How common are co-occurring disorders?
According to statistics, approximately 8 million individuals in the United States have a co-occurring disorder and individuals with a mental health disorder such as depression or anxiety are more likely than individuals without a mental health disorder to also have a substance abuse disorder. Co-occurring disorders can be difficult to diagnosis as many individuals have an array of symptoms and often times only one disorder is diagnosed and treated at the time of admission and the other disorder is left out, resulting in the individual not showing much improvement in their symptoms. As a result, 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 who have been diagnosed with specific mental health disorders have the following increased risk for developing a substance abuse disorder:
- 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
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 abuse 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 and therefore 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 sexual deviance
- Hygiene and health problems
Common examples of co-occurring disorders
There is no single combination of co-occurring conditions but rather a wide variety that ranges in severity and duration. Common co-occurring disorders 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 and 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 and 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 a mental health or a substance abuse disorder alone. Having two disorders also increases the likelihood of relapse in these individuals. Furthermore a worsening mental health condition can result in increased substance abuse and vice versa. The following are additional 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 specific disorder however general causes of mental health disorders and substance abuse disorders are listed below:
- 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 in an integrative approach. Integrated treatment approaches include the following:
- Medical detoxification
- Family therapy
- Social support groups
- Medications to treat mental health disorders
- Aftercare treatment
- Cognitive behavioral therapy: Specifically concentrates on patterns of abnormal thinking and distorted beliefs that are the underlying causes for irrational emotions and thought patterns that can lead to mental illness. This key concept for this type of therapy approach lies within the idea that thoughts and feelings are directly related to behavior and therefore gaining control of one’s thoughts and emotions can better dictate their behavior.
- Dialectal behavioral therapy: 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: Type of psychotherapy that focuses on the interpersonal relationships and interpersonal skills that maybe causing the individual to have psychological problems such as depression or alcohol abuse disorder. Interpersonal psychotherapy works to help individuals identify emotions and where they are coming from, helping the individual express emotions in a healthy manner, and learning to deal with emotional baggage. Interpersonal psychotherapy is differentiated from other forms of psychotherapy in that it focuses on the personal/relational practices rather than attempting to modify aspects of an individual’s personality.
Should co-occurring disorders be treated in parallel or separately?
The substance abuse disorder can be an unhealthy coping mechanism that has developed secondary to the underlying mental health disorder or eating disorder or vice versa. Therefore, it is important to treat all co-occurring disorders simultaneously or in parallel in an effort to prevent any future relapse. If co-occurring disorders are treated as separate disorders than the individual may struggle with their substance abuse disorder while they are currently undergoing treatment for their mental health disorder.
Levels of care for co-occurring disorders
Similar to treating a substance abuse disorder or a mental health disorder, the treatment level of care for co-occurring disorders depends on the duration and severity of the individual’s signs and symptoms. Detoxification may be the initial step in treatment if the individual is currently intoxicated or withdrawing from the addicted 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. A multidisciplinary treatment team includes an array of professionals ranging from intake admission counselors, life skill coaches and therapists to dieticians, physicians and nurses. All professionals on the therapeutic team should be 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 after an individual has successfully completed treatment for their co-occurring disorder. Many therapists and addiction counselors can recommend an aftercare treatment program, which consists of community group sessions and online support groups. Recovery is a lifelong process and even though the individual has completed therapy and is learning to cope with the real world, continuing some form of aftercare is important. 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 on a regular basis.
Lifestyle goals for treating a co-occurring disorder
Treatment for co-occurring disorders is initially focused on detoxification from the substance abuse of choice 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 relationships
- Addressing job skills and work-related issues
- Managing legal issues