Co-Occurring Disorders guide
Co-Occurring Disorders
It is common for substance use disorders (SUDs) to co-occur with other mental disorders; however, this does not imply that one condition caused the other.Establishing the sequence or the underlying reasons for the co-occurrence can often be challenging for clinicians. Nevertheless, research indicates that one disorder can influence or, in certain cases, even cause the other. Additionally, they can have a bidirectional relationship, meaning that each disorder can influence or exacerbate the course of the other.1
The Substance Abuse and Mental Health Services Administration (SAMHSA) advises an integrated treatment approach that simultaneously addresses both substance use disorders and mental disorders, as it has been shown to improve outcomes and the quality of life for individuals with co-occurring disorders.2 Treatment is typically tailored to address the unique diagnoses of each person and may involve a combination of behavioral therapies and medication.1,3
This co-occurring disorders guide aims to provide information on the prevalence of co-occurring mental disorders, their treatment approaches, and resources for finding appropriate treatment for individuals experiencing substance use disorders alongside other mental disorders.
Statistics and Prevalence of Co-Occurring Mental Health Disorders
- Over a third of adults diagnosed with SUDs, more than 6.7 million individuals, also experience mental illness.
- Nearly 20% of individuals diagnosed with mental health conditions which are approximately 8.4 million individuals, also have co-occurring SUDs.
- Sadly, more than 50% of individuals diagnosed with co-occurring disorders do not receive treatment for either condition due to barriers such as cost.
- The primary barrier to treatment for over half of individuals diagnosed with co-occurring disorders who do not receive treatment is cost.
Dual Diagnosis vs. Comorbidity vs. Co-Occurring Disorder
The concepts of dual diagnosis and co-occurring disorders are often used interchangeably, although there are some academic distinctions between them. Dual diagnosis is a psychiatric term that originated in the 1980s and referred to individuals experiencing two or more psychiatric conditions simultaneously, each considered a distinct diagnosis. Initially, dual diagnosis described individuals with severe mental illness and a substance use disorder (SUD). However, since the early 2000s, the term “co-occurring disorders” has been increasingly used by the Substance Abuse and Mental Health Services Administration (SAMHSA) to refer to the existence of two or more conditions.4
Currently, co-occurring disorders is the more commonly used term for individuals with SUD and another mental health disorder. However, it can also be used to describe individuals with two or more mental health disorders, such as comorbid depression and schizophrenia. In such cases, each condition can be considered a comorbidity of the other. It is worth noting that the term comorbidity is widely used outside of the mental health/behavioral health field to describe the coexistence of multiple medical issues.
It is common for people with SUDs to have one or more additional co-occurring mental health disorders, with approximately half of those with one disorder also having the other. Co-occurring disorders often overlap and can start at the same time, or one may show up before or after the other.6 There is a strong association between SUDs and other mental health disorders; individuals with one disorder are likely to develop at least one more co-occurring mental health condition during their lifetime.5
Co-occurring disorders can also exacerbate the severity of each other. Researchers have determined a few potential mechanisms that may explain why co-occurring disorders are so prominent:5
Overlapping Risk Factors
Common risk factors for substance use disorders (SUDs) and other mental health conditions frequently share similarities and can contribute to the development of these issues. These risk factors encompass a combination of genetic and environmental influences, including factors like exposure to trauma, which can heighten the chances of experiencing these conditions.
Genetic factors play a role in both SUDs and mental health conditions. Certain genes can predispose individuals to be more susceptible to developing substance abuse problems or mental disorders. Family history and a genetic predisposition can increase the likelihood of an individual developing either or both of these conditions.
In addition to genetics, environmental influences also play a significant role. Exposure to traumatic events, such as physical or emotional abuse, neglect, or other adverse experiences, can contribute to the development of both SUDs and mental health disorders. Trauma can have a long-lasting impact on an individual’s well-being and may increase the risk of engaging in substance use as a coping mechanism or exacerbating existing mental health issues.
Self-Medicating
It is widely recognized that individuals with mental illness may resort to substance abuse to cope with their symptoms. This phenomenon is often described as “self-medicating.” However, it is crucial to acknowledge that while substance use may provide temporary relief and mask symptoms, it can also worsen them both in the short and long term. Therefore, the term “self-medicating” can be somewhat misleading, as it implies that substance use effectively alleviates symptoms, whereas it can actually have detrimental effects on mental health over time.
