The National Institute on Drug Abuse (NIDA) reports there are 7.7 million American adults with co-occurring mental health conditions and substance abuse issues. Additionally, of the 20.3 million adults in the United States with substance use disorders, 37.9% also have mental health conditions. What’s more, of the 42.1 million with mental illness, 18.2% also have a co-occurring substance use problem.
A co-occurring disorder, or comorbidity, is when an individual has two or more mental health issues that occur simultaneously or sequentially with one coming after the other. Comorbidity is more common than many believe. Not only does having more than one mental illness somewhat complicate matters, one problem can actually exacerbate or make the other worse and vice versa. However, this is not uncommon.
NIDA also reports that having a mood disorder puts an individual at twice the risk of developing a drug use issue. The reverse is also true, individuals diagnosed with drug use issues are twice as likely to suffer from an underlying mental health disorder.
WHY DO DRUG USE AND MENTAL HEALTH ILLNESSES OCCUR TOGETHER?
When an individual has an alcohol or other drug problem it can often mask other psychiatric disorders. For example, major depressive disorder (MDD) or generalized anxiety disorder (GAD). Alcohol is a depressant and when a person is an alcoholic they may think they are sad because of the alcohol. However, this may not be the case. When a person is on drugs, their true emotions may also be masked by the effects of the drug. For these reasons, it can be difficult to determine when someone has both an alcohol use disorder (AUD) or substance use disorder (SUD) and another mental health condition.
This is one reason it’s essential to fully understand the connection between AUD, SUD, and other mental health issues or co-occurring disorders. Many people want to know why so many with mental disorders also have drug or alcohol issues and vice versa. According to NIDA, there are several reasons for this frequency of occurrence.
1. Some of the common risk factors for developing an alcohol or substance use issue are the same development of another mental illness. These include:
- Brain deficits in certain areas
- Early exposure to trauma and abuse
2. Substances that are commonly abused can often cause symptoms in the users that mimic other mental illnesses. For example, marijuana users report having psychosis at times and research indicates that chronic marijuana use can increase the risk for developing this condition.
3. Individuals with mental illness often turn to alcohol and drugs to self-medicate. For some, the use of alcohol or drugs can initially help to lessen the symptoms. However, over time this use only makes both issues much worse. One example is the use of cigarettes by those who have been diagnosed as schizophrenic. Tobacco has been found to lessen some of the symptoms of schizophrenia and improve mental cognition.
PROPER ASSESSMENT FOR CO-OCCURRING DISORDERS
When it comes to treatment for either mental health disorders or addiction, it’s vital to have a thorough and proper evaluation and assessment. Without this first crucial step, the entire treatment process could potentially not address underlying issues. This is true for both a mental illness and a substance abuse problem.
NIDA recommends broad assessment tools to be used in both situations. If an individual comes for a mental illness such as anxiety or depressive disorder, they should be screened for substance use issues. And vice versa. When an individual is being evaluated for and in treatment for alcohol or drugs, they should be screened for underlying psychiatric disorders.
It’s important in the latter case, to also observe the individual over a period of time when they are abstaining from alcohol or drugs. During this time, other mental illness symptoms may get worse or disappear. When this happens, it’s vital to have resources to address any new psychiatric symptoms immediately.
There are a number of individuals in recovery who once believed they had a psychiatric condition. However, once their bodies and minds became free from substances for a time they found these issues went away. There are also those who after a time sober begin to notice more symptoms of a mental illness. This could be because the drugs or alcohol were helping to mask the mild symptoms that are now presenting. Observing those in treatment for substance use disorder over a period of time is important because there are also withdrawal symptoms that can present as mental health symptoms, such as anxiety, depressive disorder, mood swings, and more.
When assessments for alcohol and drug issues as well as mental health issues are comprehensive, this allows for more accurate diagnosis and targeted treatment plans created to meet that person’s unique needs.
TREATMENT FOR CO-OCCURRING DISORDERS
An individual with co-occurring mental health issues such as alcohol addiction and generalized anxiety disorder needs specialized, targeted, and integrated treatment in order to successfully recover or manage both. One reason for this is that research indicates that individuals with co-occurring conditions that include a substance abuse issue often have mental health symptoms of both that are more severe, persistent, and treatment-resistant. This is compared to those individuals who have only one of the conditions.
However, progress continues to be made in the treatment of dual diagnosis. There are some treatment approaches that have worked better than others. These include the following:
Behavioral treatments include therapies such as cognitive-behavioral therapy and dialectical-behavioral therapy. In addition, there are certain types of therapies found to be more helpful for adults and others more helpful for teens and adolescents. According to NIDA, the following are helpful for adults with co-occurring mental disorders:
- Therapeutic communities
- Assertive community treatment
- Dialectical-behavioral therapy
- Exposure therapy
- Integrated group therapy
They recommend the following for adolescents:
- Multisystemic therapy
- Brief strategic family therapy
- Cognitive-behavioral therapy
And while it is suggested to treat both conditions concurrently, there remain barriers to this approach. These barriers to treatment for co-occurring disorders include the following:
- Many substance abuse treatment centers don’t employ the professionals needed to prescribe, dispense, and monitor medications needed by some for their co-occurring mental illness.
- A high number of individuals in prisons have co-occurring disorders. According to data, a staggering 45% of those in state and local correctional facilities have both a mental illness comorbid with a substance abuse problem. Sadly, effective treatment for both drug and alcohol use as well as other mental health issues is basically nonexistent in these settings.
- The United States often addresses and treats both of these issues, addiction, and mental illness, separately and in different healthcare systems. Primary care providers tend to deal with more mental health issues while addiction is addressed by a number of different types of treatment providers. Neither group really has the expertise to deal with both comprehensively and successfully in many cases.
While barriers to treatment for comorbid issues exist, there are treatment centers that are at the forefront of treating co-occurring disorders. Treatment for co-occurring disorders does work and thousands have found they are able to recover from addiction and manage their mental illness.
If you or someone you love has both a mental illness and addiction issues, Futures Recovery Healthcare can help. Utilizing evidence-based therapies with medical and addiction treatment professionals, Futures has helped so many recover from comorbid conditions and improve their quality of life. We want to help you too.
Reach out online or call us at 866-804-2098.