Evaluating an Individual’s Treatment Needs
Addiction Among Those With Co-Occurring Disorders
Almost one out of every five American adults aged 18 and older in 2014 suffers from some form of a mental health disorder each year. These mental health issues may disrupt a person’s ability to interact with the world, making changes to moods, behaviors, and thinking, the National Alliance on Mental Illness (NAMI) reports. Mental illness may vary in severity. According to NAMI, 10 million adults in the United States in any given year battle a mental illness severe enough to disrupt daily life functioning and abilities.
Almost 22 million Americans aged 12 or older had issues with substance abuse or dependence in 2013, the National Survey on Drug Use and Health (NSDUH) publishes. When an individual uses drugs or alcohol regularly for a period of time, a chemical and psychological dependency may occur, and substance use may no longer be controllable creating social, emotional, physical, and behavioral concerns.
Substance abuse and mental illness may be complexly intertwined and often occur together. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that close to 8 million American adults battled both a substance use disorder and a mental health disorder in 2014. The presence of both an alcohol or drug use disorder and a mental health disorder in the same person at the same time is known as co-occurring disorders, per Psychology Today. Mental illness can increase the side effects of drug or alcohol abuse just as abusing substances can exacerbate mental illness symptoms.
Both disorders complicate treatment and increase risk factors for each disorder. Co-occurring disorders present specialized circumstances and needs for treatment and recovery.
Determining Which Came First
Substance abuse and mental illness may be a little like the chicken-and-the-egg scenario. Someone suffering from an untreated mental illness may use drugs or alcohol as way to self-medicate symptoms; on the other hand, drugs or alcohol may cause mental illness symptoms to surface. An initial assessment may be able to screen for the presence of mental illness when individuals seek substance abuse treatment or vice versa.
Mental illness symptoms may be caused by the withdrawal side effects of drugs or alcohol, which may include psychosis, anxiety, depression, difficulties feeling pleasure, insomnia, irritability, restlessness, troubles concentrating, memory deficits, cloudy thinking, and other physical symptoms. The first step in treatment is often medical detox in a supervised facility, sometimes with the use of medications.
Sometimes, taking large amounts of drugs repeatedly, particularly stimulant drugs like methamphetamine, may cause psychotic symptoms like hallucinations, delusions, paranoia, or mania. It may take several weeks, months, or even years of prolonged abstinence for these side effects to completely dissipate, SAMHSA’s Treatment Improvement Protocol (TIP) reports. Substance-induced psychosis or mental health disorders can often be improved by remaining sober. On the flip side, substance abuse can also interfere with the treatment and increase the severity of mental illness symptoms that may be already present. By removing drugs or alcohol, symptoms often improve.
Both substance abuse and mental illness may be considered developmental disorders, as they often begin in adolescence or young adulthood, the National Institute on Drug Abuse (NIDA) reports. This may also make them easy to confuse with each other. In addition, typical teenage behavior, such as mood swings, erratic behaviors, and poor decision-making skills, may include these symptoms. Mental health disorders may go undiagnosed, and substance abuse may not be recognized as problematic, increasing the potential risk factors and negative consequences of both disorders.
Overlapping biological or genetic factors may play a role in the development of a substance use disorder or mental health disorder, or both, as may environmental factors. Stress may be closely related to the onset of mental health disorders and substance use disorders, as chronic stress may make chemical changes in the brain, which may be especially detrimental for young people, Psychology Todayreports. For instance, if individuals experience trauma or abuse in childhood, their risks for developing a psychiatric condition, an addiction to drugs or alcohol, or both, in adulthood goes up significantly, the journal Depression and Anxiety publishes.
Abusing substances at a young age may also be damaging to regions of the brain responsible for decision-making, feeling pleasure, and mood regulation. Early exposure to drugs or alcohol may increase the likelihood of addiction or mental illness manifesting in adulthood, NIDA reports.
Optimal treatment plans typically dictate that determining the root cause and which issue came first may be vital to sufficient care and recovery. That being said, the answer to this question isn’t always clear cut; specifics of how each disorder influences the other may become clearer as treatment progresses. Simultaneous treatment of both issues from the outset of care is important to get individuals started on comprehensive recovery paths. In many instances, one of the disorders may be more severe than the other, and treatment plans should specifically to cater to this.
