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Co-Occurring Disorder Treatment Options: What You Need to Know About Dual Diagnosis

One or more main illnesses or chronic diseases are more likely to develop in people with substance use disorders. People receiving medication-assisted treatment frequently have co-occurring disorders, which are defined as having both a mental disease and a substance use disorder (MAT). Substance use disorders are more common in people with mental illness than in people without such a condition. About 9.2 million adults in the US have a co-occurring disorder, according to SAMHSA’s 2018 National Survey on Drug Use and Health. It is important to remember that taking MAT medicines like Suboxone with anxiety medications to treat anxiety might have adverse effects that may be life-threatening. Among other benzodiazepines, common ones include Xanax, Valium, and Klonopin. In this post, I discuss what it means to have co-occurring disorders as well as co-occurring disorder treatment options.



Introducing Co-occurring Disorders

Any combination of two or more mental disorders and drug use disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition may be considered a co-occurring disorder (DSM-5). There is no single definition of co-occurring disorders that applies to certain combinations of mental and drug use disorders. Co-occurring illnesses, also known as dual disorders, are identified in people who have substance use problems as well as mental health disorders. Dual diagnosis is another name for this.

Among the most typical mental illnesses that co-occur are:

  • Anxiety and mood disorders
  • Schizophrenia
  • Bipolar disorder
  • Major depressive disorder
  • Conduct disorders
  • Post-traumatic stress disorder
  • Attention deficit hyperactivity disorder

Common Symptoms of Co-Occurring Disorders

A mental health or drug use disorder can only be diagnosed by a mental health expert. However, being aware of the typical signs of co-occurring illnesses might help someone realize when they want to care. Co-occurring disorders share symptoms with mental health and substance use disorders, but they affect the same individual. These signs include:

  • avoiding interactions with family and friends
  • sudden behavioral changes
  • handling of daily tasks is difficult.
  • pursuing dangerous activities
  • ignoring personal hygiene and health
  • using narcotics in dangerous circumstances
  • losing control over one’s use of drugs
  • symptoms of withdrawal or a high tolerance to a substance
  • the desire to utilize drugs in order to operate normally

Common Effects of Substance Abuse on Mental Health Issues

It can have an effect on a person’s underlying mental health when they take a substance that alters their mood in addition to having a mental health issue. Drug usage typically has an impact on mental health by exacerbating the symptoms of the mental health issue.

Substance misuse can also have a number of other negative effects on mental health problems. It might be challenging to control the symptoms of a mental health problem in people with drug use disorders because they are less likely to take their medication as prescribed. There is additional evidence that substance use problems are linked to an increase in aggressive and violent conduct.

How Frequently Do Co-Occurring Disorders Occur?

Disorders that co-occur are rather typical. In 2017, it is projected that 8.5 million adults in the US had co-occurring disorders. Nearly 51% of the 8.5 million individuals received treatment for a mental health issue or a drug use disorder. Just 8.3% of people received care for both diseases. 

It might be difficult to create treatment strategies for co-occurring illnesses for a variety of reasons. Depending on the type of substance use illness and mental health disorder, a different sort of treatment may be required. More specialized research is required to comprehend the relationship between particular mental health issues and addiction. Case studies with dual diagnoses will be useful in predicting how well certain co-occurring disorders may respond to therapy. 



Causes and Risk Factors for Co-Occurring Disorders

A person may be more likely to be diagnosed with co-occurring illnesses due to a number of common risk factors. According to studies, those who suffer from mental health issues like anxiety, depression, or PTSD are more prone to self-medicate with drugs or alcohol. This self-medication behavior has the potential to develop into an addiction. On the other side, research has also demonstrated how persistent drug and alcohol use can alter brain chemistry and result in the emergence of mental disorders. Doctors and therapists may be able to determine whether mental illness or addiction first manifested itself in a patient by looking at past behaviors and patterns.

Therefore, a person may be more vulnerable to co-occurring disorders if they have certain underlying illnesses, such include:

  • Genetics
  • Family history
  • Environmental influences
  • Stress and response to stress
  • History of trauma or adverse childhood experiences

Which Occurs First; Mental Illness or Addiction?

Dual diagnoses, also known as co-occurring disorders, are when a mental health illness and a substance use disorder coexist. It is uncommon for a substance use disorder and a mental illness to manifest together. Instead, the issue is more like a chicken-and-egg scenario. The order in which mental illness and addiction develop can be difficult to determine, and it varies greatly from person to person.