Engaging in substance abuse as a coping mechanism can create a vicious cycle where individuals may experience a temporary reduction in their mental health symptoms through substance use. However, continued and excessive substance abuse can lead to increased mental health problems, such as worsening depression, anxiety, or other psychiatric conditions. Additionally, substance use can interfere with the effectiveness of prescribed medications and therapeutic interventions for mental illness.
It is crucial to approach “self-medicating” cautiously and promote alternative coping strategies and appropriate mental health treatments. Encouraging individuals to seek professional help, engage in therapy, and explore healthier coping mechanisms can provide more sustainable and beneficial approaches to managing mental health symptoms.
Drug-Induced Brain Changes
Substance use has the potential to induce changes in specific regions of the brain that are also implicated in mental health disorders. These alterations in the brain can heighten the likelihood of developing symptoms associated with a mental disorder that affects those particular brain areas. Notably, the brain regions affected by substance use are often associated with impulse-control, mood regulation, anxiety disorders, and schizophrenia.
When an individual engages in substance use, the drugs or substances interact with various neurotransmitters and receptors in the brain, leading to profound effects on brain function. Over time, these interactions can result in structural and chemical changes in specific brain regions.
Impulse-control disorders like addiction are closely linked to the brain’s reward system. Substance use can stimulate the release of dopamine, a neurotransmitter involved in pleasure and reward, reinforcing drug-seeking behavior. Prolonged substance abuse can alter the functioning of the reward system, making individuals more susceptible to addiction and impulsive behaviors.
Mood disorders, including depression and bipolar disorder, involve disruptions in the brain regions responsible for emotional regulation. Substance use can impact these areas, leading to dysregulation of mood and an increased vulnerability to mood disorders. Similarly, anxiety disorders are associated with abnormalities in brain regions involved in fear processing and anxiety regulation, which can be affected by substance use.
Moreover, certain brain regions affected by substance use overlap with those implicated in schizophrenia, a complex mental disorder characterized by altered perception, thinking, and behavior. Substance use, particularly in vulnerable individuals, may contribute to developing or exacerbating psychotic symptoms associated with schizophrenia.
Understanding the relationship between substance use and drug-induced brain changes is crucial for comprehending the complex interplay between substance use disorders and mental health conditions. It highlights the importance of addressing both the substance use and mental health aspects in treatment and recovery efforts, as interventions targeting brain changes and related symptoms can be essential for holistic and effective care.
Researchers have conducted extensive studies on co-occurring disorders and have identified specific mental health conditions that commonly co-occur with substance use disorders (SUDs).5 The following mental health conditions have been found to co-occur with SUDs frequently:
- Anxiety disorders. Approximately 18% of individuals with a substance use disorder also have a co-occurring anxiety disorder.7 Generalized anxiety disorder, social anxiety disorder, and panic disorder are all linked to an increased risk of co-occurring disorders.5,6
- Mood disorders. Around 20% of individuals with a substance use disorder also have one or more mood disorders, such as depressive disorder or bipolar disorder.7
- Personality disorders. In the general population, approximately 10-15% have a personality disorder, whereas, in individuals undergoing addiction treatment, the prevalence rate ranges from 35% to 73%. The most commonly found personality disorders in individuals with SUDs include antisocial, borderline, avoidant, and paranoid personality disorders.
- Post-traumatic stress disorder (PTSD). Individuals with PTSD are up to four times more likely to meet the criteria for a substance use disorder compared to those without PTSD.
- Attention Deficit/Hyperactivity Disorder (ADHD). ADHD is associated with an earlier onset of substance use and a higher likelihood of using various substances. Individuals diagnosed with ADHD during adolescence face an increased risk of developing SUDs in their 20s and 30s. The number of inattention, hyperactivity, and impulsivity symptoms exhibited by individuals with ADHD positively correlates with the risk of substance use.8
Understanding the co-occurrence of these mental health conditions with SUDs is crucial for comprehensive assessment, diagnosis, and treatment. Integrated approaches that address substance use and mental health are often necessary for effective recovery and improved outcomes for individuals with co-occurring disorders.
