Treatment for Co-Occurring Disorders

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It’s estimated that 7.9 million Americans with substance abuse disorders also face co-occurring mental health disorders that have just as much a need for specialized treatment as their addictions.

Individuals with mental health disorders are more at risk for developing addictions than the general population. Anyone diagnosed with a co-occurring disorder needs to receive targeted treatment for their specific and unique needs in both addiction and mental health to ensure a successful recovery.

Types of Co-Occurring Disorders

Below is an overview of the most common types of co-occurring disorders:

ADHD: A pattern of attention irregularities or hyperactivity-impulsivity that interferes with development or functioning and is not caused by another mood disorder.
Anxiety: Consistently experiencing intense and excessive worry, apprehension, nervousness, and fear. This can be aimed at specific things, such as social situations, or be a generalized feeling of dread that is not related to anything specific. Some individuals with anxiety experience panic attacks.
Borderline Personality Disorder: A mental disorder characterized by a pattern of problematic and changing behavior, moods, and self-perception that leads to frequent impulsive actions and relationship conflicts. These individuals can suffer intense bouts of anxiety, depression, and anger that can be brief or last for days.
Bipolar Disorder: Once known as manic-depression, this brain disorder leads to unpredictable shifts in energy, mood, and levels of activity and functioning that range from very energized manic episodes to very low depressive episodes.
Behavioral Addictions: Some people with substance use disorders also suffer from addictions to behaviors like gambling, gaming, sex, computers, shopping, or smartphones. These addictions can cause many of the same kinds of intense cravings, personality changes, and negative consequences as chemical addictions.
Depression: A persistent low or negative mood that interferes with how a person thinks, acts, and functions in the activities of daily living Individuals with severe depression may have difficulty finding the energy and motivation to complete simple tasks such as showering or dressing to leave the house.
Eating Disorders: An unhealthy pattern of disordered eating habits and perceptions. Individuals often have distorted body images and may binge and purge, or starve themselves. Alternatively, they may have an eating disorder that substitutes for a need they cannot otherwise address, such as depression, loneliness, anger, etc.
OCD: Obsessive-Compulsive Disorder causes reoccurring, uncontrollable obsessions, intrusive thoughts, and behaviors that an individual is compelled to repeat over and over.
PTSD: A state of heightened reactivity after a shocking, threatening, or frightening event (experienced directly or indirectly) that results in feelings of fear, stress, panic, and even a realistic mental recreation of the actual event when the individual is not endangered.
Schizophrenia: A disabling, severe, chronic mental disorder in which individuals detach from reality, and which can be very disabling.
Sleep Disorders: Problems that interfere with getting sufficient or good quality sleep, such as insomnia, night terrors, sleep apnea and other sleep/wake disruptions, REM and non-REM disorders, narcolepsy, hypoventilation, circadian disorders, sleep-walking, and other parasomnias.

Self-Medicating For Co-Occurring Disorders

The range of disruptive and painful symptoms that are caused by mental health disorders are difficult to bear, and many individuals are intensely relieved when they discover that using drugs or drinking can make them feel “normal,” so that it is easier to function in ways they found challenging before. They may then slip into a pattern of self-medicating that not only puts them in danger of addiction but also makes it difficult for them to be correctly diagnosed and treated for their mental health problems.

As the individual develops a tolerance and needs increasing amounts of drugs or alcohol to control symptoms, they get caught in a downward spiral where substance use exacerbates the mental health issues and vice versa. Ultimately, this leads to a situation far worse than the original issue, as the individual now faces a potentiated dual diagnosis—that is, their original problem and the co-occurring substance use disorder have become more than the mere addition of the parts.

How to Treat Co-Occurring Disorders

Some people with co-occurring disorders (also known as dual diagnosis) only develop a mental health issue after they become addicted to a substance. Chronic substance use alters brain chemistry in ways that can easily create a new psychological problem or trigger one that has not yet developed, such as the association between adolescent cannabis use and schizophrenia. In these cases, people will sometimes assume that they only need treatment for their substance use disorder because they believe that their depression, panic attacks, or other new mental health issues will disappear after detox. While this can happen, more likely it will not.

Individuals with co-occurring substance use and mental health disorders need specialized treatment—not just for their addiction, but for their mental health issues, as well as the interplay between the two. Just as substance use disorders may require different treatment approaches depending on the individual’s history and the specific substance/s used, different mental health disorders require targeted, individualized forms of treatment.

To accurately diagnose and treat co-occurring disorders, an individual must first fully detox from substance use. As detoxing can often lead to an initial worsening of mental health symptoms due to the inevitable challenges of trying to cope with the stress of withdrawal, or may even lead to the development of new symptoms, inpatient rehab programs are the usually best option for dual diagnosis treatment.