A person who has both a mental disorder and a drug addiction diagnosis could first experience one or the other. The illnesses are often diagnosed in no particular sequence. Although it’s not always clear which usually comes on first, mental illness and addiction frequently interact with one another. Addiction can occasionally develop before the mental disease. The structure and operation of the brain are altered over time by alcohol and drugs. They impact how neurotransmitter receptors process information and the brain makes important substances like dopamine, serotonin, and GABA.

Addiction can occasionally cause mental health issues to arise. Sometimes treating a mental disease by self-medication leads to addiction. Treatment for co-occurring disorders is the same since it seeks to treat both problems concurrently, regardless of whether mental illness or addiction started first.

Moreover, treatment for the co-occurring disorder is covered by almost all private and state-funded insurance providers. 

Mental Illness as an Addiction’s Underlying Cause

When a person uses a substance to self-medicate, mental illness may contribute to addiction. As a result, they start to depend on the drug to feel normal. This could result in a demand for more and more of the substance to experience its effects, which could then result in the development of an addiction to the substance.

An individual with mental health conditions may also experience changes in the way their brain functions, which increases their risk of developing a substance use problem. People may seek drugs more as a result of alterations in their brain signaling pathways, increasing their propensity to become addicted to them.

Dual Diagnosis Treatment Options for Co-Occurring Disorders

It is crucial to treat both diseases while treating co-occurring disorders. Treatment for dual diagnoses gives the patient the tools to manage their substance use disorder and the resources required to treat the symptoms of their underlying mental health condition.

A client’s drug use disorder is treated as part of an integrated treatment program for co-occurring disorders that also offers counsel for their mental health issues. After gaining control over their substance use disorder, the patient’s treatment plan could additionally include medication to help with their mental health issue. Due to the negative side effects of combining mental health medication with commonly abused substances, it is typical to wait until the patient stops abusing substances before starting medication.

The dual diagnosis treatment includes:

  • Behavioral Therapies – People with co-occurring disorders may benefit from therapies including CBT, DBT, CM, and family therapy.
  • Medications – It is possible to administer medication such as Suboxone or Subutex to aid someone with their symptoms. Depending on the person’s mental health diagnosis and how they respond to behavioral therapy, the exact medicine will be prescribed.
  • Lifestyle Changes – These include adhering to a daily schedule, creating healthy routines, eating balanced food, exercising frequently, and practicing coping mechanisms on a regular basis.
  • Peer Support – Peer support can have the opposite effect of loneliness on appetites and mental health issues. Additionally, peer support might enhance a person’s quality of life.



Parting Words on Co-Occuring Disorder Treatment

There’s a good chance that you or someone you care about has an underlying illness that is contributing to their addiction. A person who has been diagnosed with both a substance use disorder and a mental health disorder is said to have a co-occurring disorder, which can be present even more problems than having a substance abuse or mental health disorder alone.

Whether addiction or mental disease arrived first. It is important to have customized therapy for both problems. The National Institute of Mental Health states that treating substance use disorder and mental health disorders concurrently is always preferable to treating them separately. Treatment should, above all, take into account each patient’s unique needs, beliefs, circumstances, faith, and culture. The patient will be more effective in overcoming their co-occurring illnesses the more individualized the treatment is. 

Additionally, each individual’s symptoms of a mental health disorder will be unique. The most serious warning symptoms, however, include a number of indicators like unclear thinking, attention issues, and suicidal ideation. It is critical that patients who exhibit these signs of a co-occurring condition receive prompt medical care from trained mental health and substance abuse counselors.

If you need help with co-occurring disorder treatment, find a mental health professional that treats co-occurring disorders.

Jordyn Mastrodomenico LPC, LCADC CTP
Author: Jordyn Mastrodomenico LPC, LCADC CTP

Jordyn is a Licensed Professional Counselor (LPC), Licensed Clinical Alcohol and Drug Counselor (LCADC) and Certified Trauma Professional (CTP). She holds a Master's degree in Mental Health Counseling, from Caldwell University, Jordyn has extensive experience in Outpatient and Intensive Outpatient settings and is skilled at guiding clients through the recovery process in individual and group therapy sessions.

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