Symptoms & Signs of Co-Occurring Disorder
While each mental health disorder has distinct symptoms, some general signs may indicate the presence of mental illness:9
- Significant alterations in appetite or disruptions in sleep patterns
- Loss of interest in activities that were once pleasurable or fulfilling
- Intense mood swings or emotional states that are disproportionate to the situation
- Persistent and irrational feelings of fear or anxiety
- Difficulty focusing, making decisions, or thinking coherently
- Inability to recognize significant changes in one’s behavior or personality
- Unexplained and heightened irritability or anger
- Noticeable changes in sexual desire or behavior
- Withdrawal of social connections and isolating oneself from loved ones
- Neglect of personal hygiene or self-care
- Experiencing hallucinations (seeing or hearing things that aren’t there), holding paranoid beliefs, or having fixed false beliefs (delusions)
- Engaging in risky activities
- Physical complaints without an identifiable cause:
- Thoughts of self-harm or engaging in suicidal behaviors
- Incapability to stop using drugs despite a desire to quit
- Experiencing withdrawal symptoms when drug or alcohol use is stopped
- Struggling to function or manage stress without substance use
- Lacking the ability to meet responsibilities at home, school, or work due to drug or alcohol use
- Persisted substance abuse despite declining physical or mental health conditions and strained relationships
- Seclusion from loved ones or association with a new social circle
- Regular tardiness or absences from school or work
- Developing increased tolerance to the substance needing bigger amounts to achieve the same effect
- Engaging in risky behaviors like driving under the influence
- Devoting significant time to obtaining, using, or recovering from the effects of the substance
If you or a loved one is struggling with addiction and/or mental health, do not hesitate to reach out for help. We understand how overwhelming it can be to make the decision to enter a treatment program, and we’re here to answer any questions you may have. Call (866) 716-0971 today to have your questions answered with no obligation to enter treatment.
Assessment of Co-Occurring Mental Disorders
Assessing co-occurring mental disorders and substance use disorders (SUDs) can be complex due to the shared risk factors and coinciding symptoms between the two conditions.10 Therefore, it is important to conduct thorough assessments to accurately diagnose and distinguish between symptoms caused by substance use and those associated with mental health disorders.8
SUDs and mental health disorders should be screened for when individuals seek treatment for either condition. This two-way screening ensures that individuals receive appropriate care and interventions for their needs. After abstinence, additional assessments may be needed to differentiate symptoms related to substance intoxication or withdrawal from mental health disorder symptoms.
The assessment process for co-occurring disorders should also consider genetic and environmental factors that can influence an individual’s mental health and substance use.8 This comprehensive evaluation may involve the following:
- Establishing a medical diagnosis by gathering detailed information about the impact of SUDs and mental illness on various aspects of the individual’s life, including relationships, work, activities, and overall health.
- Assessing the individual’s motivation to change. Successful treatment outcomes are more likely when individuals are committed to reducing or abstaining from substance use, allowing psychosocial interventions to improve their mental health.
- Conducting tests to confirm the presence of substances in the individual’s system and determine the extent of associated damage.
By conducting thorough assessments, healthcare professionals can provide appropriate and tailored treatment approaches for individuals with co-occurring disorders, addressing both the substance use and mental health aspects of their well-being.
What is Integrated Treatment for Co-Occurring Disorders?
Integrated treatment programs are designed to screen, assess, and provide treatment for individuals who have both a substance use disorder (SUDs) and another mental disorder. These programs recognize the interconnectedness of these conditions and aim to address them concurrently.
In addition to addressing substance abuse, integrated treatment programs often offer additional support services to cater to various needs, such as housing assistance, employment support, and socialization opportunities.11 By addressing broader areas of need, these programs promote comprehensive recovery and overall well-being for individuals.
Within an integrated treatment program, individuals receive a combination of medical and therapeutic interventions to simultaneously address their SUD and mental health disorders. This approach allows a multidisciplinary team of professionals, including physicians, therapists, psychologists, counselors, and other clinicians, to assess and manage the symptoms of mental health disorders without the influence of drugs or alcohol, which can potentially exacerbate those symptoms.
