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Comorbidity refers to the condition where an individual is diagnosed with more than one type of medical condition or psychological disorder.
When people are consistently diagnosed with two or even more different psychological disorders at the same time, clinicians refer to these disorders as being comorbid with each other.
In a sense then, any situation where there are two or more comorbid disorders in an individual could be considered as a situation of co-occurring disorders. However, one of the most common pairings of different disorders is a specific mental health disorder (a psychological or psychiatric disorder) and a comorbid diagnosis of a substance use disorder (substance abuse or addiction). When clinicians encounter this, they commonly use the terms co-occurring disorders or dual diagnosis to specify this type of situation.
It is common for someone to be diagnosed with more than one type of mental health disorder. Some of the statistics regarding co-occurring diagnoses from the National Institute of Mental Health and the Substance Abuse and Mental Health Services Administration indicate the following:
The American Society of Addiction Medicine (ASAM) has discussed professional policies regarding dealing with co-occurring disorders. ASAM also lists the different mental health disorders that are most commonly associated with some type of substance use disorder. These include:
Any type of substance use disorder can be comorbid with a form of mental illness; however, certain combinations are more common. Some combinations that are relatively common include:
The relationship between the mental illness and co-occurring substance use disorder is not always easy to assess. It is essentially impossible at this time to determine if one particular disorder causes or results in the development of another disorder. For example, individuals who have schizophrenia are notoriously apt to have serious tobacco use disorders or smoking issues. Part of the reason for this is believed to be that nicotine may actually alter some of the effects associated with having schizophrenia. On the other hand, individuals who have early cannabis use disorders are more likely to develop psychosis and be diagnosed with schizophrenia. Thus, the relationship between the substance use disorder and the mental illness is not always well-defined.
There is no real way to generally describe cause-and-effect in an overall sense. The development of a co-occurring disorder most likely represents an overall liability to develop mental illnesses based on one’s personal experiences, genetic factors, and other interacting factors.
Individuals diagnosed with co-occurring disorders present specific challenges in terms of treatment. First, individuals with co-occurring disorders also have other complicating issues that affect treatment. These include:
People with co-occurring diagnoses or any types of comorbid mental illnesses should preferentially be involved in treatment programs that address all co-occurring disorders at the same time. Research has shown indicated that trying to focus on one disorder while ignoring or holding the others constant results in very poor treatment outcomes. Only by treating the entire person and all issues can the chances of successful treatment outcomes be optimized.
This has led to the notion of using integrated treatment as the first line approach in treating someone who has a dual diagnosis. The emphasis of integrated treatment is to use a multidisciplinary approach, treat all issues concurrently, and get the individual to the most self-sufficient level possible. While integrated treatment programs follow standardized treatment outlines or blueprints for the specific mental disorders and substance use disorder in question, they also ensure a tailored approach and adjust for the changing needs of the individual.
With integrated care, the treatment is broken down in the specific stages in order to achieve the overall goals of the program. This is generally conceptualized as four related stages of overall treatment:
Integrated treatment is delivered by a multidisciplinary team that includes physicians, therapists, social workers, case managers, and other healthcare professionals and volunteers suitable for the specific case.
In addition, treatment should incorporate the following services:
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The overall goal is to provide a comprehensive treatment approach that addresses all the needs of the individual. This care allows the person the best opportunity for recovery and to reach the highest possible level of autonomy.
Part of the approach in an integrated treatment program includes medically assisted treatment. The medications used in these integrated treatment programs are determined on a case-by-case basis. They may include:
All medications should be administered under the strict supervision of a physician, and dosage levels should be regularly assessed.
When looking for treatment options for an individual who has a substance use disorder that is comorbid with some other psychological condition, there are certain features a treatment program should offer.
While the presence of co-occurring disorders can complicate the treatment process, integrated care ensures that all issues can be fully addressed, making recovery from all conditions within reach.
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