Ben J. Wilson, PhD, LMHC, LCAC, NCC

Assistant Professor (Clinical Faculty) in the Department of Counselor Education at Adams State University

1. Given your extensive experience in addiction counseling and your personal journey of recovery from co-occurring disorders, can you share some insights or strategies that have proven particularly effective in supporting individuals on their path to recovery?

Recovery is a multi-faceted continual process of change and self-directed growth, in which individuals seek to improve their health while striving to reach their full potential. This process is unique to each individual and can occur via many different pathways. There is no single approach that works for everyone; however, there are some strategies that have proven to be particularly effective for many people (including myself).

I’d be remiss if I didn’t mention the importance of treatment and asking for help. Recovery is possible, and quite probable, with the support and help of others, including treatment professionals. Schedule an assessment with a qualified health professional and follow all treatment recommendations. Treatment for chronic behavioral health and/or medical conditions can improve outcomes for individuals with these conditions, as well as their families. Evidence-based treatment, in conjunction with FDA-approved medications, can help people regain control of their lives, as well as improve functioning and over-all health and well-being. In addition, treatment helps people gain a better understanding of these complex and often misunderstood conditions. Other strategies that can be helpful are: recovery support services; self-help meetings/groups; service work/volunteering; as well as engaging in healthy leisure activities.

2. As both a licensed mental health counselor and licensed clinical addiction counselor, what role do you see counseling playing in addressing the stigma often associated with addiction and mental health disorders, and how can professionals like yourself help reduce this stigma?

Stigma is a well-documented barrier for those with addiction and mental health conditions. Addiction is one of the most stigmatized conditions in the world; it’s also one of the most pressing public health concerns of our time, so efforts to reduce stigma are needed. Better education and training among the clinical workforce can certainly help reduce stigma and its far-reaching impact. In addition to education and training, professionals are encouraged to use language (terminology) that reduces stigma. For example, researchers have found that certain common words (terms) used to describe individuals suffering from chronic drug‐related impairment or conditions (e.g., ‘substance abuser’) perpetuate stigma and may induce explicit and implicit cognitive biases that result in a perceived need for punishment rather than treatment (Kelly et al., 2021). Using words such as ‘positive’ and ‘negative’ to describe the results of a urine drug screen/urinalysis, instead of ‘clean’ or ‘dirty’ can go a long way in reducing stigma.

Another powerful and effective way to reduce stigma is for professionals with lived experiences with these conditions to share their journey of recovery. This is one of the reasons why I am open about my journey of recovery. I want others to know that they’re not alone; there is hope!

3.You’ve spent close to two decades working in the behavioral health field. Could you highlight some key trends or changes you’ve observed in addiction treatment and counseling during this time, and how do you envision the future of addiction treatment evolving to better serve individuals and families?

Chronic behavioral health conditions and/or medical conditions rarely occur independently; however, historically, treatment for individuals with behavioral health conditions, such as substance use and mental health disorders, has been siloed (treated as separate systems). Those needing treatment often faced significant and seemingly insurmountable barriers while accessing separate systems of care. Recently, though, over the last decade, there’s been a push toward a more integrated and concurrent system of care that focuses on reducing barriers for consumers while expanding access to multiple specialized treatment services. Federally Qualified Health Centers (FQHCs) and Certified Community Behavioral Health Centers (CCBHCs) are federally designated organizations that operate on the premise of this collaborative approach. Both FQHCs and CCBHCs are gaining more support and are very well-funded, so I envision that these organizations, as well as other collaborative and integrated systems of care, such as recovery-oriented systems of care, will redefine the future of addiction and behavioral health treatment.

Reference:
Kelly, J., Greene, M., & Abry, A. (2021). A US national randomized study to guide how best to reduce stigma when describing drug-related impairment in practice and policy. Addiction, 116(7):1757-1767. doi: 10.1111/add.15333.

Dual Treatment for Better Outcomes

Addiction and mental health are intimately connected, with one potentiating the other. It’s estimated that as many as six out of 10 people who are suffering from addiction also have a mental health disorder, yet most are not receiving treatment for either problem.

To get the best treatment possible for co-occurring disorders, individuals in recovery need to receive therapies for both the addiction and mental health disorders at the same time. An integrated treatment approach allows both problems to be stabilized simultaneously, allowing for a more thorough recovery with a much lower risk of relapse and a much brighter future.

Treatment for Co-Occurring Disorders

Types of Co-Occurring Disorders

Self-Medicating For Co-Occurring Disorders

How to Treat Co-Occurring Disorders

Dual Treatment for Better Outcomes

Levels of Care / Treatment

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