Integrated care typically begins during the detoxification phase and continues through aftercare treatment and support. By providing comprehensive and continuous care, these programs aim to achieve positive outcomes for individuals seeking to overcome substance abuse and manage other mental disorders. This holistic approach supports individuals in building a new life in recovery, addressing their substance abuse and mental health challenges.
How to Find Treatment for Co-Occurring Disorders?
Integrated treatment is considered the standard of care for treating co-occurring disorders, which involve both a mental health condition and a substance use disorder. When seeking treatment for co-occurring disorders, it is important to find a provider or treatment facility equipped to assess and treat both conditions concurrently or in a staged approach, depending on the individual’s needs.11
Integrated treatment approaches aim to provide comprehensive and coordinated care by offering services and therapies that address both mental health disorders and substance misuse without division or fragmentation. This means that treatment occurs in the same setting, ensuring that the individual’s needs and conditions are properly addressed.
However, it is important to note that there is no one-size-fits-all approach to treating co-occurring disorders. Treatment plans should be tailored to the individual’s specific needs, considering factors such as the disorders’ severity and withdrawal symptoms.
When choosing a treatment facility for co-occurring disorders, there are several things to look for:11
- Specific services for co-occurring mental health disorders and substance use disorders. Ensure the facility employs a multidisciplinary team of professionals experienced in evaluating, assessing, and treating various mental health conditions and substance use disorders.
- Variety of therapy modalities. Look for a facility that offers a range of counseling, behavioral therapies, motivational interventions, and ongoing support that have been shown to be effective in treating co-occurring disorders.
- Various options for inpatient and outpatient treatment. Consider the different program lengths available, such as 30-, 60-, and 90-day programs, and choose the one that best suits your needs based on factors like the severity of the disorders and withdrawal symptoms.
- Aftercare support. Find out if the facility offers ongoing services and social support to help manage both disorders beyond the treatment period. Having continued support and positive relationships are crucial for sustained recovery.
- Multicultural or population-specific programming. If desired, look for a treatment facility that offers specialized programs tailored to specific populations, such as women, veterans, first responders, or members of the LGBTQ community.
- Insurance coverage. Check with your insurance provider to understand the specifics of coverage for co-occurring disorder treatment. You can also verify insurance coverage for a particular treatment facility by contacting them directly.
By considering these factors, individuals can make informed decisions when selecting a treatment facility that can provide comprehensive and integrated care for their co-occurring disorders.
Co-Occurring Disorder Treatment Centers Near Me
Our Rehab Advisors can help you find a co-occurring disorder treatment center that meets your unique needs. Whether you are looking for inpatient or outpatient treatment, short-term or long-term programs, we can help you find a facility specializing in treating co-occurring disorders with integrated approaches. Call us at (866) 716-0971 to learn more about co-occurring disorder treatment options available for you or a loved one.
- National Institute on Drug Abuse. (2018). Comorbidity: Substance use and other mental disorders.
- Substance Abuse and Mental Health Services Administration. (November, 2021). Co-Occurring Disorders.
- Substance Abuse and Mental Health Services Administration. (2020). Mental health and substance use disorders.
- Substance Abuse and mental Health Services Administration. (2020). Substance Use Disorder Treatment for People With Co-Occurring Disorders. Treatment Improvement Protocol (TIP) 42.
- Hryb, Kathryn, MSW, Kirkhart, Rob, Ph.D., PA-C, and Talbert, Rebecca, PharmD. (September 2007). A Call for Standardized Definition of Dual Diagnosis. Psychiatry, 4(9), 15-16.
- National Institute on Drug Abuse. (2018). Comorbidity: Substance use disorders and other mental illnesses.
- Flynn, P.M., & Brown, B.S. (2008). Co-occurring disorders in substance abuse treatment: Issues and prospects. Journal of Substance Abuse Treatment, 34(1), 36-47.
- National Institute on Drug Abuse. (2020). Common comorbidities with substance use disorders.
- Kelly, T.M., & Daley, D.C. (2013). Integrated treatment of substance use and psychiatric disorders. Social Work in Public Health, 28(3-4), 388-406.
- American Psychiatric Association. (2022). What is a Substance Use Disorder?
- National Alliance on Mental Illness, Minnesota. (March 2017). Dual Diagnosis and Integrated Treatment of Mental Illness and Substance Use Disorders.
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