Mental health and addiction issues often go hand in hand, and many people suffer from both. When you have a mental health disorder and substance use disorder at the same time, it is referred to as co-occurring disorders. Co-occurring conditions can be very difficult to manage, as each disorder often significantly impacts the other.
The Substance Abuse and Mental Health Service Administration estimates that about 9.2 million adults in the United States have a co-occurring disorder. Yet, only 7% of those individuals receive treatment for both issues. A whopping 60% of individuals with co-occurring disorders do not receive treatment for either issue. This is a growing concern when it comes to overall public health.
Co-occurring disorders, also known as dual diagnosis or comorbidity, refer to the simultaneous presence of a mental health disorder and a substance use disorder in an individual. This means that an individual may struggle with drug addiction and an underlying mental health condition such as bipolar disorder, depression, anxiety, PTSD, trauma, etc.
Research has shown that people with mental health disorders are more likely to develop a substance use disorder, and people with substance use disorders are more likely to develop a mental health disorder. In fact, roughly about 50% of people with severe mental illnesses are affected by substance abuse and vice versa. This is because individuals may turn to substances as a form of self-medication to cope with their mental health disorder symptoms. Substance use may also worsen existing mental health symptoms or lead to new mental health problems.
Self-medication is one of the main issues surrounding co-occurring disorders. People self-medicate to attempt to numb or cope with the symptoms of their mental health disorder, such as feelings of sadness or worthlessness. However, this is a risk factor for substance abuse and addiction.
Self-medication can also mask the underlying mental health issue, making it difficult for individuals to access the appropriate mental health services. This further perpetuates the cycle of substance abuse, making it even harder for individuals to break free from addiction.
The signs and symptoms of a co-occurring disorder vary depending on the abused substance and mental condition. For example, marijuana abuse and depression could look very different from the signs of alcohol abuse and schizophrenia.
That said, here are some questions you can ask yourself to help determine if you or a loved one may be struggling with comorbidity:
If you answered yes to any of these questions, you may have a dual diagnosis and should consider seeking professional help.
Co-occurring disorders can be challenging to diagnose and treat because the symptoms of the mental health disorder and the addiction tend to overlap. This makes it difficult to determine which condition is causing which symptoms. In some cases, the symptoms might vary in severity, making a patient receive treatment for one disorder while the other disorder remains untreated. People may also be less likely to seek help if they struggle simultaneously with both issues.
But the good thing is that many treatment facilities and professionals (like psychiatrists, psychologists, and therapists) specialize in treating comorbid conditions. These healthcare professionals are experienced in diagnosing and treating substance use and mental health disorders. They will perform a comprehensive assessment that includes physical exams, psychological evaluations, mental health screenings, and substance use assessments to determine the primary and contributing conditions.
Once a dual diagnosis is established, the healthcare provider will create a treatment plan that integrates both mental health and substance abuse treatment co-currently. Addressing these comorbid disorders at the same time ensures the best outcome.
With integrated treatment plans, the same practitioner offers both substance and mental health interventions in an integrated manner. The goal is to treat the person as a ‘whole,’ not just two separate issues. This treatment addresses the underlying causes of addiction, such as depression and anxiety, while providing strategies to help deal with cravings and overcome the physical aspects of addiction.
Integrated treatment often involves specialized therapies such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), motivational therapy, and trauma-informed psychotherapy. Each type of therapy helps address the underlying issues contributing to addiction while promoting healthy coping skills and emotional regulation. These therapies can be offered in individual or group settings.
According to SAMHSA, co-occurring disorders are treated in a stage-wise fashion with different services provided at different stages: engagement, persuasion, active treatment, and relapse prevention. At each stage, a team of professionals provides services that address mental health and substance use disorder.
After treatment, the patient is encouraged to attend support groups, such as Narcotics Anonymous (NA) and Alcoholics Anonymous (AA), to maintain sobriety. Additionally, they are encouraged to use the skills and techniques they learned in therapy, such as mindfulness and stress management, to help them cope with triggers and handle cravings.
Co-occurring disorders are complex conditions that require integrated and comprehensive health services. With the right combination of therapies, medications, and peer support, individuals can recover from mental health disorders and addiction.