Co-occurring disorders are present when two or more conditions occur simultaneously in a single person. This concept is similar to that of comorbidity, which, according to the National Institute on Drug Abuse (NIDA), is the occurrence of two or more disorders simultaneously or one after the other. It is very common for people who have a substance use disorder to also have another mental health issue. Substance abuse is considered by NIDA to be a mental illness, as it changes the fundamental hierarchy of the brain, and it is estimated that six in 10 substance abusers have some kind of other mental health disorder as well.
Smoking tobacco seems to highlight the basic relationship between mental illness and substance abuse. Individuals struggling with a mental illness are about twice as likely to smoke, according to NIDA. In cases of people with schizophrenia specifically, 75-95 percent of these individuals smoke.
The Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that about 8 million adults suffered from co-occurring disorders in 2014.
Common Co-Occurring Disorders
Some disorders appear to have a more significant correlation with other disorders. For children, attention deficit hyperactivity disorder (ADHD) seems to greatly increase the risk for co-occurring disorders, according to NIDA. However, early drug use has also indicated a higher risk for the development and acceleration of psychiatric issues, so it goes both ways.
Post-traumatic stress disorder (PTSD) is a condition that often co-occurs with other issues in adults. PTSD is a disorder that usually develops following some kind of trauma or life-threatening event, according to the National Center for PTSD. Affected individuals are plagued with upsetting memories that can result in trouble sleeping and increased anxiety in day-to-day life. More than 75 percent of people affected by lifetime PTSD experience some kind of comorbidity, and substance use disorders are very common among those suffering from PTSD, affecting nearly half of individuals. This co-occurrence is more common among men, but women with PTSD are about 2.5 times more likely to experience alcohol abuse than women without PTSD.
Antisocial personality disorder and alcoholism commonly co-occur together. Antisocial personality disorder is a condition in which an individual frequently manipulates and violates the rights of others, which can result in criminal activity, according to the U.S. Department of Health and Human Services. People suffering from this condition are more likely to suffer from alcoholism as well, and the abuse of alcohol can compound mental illness.
Cocaine abuse has been associated with a multitude of anxiety disorders, according to Medscape. As a result, paranoia and violent behavior are common among cocaine users. Cocaine use is known to produce many mental health issues, and it can compound pre-existing conditions as well.
Schizophrenia has come to be associated with substance abuse as well. This condition is a severe disorder that has a drastic impact on how a person thinks and perceives the world. Those affected often lose touch with reality, according to the National Institute of Mental Health. A study published in the American Journal of Psychiatry estimated that approximately 50 percent of people diagnosed with schizophrenia will abuse substances at some point in their lives. A common drug of abuse associated with this mental health disorder is marijuana, though the reason for this correlation remains unidentified.
Heroin abusers often experience depression. This is due to the damage that heroin can do to a person’s brain, effectively making it more difficult for them to experience pleasure. Depression is a long-term side effect of heroin use, and it can also arise during withdrawal from the drug.
Causes of Co-Occurring Disorders
It is common for someone dealing with a mental health issue to experiment with forms of self-medication, especially if that mental health issue remains undiagnosed. Drugs and alcohol may provide some relief in the short-term from the symptoms of the mental health issues, but they often have a negative impact in the long-term. Drug use will not repair the mental health issue and can inhibit the person’s ability to develop appropriate coping skills and receive treatment.
In some cases, it may be the drug use that brings on the mental health issue, according to NIDA. Drug use and other mental illnesses can be developmental issues experienced early in life. Exposure to drugs at a young age can lead to changes in the brain that make an individual more susceptible to mental health disorders. In some cases, when a person has a genetic predisposition to mental illness, drug use can trigger the onset of a particular disorder.
Just as a person may be more likely to develop certain mental health disorders, genetics play a role in the likelihood that a person will develop substance abuse and addiction issues. In addition, a person with a mental health issue is more likely to also develop addiction issues, and the reverse is also true.
Environmental triggers may overlap, contributing to both addiction and mental health issues. Exposure to drug use in the home can increase the risk for either kind of disorder, as can experiences of stress or trauma at a young age.
Treatment for co-occurring disorders is more complex and challenging than treatment of a single disorder. For example, an individual suffering from alcoholism and depression will have a difficult time recovering from their alcohol abuse issues if the depression is not treated. Behavioral Health Evolution asserts that alcohol and drug addictions may seem resistant to treatment if the mental illness is left untreated. On the inverse side, someone being treated for depression but not their alcoholism will have difficulty making progress in treatment. Alcohol consumption can influence the effectiveness of antidepressants or other medications used in treatment. In addition, drinking can compound feelings of depression and sadness over time. When co-occurring disorders are present, it’s clear that treating just one disorder decreases the chances of recovery on all fronts.
This is why an integrated treatment strategy is most effective for an individual suffering from co-occurring disorders. Integrated treatment deals with all disorders simultaneously, ensuring that one disorder is not being neglected. Integrated treatment involves a single recovery plan put in place by a single agency (made of all treating professionals) to address all disorders present, eliminating the need for a person to attend treatment in multiple locations.
Shared decision-making is a big part of the integrated treatment process. The client has input into their treatment plan, and decisions are made by the entire treatment team. Generally, there is a case manager to lead the team and keep care focused on all fronts.
Integrated treatment usually involves a comprehensive approach to recovery in an effort to give an individual the best chance of long-term health, incorporating various factors like:
- Employment support
- Housing assistance
- Social skills training
- Behavioral therapy
- Specialized or complementary therapies
According to a study published in CNS Spectrums, the combination of medication, Cognitive Behavioral Therapy (CBT), Motivational Enhancement Therapy, and 12-Step facilitation is one that all mental health clinicians should be familiar with, as it greatly helps those suffering from co-occurring disorders and is consistently superior to other forms of treatment.
Medications like antidepressants and anti-anxiety drugs are often employed in integrated treatment for co-occurring disorders, but medication alone is not sufficient. It is the mixture of medication and a variety of therapeutic approaches that is most effective in treating co-occurring disorders. The medications of choice will, of course, vary according to the particular mental health issues in question.
Since co-occurring disorders are more difficult to treat, treatment often begin in an inpatient setting where an individual can receive 24-hour care. The structured lifestyle afforded at a treatment facility can be hugely beneficial for an individual as they take on the task of tackling multiple issues at once. In some cases, outpatient treatment may be preferable for an individual dealing with co-occurring disorders. The specifics of treatment should be determined by the individual’s treatment team, as all care should be individualized.