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How Co-Occurring Disorders Are Best Treated

It's estimated that over 7 million adults have co-occurring mental illness and substance use problems. This means that of the over 20 million adults facing mental illness, about 35 percent are also dealing with a substance use problem.

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The relationship between substance abuse and mental illness is a complicated one. In most cases, it’s difficult or impossible to determine which came first — the substance use problem or the mental illness. Experts agree that both conditions should be treated simultaneously for the best chances at a complete recovery on all fronts.

The existence of both a mental illness and a substance use problem is an example of comorbidity, which occurs when a person has two or more disorders at the same time. Treating a comorbid substance use and mental illness can be complex, as the two conditions can make each other worse and often share the same risk factors.

It’s important to find treatment programs where professionals are experienced in treating co-occurring mental illness and substance abuse problems. These professionals can turn a challenging diagnosis into an opportunity for true recovery.

With a proper diagnosis and holistic approach, comprehensive programs allow for a deeper examining of behavioral and mental patterns. They work to get to the root causes of both conditions and find practical solutions and effective coping tools. These programs treat the whole person, and they cater treatment to each individual, ensuring all issues are effectively addressed.

Which Mental Illnesses Are Most Often Connected to Substance Use?

Anyone can develop a substance use disorder, but people with existing mental health issues are more likely to abuse substances. Some mental illnesses are more commonly linked to substance use disorders than others.

  • Depression: Mood issues like depression are frequently connected to substance use problems. It’s estimated that 20 percent of individuals with a depression disorder also have a substance use disorder, and 20 percent of those with a substance use disorder suffer from depression.For many reasons, including the fact that many cases of depression are undiagnosed or dismissed by the person struggling with it or even by medical professionals, it’s often difficult to determine whether a person turned to a substance because they were depressed, or if they became depressed as their dependence on a substance became more severe. Ultimately, it doesn’t matter in terms of how treatment goes forward.Depression and substance use often form a dangerous, symbiotic relationship. A person may turn to a substance to soothe their feelings of depression, and they then feel ashamed or hopeless about their condition. In addition to the negative feelings they face after using a substance, many will also deal with physical symptoms that will worsen depression.Alcohol, for example, is a depressant, and many other substances cause an emotional and physical crash after using them. This only compounds the depression issue, and this often leads to further substance abuse.
  • Anxiety: Like depression, anxiety is a mood disorder that many people may seek to alleviate with the use of alcohol or drugs. Some people may seek refuge from their anxiety-ridden thoughts with a downer or depressant, like alcohol or prescription painkillers. Others may seek the aid of a stimulant or upper to help them overcome their anxiety and take on daily tasks, dreaded events, or stressful interactions.Again, this can become a harmful cycle. In the aftermath of taking a substance, the person may experience physical and emotional side effects that can make their anxiety worse. They are then tempted turn to the substance for relief.
  • Bipolar disorder: This disorder is a commonly misunderstood and misdiagnosed mental illness that leads to extreme mood swings and drastic changes in energy and personality. Many people may self-medicate with drugs and alcohol in order to smooth out the tumultuous phases of their disorder, which often include manic highs and depressive lows.In fact, the connection between substance abuse and bipolar disorder is even stronger than the connection between substance abuse and depression. People who have bipolar disorder are estimated to be at least four times more likely to use alcohol and recreational drugs than those who don’t struggle with mental illness.
  • Attention deficit hyperactivity disorder (ADHD): The link between ADHD and substance use is undeniable. Some estimates indicate that as many of 25 percent of people with a history of substance abuse may also have ADHD, and that almost a third of juveniles diagnosed with ADHD will experience a substance use disorder later in life.Some factors contributing to these high numbers include depression that a person with ADHD may feel as a result of feeling inadequate or incapable due to the symptoms of their condition, and the increased impulsiveness that many people with ADHD experience, which may make them more likely to experiment with substances. Both of these factors can be exasperated by a misdiagnosis or dismissal of their ADHD symptoms by family, friends, and even medical professionals.
  • Schizophrenia: Recent studies have indicated that up to half of people with schizophrenia also struggle with substance use problems. Many with psychotic disorders such as schizophrenia seek to self-medicate with alcohol or drugs in order to ease the feelings of depression and isolation they experience as a result of their mental state. This may be especially true in cases of undiagnosed or mismanaged schizophrenia.
  • Post-traumatic stress disorder (PTSD): After a traumatic event, or after dealing with continuous chronic trauma, many individuals may feel unable to cope with normal life. They may turn to alcohol or drugs to manage their high levels of depression and stress.

