A co-occurring disorder diagnosis is indicated when an alcohol or drug-related disorder occurs alongside a mental health disorder. The mental health disorder and the substance abuse disorder interact with each other and commonly increase the severity of both. The term “co-occurring disorder,” also called a dual diagnosis disorder, does not imply that one diagnosis is primary and that the other is secondary. The term also does not imply that one causes the other.
There is, however, good indication that substance abuse issues make mental health issues worse, and mental health issues increase the likelihood and severity of substance abuse behaviors. There are several categories, or classifications, of common mental health issues associated with co-occurring disorders. These mental health issues include depression, anxiety, other mood disorders such as bipolar illness, and personality disorders.
Recognizing the Symptoms
The symptoms of a mental health disorder may lead the client to self-medicate with drugs or alcohol. For example, severe depression may lead a person to abuse alcohol or smoke methamphetamine. There is no standard pairing of a particular drug with a specific mental health disorder.
Generally speaking, one disorder may be more severe than the other, although this may change over time. Additionally, it is common for the mental health issue and the chemical dependency problem to increase in severity.
Drug or alcohol abuse can frequently launch a major mental health episode which may have been dormant or had very mild symptoms. Co-occurring disorder treatment must address the unique symptoms experienced by the client and treatment must address both the substance abuse and the underlying mental disorder.
In co-occurring disorders, treatment is designed to achieve abstinence from drugs and alcohol, reduce the symptoms of the mental health disorder, and prevent relapse for both.
Mental Health Issues
There are cases a person develops mental illness symptoms only after using drugs and alcohol, which suggests that the substance abuse made the mental health problems worse.
Illnesses that frequently co-occur with addiction include the following:
- Bipolar illness
- Conduct disorder
- Personality disorders
- Anxiety disorders
- Thought disorders, including schizophrenia
- Post-traumatic stress disorder (PTSD)
- Attention deficit hyperactivity disorder (ADHD)
Identifying Co-occurring Disorders
To provide the most effective treatment, a thorough evaluation must be conducted. This assessment includes mental health functioning, psychological issues, psychiatric history, cognitive abilities, medical problems, social history, relational problems, substance abuse behaviors, and general history.
A comprehensive evaluation helps target specific areas to be addressed and increase the probability of recovery. A customized treatment plan is developed addressing medical and psychiatric treatments, mental health problems, and substance abuse issues.
The more issues directly addressed by the treatment team, the more likely a positive outcome can be achieved.
Treatment centers use a variety of approaches to assist individuals with co-occurring disorder treatment.
1. Sequential treatment targets one disorder, followed by treatment for a second disorder.
These separate treatments are often done in different clinics or care systems. In the past, treatment centers would sometimes suggest substance abuse difficulties be dealt with first and the mental health issues could be targeted at a later point in time.
2. Parallel treatment uses distinct interventions that target each disorder separately.
These treatments may be conducted at the same time, but are often delivered by different providers.
3. Integrated treatment for co-occurring disorders specializes in interventions that work at the same time, in the same place, using the same team.
Most effective is an integrated treatment including psychiatric, psychological, and addiction treatment services. Integrated treatment leads to higher recovery success rates.
Most Effective Treatment Programs
In order to achieve the best outcomes and be most effective, a treatment program should include:
- Helping the patient identify signs and symptoms of co-occurring disorders
- Provide screening and assessments for mental health and substance use disorders
- Identify the interaction of substance use disorders and mental health problems
- Offer direct access to psychiatric providers
- Present integrated and evidence-based treatment for co-occurring disorders
- Teach symptom reduction and relapse prevention planning
- Assist the client in finding available community services
- Make referrals for further assessment and treatment
- Address past trauma issues
- Aid clients in developing pro-social attitude
- Support client in discharge planning, including employment and housing
There is hope for those struggling with co-occurring disorders. Quality treatment facilities and integrated programs reduce symptoms and prevent relapse. Although effort is required on part of the client, real progress can be made.
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Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved from http://www.samhsa.gov/data/
Center for Substance Abuse Treatment. Substance abuse treatment for persons with co-occurring disorders. Treatment Improvement Protocol (TIP) Series 42. DHHS Publication No. (SMA) 05-3922. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2007
James, D.J., & Glaze, L.E. (2006). Mental health problems of prison and jail inmates. Washington, D.C.: United States Department of Justice, Bureau of Justice Statistics.
Torrey, E.F., Kennard, A.D., Eslinger, D., Lamb, R., & Pavle, J. More mentally ill people are in jails and prisons than hospitals: A survey of the states. Alexandria, VA: National Sheriffs Association, Treatment Advocacy Group, 2010.