Co-Occurring Disorders in Addiction Treatment

Which came first — the mental illness or the substance abuse? For patients with co-occurring disorders, sometimes also called dual diagnosis, understanding the overlapping symptoms is crucial to determining the most effective treatment.

A Common Problem That’s Commonly Neglected

The issue of co-occurring disorders is not a rare one. According to a study from the Journal of the American Medical Association shared by the National Association on Mental Illness, “Approximately 50 percent of individuals diagnosed with severe mental illness are affected by substance abuse. About 37 percent of individuals with alcoholism and 53 percent of individuals with drug addictions have at least one serious mental illness.”

Unfortunately, many patients who battle concerns on multiple fronts in this way aren’t receiving the treatment they need: “Only 7.4 percent of individuals receive treatment for both (mental and substance use concerns), with 55.8 percent receiving no treatment at all,” the Substance Abuse and Mental Health Service Administration reports.

Substance Abuse and Mental Illness: A Chicken-and-Egg Situation

These statistics reveal a complicated issue for clinicians and clients. When evaluating a new patient, therapists ask specific questions to determine which concern is the most pressing.

Discussing the onset of symptoms and later use of drugs or alcohol can help therapists and clients figure out where to begin. Creating a timeline also helps. Determining incidents of potential trauma, abuse, awareness of depression, anxiety, or psychosis can point to decisions — conscious or unconscious — to self-medicate.

On the other hand, if the patient doesn’t have an overt history of mental health issues, he or she might have acquired identifiable indicators as a result of using substances. Use of certain drugs, including alcohol, methamphetamines, cocaine or LSD, can cause substance-induced psychosis, which might include delusions and auditory, visual or tactile hallucinations.

Accounting for the initial use of one or more substances and the reasons behind that first use can help clients and therapists figure out whether mental illness led to substance abuse or vice versa, which in turn can help them figure out how best to treat these concerns.

For example, a person seeking treatment might admit to snorting cocaine for the first time in the presence of a friend who offered it to him or her in a social situation. Or a client might abuse alcohol to try to ease depression.

Likewise, someone suffering from an overwhelming sense of anger might turn to something sedative such as an opioid, or someone with a mood disorder might use marijuana in an attempt to regulate his or her fluctuating emotions.

The Many Tentacles of Co-Occurring Disorders

An image that illustrates the challenge of treating co-occurring disorders is that of an octopus who wraps it tentacles around the addicted person. To free him or herself, the patient must address the root of his or her addiction as well as the addiction itself.

The therapist and client can work together determine the best treatment and continue the process to the desired conclusion. A skillful clinician can help the patient continue to reassess the triggers to substance abuse.

Determining the approach that leads to an individual client’s long-term recovery is key — regardless of whether “the chicken or the egg” drives their problems.

By Edie Weinstein, LSW

Follow Edie on Twitter at @EdieWeinstein1