Simultaneous Treatment for Co-Occurring Disorders

While each individual is unique and requires a treatment plan that is designed with their specific history, condition, and behavioral patterns in mind, most medical professionals experienced in dual diagnosis care take a comprehensive approach to recovery that includes the following:

  • A consideration of underlying issues related to both disorders: The connection between mental illness and substance use disorders is often linked to common underlying issues that include genetics, chemical imbalances and deficiencies, trauma, and environmental factors, such as growing up in a household where substance abuse or mental illness was present.By identifying these issues, the person can begin to understand their patterns of behavior and emotional responses. Then, they can work to change them.
  • Integrated treatment: Because concurrent mental health and substance abuse problems are often so deeply intertwined, many recovery professionals see the benefit in working through the issues together rather than treating each as a separate issue. This allows the individual to address the underlying issues, as well as the behavioral and thought patterns, that may be behind both problems or play a part in the relationship between the two issues.Across the board, experts agree that integrated treatment is preferable. Co-occurring disorders are treated simultaneously.

While specific treatment plans will vary, most plans for dual diagnosis treatment combine some of these elements:

  • Cognitive behavioral therapy (CBT): CBT is a form of psychotherapy that focuses on modifying dysfunctional beliefs, behavioral patterns, and thoughts. Unlike some other forms of therapy, CBT is more solutions-oriented, with the goal of helping an individual develop life skills and coping mechanisms to guide them through recovery and real life.CBT is often used as part of individual therapy.
  • Medication management: Treating concurrent mental illness and substance use disorders sometimes requires the use of prescription medications. The specific medications used will depend on the particular mental health disorder, but options include antipsychotics, anti-anxiety medications, antidepressants, and other mood-stabilizing drugs.Medication-assisted treatment (MAT) may be used to address withdrawal from and addiction to certain types of drugs, particularly opioids, alcohol, and benzodiazepines. Some medications may be used to alleviate severe withdrawal symptoms, while others may be used throughout treatment and beyond to address underlying chemical imbalances or ongoing symptoms.Most often, a tapered approach is used with MAT. The supervising physician may start you on an initial dose, which is then lowered over time as you adjust to life without any substances. The ultimate goal is to get you off the maintenance medication.

If you are taking medications to manage certain mental illnesses, you may remain on these indefinitely.

  • Group therapy: By communicating honestly with others who have similar experiences or backgrounds in a supportive environment, individuals are reminded that they’re not alone in their struggles. Group therapy can also encourage accountability and positive social behavior.
  • Expressive therapy: Expressive therapy, such as art therapy or journaling, may help an individual to release pent-up feelings, or work through emotions or trauma through creative expression. It may also help to change negative behavioral patterns and create feelings of accomplishment.
  • Yoga, exercise, and mindfulness practices: These activities are helpful in addressing both substance abuse issues and mental health problems. They promote overall wellness, increase an individual’s sense of physical well-being, and also aid in changing harmful behavioral and thought patterns. The skills learned in these practices can be effective tools in navigating everyday life during and after recovery.Because these activities can be done alone or in a group setting, they can both foster a sense of self-reliance and encourage positive social interactions. Ultimately, they help to promote a healthy lifestyle, and this is supportive of recovery from co-occurring conditions.

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