Substance use disorders, including addiction, regularly occur alongside other mental illnesses. In 2014, according to the Substance Abuse and Mental Health Services Administration, approximately 7.7 million adults in the US experienced co-occurring substance abuse and other mental health disorders – that is more than 3 percent of adults. For about 1 percent of adults, the co-occurring mental health disorder was serious.
Treating these co-occurring disorders can be a challenge, because often the symptoms of one disorder will contribute to the other, making it impossible to recover from one without treating the other. For this reason, specific steps need to be taken to treat co-occurring disorders that may not otherwise be necessary for a substance use disorder alone.
Step 1: Diagnosing Addiction and Co-occurring Disorders
When a person sees a doctor, psychiatrist, or other treatment professional asking for help for suspected substance abuse, the first step for the treatment professional is to perform an assessment and diagnosis. Through interviewing the person and making educated observations based on the professional’s expertise, including, if possible, talking to other family members, the professional assembles information on the person’s behavior, attitudes, and symptoms, and compares them with the standard manual used for diagnosing mental health disorders.
The most current version of this manual is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, also known as DSM-5. By comparing the information gained from screening the person to the symptoms listed in the manual, the professional can begin to determine whether or not the person actually has a substance use disorder and whether there are also any co-occurring disorders. By performing integrated screening, which looks specifically for co-occurring disorders, the professional can make a more precise diagnosis.
Step 2: Considering Other Factors
Sometimes, the symptoms of a mental health disorder underlying substance abuse may not be attributed to an independent, co-occurring disorder. Substance abuse symptoms can manifest in ways that are similar to symptoms of other mental health disorders, making it seem that there is another issue co-occurring. However, later it turns out that the symptoms were a result of the substance abuse to begin with.
An example of this is when a person who is struggling with alcohol abuse presents symptoms of depression, which is a common occurrence; the rate of alcohol use disorders is as high as 40 percent among people who have a lifetime history of major depression. However, because the symptoms of alcoholism sometimes include depression, it can be hard to tell whether depression of some kind exists separately. A way to determine this can be through the screening process. If the symptoms of depression came before the alcoholism started, it is most likely a separate disorder. On the other hand, if the alcoholism is treated and the symptoms of depression begin to resolve, the depression may instead be a result of the substance abuse.
Because of these possibilities, it is important for diagnosis and treatment to be flexible. If conditions change, and it becomes apparent that there is more to consider than substance abuse alone, the treatment program should be able to adjust accordingly.
Step 3: Finding Treatment Options
When seeking treatment for substance abuse when a co-occurring disorder is present, it is important to find treatment centers with personnel who are trained and experienced in treating co-occurring disorders using an integrated model, rather than having two parallel treatment processes going on together. Research from the Journal of Substance Abuse Treatment has shown that integrated treatment of substance abuse and mental illness together is more likely to reduce psychiatric hospitalization and arrest than treating the two disorders separately.
Integrated treatment programs include professionals and programs designed to meet the treatment needs of co-occurring disorders, paying special attention to the ways in which the disorders may be intertwined. Using our earlier example, if a depression disorder is co-occurring with alcoholism, it’s important to treat the depression and alcoholism based on the ways they reinforce each other in order to have a better chance at resolving both. Without treating depression as an aspect of alcoholism, the depression may not be resolved, and the alcoholism may then be more likely to recur.
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Step 4: Entering Treatment
According to the National Institute on Drug Abuse, one of the most important factors in long-term recovery from any substance abuse or mental health disorder is customizing the treatment plan to meet the individual’s specific needs. For that reason, when a person enters a treatment program, it is important that assessment and specific program planning based on the person’s individual diagnosis take place at the point of admission to the treatment program.
This assessment should also be ongoing throughout treatment. Research from Professional Psychology: Research and Practice has shown that progress monitoring can provide important progress measurement and feedback on the treatment approach. This enables the treatment program to be adjusted over the course of care to better meet the person’s needs, making it more likely to have a positive, long-term result.
Step 5: Treatment Therapies
Treatment for co-occurring disorders involves many of the same therapy types as treatment for substance abuse alone. However, these treatment modalities are adjusted to meet the needs of an individual with a co-occurring disorder in various ways. A treatment plan may include:
- Education to help the person understand how the substance abuse and mental health disorders contribute to one another and can affect the person’s behaviors
- Cognitive Behavioral Therapy to help a person recognize triggers, including mental health disorder symptoms, and change behavioral responses to more positive behaviors
- Family therapy to help other family members understand how relationships and dynamics may affect the person’s condition and to help them provide the person with a supportive environment to manage all involved disorders
- Medications to reduce the symptoms of the mental health issues but that do not contribute to substance abuse; sometimes medicines may be prescribed to control the addiction before any psychoactive drugs are prescribed to treat the mental health disorder
Step 6: Post-Treatment Care and Long-Term Recovery
Long-term recovery from co-occurring disorders is achievable. After inpatient treatment is complete, it is important for the person to continue in aftercare, including maintaining treatment regimens as required for the co-occurring disorders. Aftercare may consist of:
- Continued counseling or therapy for the co-occurring disorder
- Medication to control symptoms of the mental health issue
- Self-help peer counseling groups, like 12-Step groups
- Continuing education groups
- Motivational therapies and interventions to encourage maintenance of aftercare programs
With commitment and willingness to adhere to treatment plans, people can achieve long-lasting recovery from both substance abuse and mental health disorders, and return to sober, productive lives.