrational emotions and thought patterns. The key concept of CBT is the idea that thoughts and feelings are directly related to behavior. Therefore, by gaining control of one’s thoughts and emotions, one can better dictate their behavior.
- Dialectal behavioral therapy: A type of psychotherapy that combines parts of cognitive behavioral therapy with principles of mindfulness. Traditional dialectal behavior therapy focuses on concrete behavioral skills for four domains: emotional regulation, interpersonal effectiveness, distress tolerance, and mindfulness.
- Interpersonal therapy: Interpersonal therapy focuses on relationships and social skills that may be contributing to psychological problems such as depression, or substance abuse disorders. Interpersonal psychotherapy works to help individuals identify emotions and where they are coming from, allowing the individual express emotions in a healthy manner, and deal with emotional baggage.
Should co-occurring disorders be treated together or separately?
A substance abuse disorder can be an unhealthy coping mechanism that has developed secondary to an underlying mental health disorder or eating disorder. Therefore, it is important to treat all co-occurring disorders simultaneously, in an effort to prevent any future relapse. If co-occurring disorders are treated separately, then the individual may struggle with symptoms of one condition while fighting to recover from another.
Levels of care for co-occurring disorders
The treatment level of care for co-occurring disorders depends on the duration and severity of the individual’s condition. Detoxification (detox) is generally the initial step in treatment if the individual is currently intoxicated or withdrawing from the addictive substance. Once the individual has successfully completed detoxification, he or she will enter residential treatment, partial hospitalization treatment, intensive outpatient treatment, or outpatient treatment depending on the severity of their disorders.
Who is qualified to treat co-occurring disorders?
Various professionals are qualified to treat different aspects of co-occurring disorders across different medical, therapeutic, and support specialties. At AKUA Mind and Body, a multidisciplinary treatment team includes an array of professionals including intake admission counselors, life skill coaches, therapists, dieticians, physicians, and nurses. All professionals on the therapeutic team are experts in both mental health disorders and substance abuse disorders.
Aftercare and continued therapy for co-occurring disorders
Aftercare consists of successful living in recovery and sobriety after an individual has successfully completed treatment. Therapists and addiction counselors can recommend an aftercare treatment program, such as community group sessions and online support groups.
Recovery is a lifelong process. Even though someone has completed therapy and is learning to cope without dangerous behaviors, continuing some form of aftercare is vital. 12-step meetings, recovery support groups, online support groups, or outpatient therapy sessions are all a great way to discuss feelings, triggers, or even relapses that may occur.
Lifestyle goals for treating a co-occurring disorder
Treatment for co-occurring disorders is initially focused on detoxification from the substance, and then providing well-rounded psychotherapy approaches to teach individuals healthy coping skills, relapse prevention techniques, and healthy lifestyle changes.
Recommended lifestyle changes that promote health and wellness for individuals who are struggling with co-occurring disorders may include the following:
- Improving sleep habits
- Addressing any chronic medical conditions
- Improving communication skills
- Improving nutritional and eating behaviors
- Working on family and intimate relationships
- Addressing job skills and work-related issues
- Managing legal issues