Information on Co-Occurring Disorders and Substance Abuse Treatment

Created On Tuesday, 11, July 2017
Modified On Friday, 17, September 2021

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Millions of Americans struggling with addiction are battling a co-occurring disorder, such as depression or anxiety. For example, severe alcoholism does lead to depressive episodes, and many addicts use drugs to manage negative feelings. Unfortunately, substance abuse exacerbates the problem, and more drugs or alcohol are consumed to feel better. Also, someone who feels depressed, anxious, or other ways would seek out prescription drugs that often become addictive. Countless addicts within the United States begin with a prescription that is taken too long or misused. Someone who is struggling with psychological issues and abusing drugs will soon be struggling with the problems associated with addiction. For example, this would include cravings for their drug of choice, tolerance to their drug of choice, increased episodes of depression and anxiety, withdrawal symptoms, and addiction.

According to the 2019 National Survey on Drug Use and Health, 24.5% of Americans aged 18 and older had a co-occurring disorder. Unfortunately, struggling with a co-occurring disorder increases the chances of suicide ideation. Per the National Survey, among adults aged 18 and older, the percentage who had serious thoughts of suicide in the past year increased from 3.7% in 2008 to 4.8% in 2019. Across the United States are countless substance abuse treatment programs equipped to treat patients with co-occurring disorders. Lengthy rehabilitation is usually the better option, such as inpatient residential treatment programs. However, some of the common reasons that people choose not to receive substance use treatment are because they were not ready to stop using drugs or did not know where to go for treatment.

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People who are battling co-occurring disorders struggle with these problems at different times during their lives. Some individuals are struggling with depression and anxiety and choose to abuse drugs to manage the problem. Other circumstances involve the person abusing drugs or alcohol and then experiencing dangerous emotional problems. Self-medication is a common reason that many people have for why they abuse drugs or alcohol. Addiction is a physical and psychological dependence upon a drug or multiple drugs and or alcohol. Physical dependence is the tolerance created by the drugs or alcohol, and the psychological dependence is defined by cravings for the substances.

Managing these problems requires integrated treatment, and this is a comprehensive rehabilitation program. The programs offer medical, therapeutic, and holistic resources to help patients heal mentally, emotionally, physically, and spiritually. According to the Substance Abuse and Mental Health Services Administration in an article titled Substance Abuse Treatment for Persons With Co-Occurring Disorders, it is clear that substance abuse treatment of clients with co-occurring disorders can be beneficial. Unfortunately, per this same article, these problems are common in the general adult population, though many individuals with co-occurring disorders go untreated.

What are the Best Treatment Options to Consider for Co-Occurring Disorders?

Well-rounded or integrated rehabilitation is the best option for someone with a co-occurring disorder. The poor lifestyle choices associated with these problems increase the risk of overdose, suicide, and deaths. Also, other health problems occur, such as heart disease, asthma, obesity, and diabetes. The long-term use of illicit drugs and prescription medication results in significant damage done to the body and mind. Integrative rehabilitation provides a range of treatment services to the individual. Most programs are residential, offering long-term or short-term care options. Typically, specific services vary, and it depends on the needs of the client.

Rehabilitation focusses on physical, psychological, and spiritual treatment. Programs will help people improve their sleep habits, address chronic medical conditions, improve communication, and interpersonal skills. Also, there is a focus on improving nutritional and eating habits, exercise, while also working on family relationships, addressing job skills, and even managing legal issues. Comprehensive, well-rounded treatment is the best option. According to the National Institute on Drug Abuse, the chronic use of some drugs can lead to both short-term and long-term changes in the brain. Unfortunately, these changes result in behavioral and mood problems like paranoia, depression, anxiety, aggression, hallucinations, and other issues. People who are addicted to drugs are twice as likely to suffer from these issues.

Why Do Substance Abuse and Mental Health Issues Co-Occur?

Substance abuse commonly occurs with mental health problems, and it does not mean that one caused the other. However, both problems are exacerbated by drug abuse and misuse of prescription drugs. However, there are common risk factors that contribute to both problems, for example, environmental factors. Some of these factors include stress and trauma, whether experienced as a child or as an adult. Psychological issues, such as depression and anxiety, cause substance abuse. The most common problem is self-medication—someone struggling with anxiety is prescribed a benzodiazepine and begins to misuse the drug or use it with alcohol. Also, the combination of prescription drugs and illegal drugs increases the risk of these problems developing.

Substance abuse also creates psychosis, anxiety, paranoia, and depression. Many of the things that influence these problems heavily depend on the person and lifestyle choices, along with the environment. Someone who naturally becomes anxious may turn to drugs or alcohol as a way to cope. However, it is typically prescription drugs that create further problems, such as central nervous system depressants and stimulants. According to the Healthcare Cost and Utilization Project in a report titled Trends in Emergency Department Visits Involving Mental and Substance Use Disorders, approximately one in eight visits to emergency departments in the United States involves mental and substance use disorders. Between 2007 and 2011, the rate of emergency department visits related to these problems increased by 15%.

How do Substance Use Treatment Programs for Co-Occurring Disorders Operate?