Devising a Treatment Model
When an individual suffers from co-occurring disorders and is chemically dependent to drugs or alcohol, medical detox is needed. With medical detox, highly trained professionals monitor vital signs and mental health 24/7 until the toxins from the substances of abuse are completely detoxed from the body. A complete drug screen and evaluation is an important tool to ensure that all medications that may be used to manage withdrawal symptoms will not have negative interactions or consequences related to the substances abused.
Motivational Interviewing (MI) is a style of counseling that is often helpful in assessing and treating co-occurring disorders, as it is nonconfrontational and goal-oriented. MI can serve to help individuals find inner motivation to want to change for the better while accepting where they are in their recovery. Behavioral therapies, such as Cognitive Behavioral Therapy (CBT) and Dialectal Behavior Therapy (DBT), may be beneficial methods that use both group and individual therapy sessions to facilitate improved self-image and healthier coping mechanisms.
Co-occurring disorders are complex, and no two people will experience them in exactly the same way, meaning that treatment plans should be individually tailored to suit the specialized needs of each person. SAMHSA recommends integrated treatment models for co-occurring disorders as the optimal choice for simultaneous and comprehensive care for both a mental illness and problematic substance abuse.
Behavioral therapies seek to uncover the root causes of substance abuse and/or mental illness in an effort to help individuals learn how to manage potential triggers and process stress, trauma, and intense emotions. Medications are often part of the treatment plan for mental illness in order to balance brain chemistry that may be unstable. When a substance abuse disorder is also present, healthcare providers may need to use caution when prescribing certain pharmaceuticals.
Someone with a history of substance abuse or addiction, for example, may be best served to use alternatives to benzodiazepine medications, which are anxiety-reducing drugs with a potential for abuse. The National Institute of Mental Health (NIMH) recommends using benzodiazepines for short periods of time, if at all, in those with potential substance abuse concerns.
Medications are typically used as part of an overarching treatment plan that will also include therapeutic methods. All treatment providers should work together to design and carry out a care and recovery plan for co-occurring disorders, in order to ensure that all disorders are treated simultaneously and effectively. Reevaluations should be done periodically to ensure progress is being made.
Support groups are often part of recovery and aftercare services for both the continued improvement of mental health and abstinence from substance abuse. Many 12-Step programs may have traditionally taken a hard line against participants using any type of drugs, even for therapeutic purposes to treat mental illness symptoms. These programs may expect complete abstinence from any type of psychoactive substance. Medications may be an important part of recovery for co-occurring disorders, however, and peer and support groups are available that are more accepting and understanding of these needs.
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Education and learning about co-occurring disorders, and where to turn for help, are vital to the treatment of and recovery from substance abuse and mental illness. Information can be found in the following places:
- The Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Co-Occurring Disorders page provides a wealth of information on co-occurring disorders, statistics, facts, news, and treatment resources.
- The National Alliance on Mental Illness (NAMI) is a nonprofit organization with local chapters providing treatment resources, online information, an FAQ page with answers to common concerns, and a helpline for families and individuals seeking care or information on mental health in America.
- SAMHSA’s Behavioral Health Services Locator can identify mental health and substance abuse treatment locations that provide co-occurring disorder services locally by inputting a city, state, or zip code and the type of treatment desired.
- The National Helpline run by SAMHSA is staffed with professionals around the clock for questions or concerns related to mental health and/or substance abuse. Calls are confidential, and this service is free.
- The National Council on Alcoholism and Drug Dependence (NCAAD) provides a host of information on drug and alcohol abuse, treatment, and recovery for families and individuals.
- The Suicide Prevention Lifeline is a crisis hotline for individuals with suicidal thoughts who need immediate mental health assistance from a well-trained mental health professional. Calls are complimentary and confidential.
- AA, or Alcoholics Anonymous, is a 12-Step program with chapters all over the globe, providing numerous different types of groups that meet to form peer support networks and fellowship in a confidential environment. These groups are supportive of recovery and help with relapse prevention through total abstinence from alcohol.
- Mental Health is a comprehensive resource with crisis hotlines and information pertaining to mental health services in the United States.
- The American Society of Addiction Medicine (ASAM) is a collection of physicians and medical professionals who specialize in treating addiction. Individuals can find local providers on the website.
If an individual is experiencing a substance abuse or mental health crisis, it is important to seek immediate medical attention. Primary healthcare providers, and state, city, or county governments, may also provide resources and information on local behavioral health services.