Most of these programs operate the same way as any other treatment center. Overall, it is an integrated treatment program covering all aspects of addiction treatment. Typically, each patient should have a unique treatment plan for the co-occurring disorder. Initially, the process would start with a medical detox because most addicts with these problems are abusing a mix of prescription drugs and illegal drugs. Proper withdrawal management is essential to control withdrawal cravings. Detox services offer clients medical support and monitoring if needed to help stabilize them before treatment.

During the medical detox phase, there is usually an evaluation done to determine the extent of addiction, underlying issues, health problems, and what counseling process is the most effective. Following the evaluation, the next process involves developing a treatment plan. Someone struggling with a co-occurring disorder benefits emotional, physical, mental, and spiritual rehabilitation. Personal therapy involves one-on-one counseling providing the patient with a safe and confidential forum to discuss the addiction and underlying issues. Overall, the treatment goals are reached based on the initial treatment plan. Throughout the therapy, the patient works with the therapist to develop new goals.

Individualized treatment is crucial for someone with a co-occurring disorder. Each person's experience before addiction and during addiction is unique. The treatments that are chosen should be tailored to address the challenges and needs that arose as a result of that experience. The initial evaluation and assessment within a residential drug rehabilitation center could be quite extensive. A medical exam, screening, and tests could be to identify all underlying medical issues. Medical history is also taken into consideration, along with drug history. The drug of abuse and the reason for using them can inform types of therapies that will be helpful. All of this information together contributes to the individual treatment goals of the patient.

Group therapy is also a common option, and there are different types of groups that are part of an integrated rehabilitation plan. For example, 12-step groups focus on specific aspects of addiction, and other forms of peer support would also do the same. The benefit of group therapy is all the participants share similar issues. Family therapy is also beneficial because many of the problems affecting someone with a co-occurring disorder pour over into the family. Working together with family and friends helps rebuild relationships damaged during addiction. Finally, it is also crucial to develop an aftercare plan before leaving rehabilitation. Clients are encouraged to create a unique plan that could involve peer support, job opportunities, school, sober living homes, or more treatment services.

Active treatment and rehabilitation are essential because there are some harsh realities that people face who are struggling with a co-occurring disorder. According to a review of empirical evidence titled, Psychosocial Treatments for People with Co-Occurring Severe Mental Illnesses and Substance Use Disorders, the authors state—"In general, people with psychosis and substance use disorders are more like to be male, have a family history of substance abuse, and be younger than their non-substance abusing counterparts, with the possible exception of alcohol abusers." (Correlates and Consequences of Living with Dual Diagnosis) Unfortunately, there is often a low motivation to reduce substance use, which results in the addiction spiraling out of control.

What are the Alternatives to Co-Occurring Substance Abuse Treatment?

A common alternative to rehabilitation programs for people with co-occurring disorders is the incorporation of holistic drug treatment. However, most addicts would still require a medical detox to manage withdrawal cravings caused by prescription drugs or illegal drugs. Medical detox is necessary for addictions involving central nervous system depressants, stimulants, and sedatives. Many addicts struggling with a co-occurring disorder become addicted to prescription drugs. Holistic programs can help patients coordinate with medical detox programs before therapy. Most medical detox programs help patients become drug-free and not rely on other drugs to maintain sobriety. The risk of prescription drug addiction is high with long-term regular use of prescription narcotics.

Holistic rehabilitation is effective for people overcoming addiction, and treatment programs help a person physically, mentally, emotionally, and spiritually. The services provided in a holistic rehab program derive from holistic or integrative medicine. The program helps people achieve optimal wellness and focus on a unified mind, body, and spirit.

Holistic rehabilitation treats the whole person, and some of the treatment methods include acupuncture, yoga, meditation, nutritional interventions, massage therapy, homeopathy, herbal therapy, and naturopathic medicine. Usually, holistic treatment methods are incorporated with cognitive-behavioral therapies and other forms of behavioral counseling. Holistic practitioners stress that a person's body has an innate healing ability, and many of the holistic tools are used to help unlock that potential.

Holistic practitioners adhere to the belief that the optimum method of detox is to minimize the introduction of other chemicals or medications to the body. Holistic remedies would also be used during detox at the patient's request to help ease withdrawal discomfort. Overall, alternatives to treatment centers providing services for co-occurring disorders may not always focus on healing all aspects of the mind and body. When deciding on alternative rehabilitation options, it is to explore all the available counseling methodologies.

Common Terminology with Co-Occurring Substance Use Treatment

Term Definition
Dual Diagnosis the term describes a situation where a person has both an addiction and a mental health problem. Some rehabilitation programs are designed to treat dual-diagnosis, providing specific treatment.
Co-Occurring Disorders is the most commonly used term to describe someone with a mental health disorder and a substance use disorder. Addiction would include drugs or alcohol and prescription drugs.
Cognitive Behavioral Therapy is a type of psychotherapy in where negative patterns of thought about the self and the world are challenged to alter unwanted behavior patterns, such as with addiction and substance use.
Contingency Management is a type of behavioral therapy in which individuals are reinforced or rewarded for evidence of positive behavioral change.
Integrated Treatment is a form of comprehensive rehabilitation that offers all the medical, therapeutic, and holistic resources to treat addiction and heal someone physically, mentally, emotionally, and spiritually.
Personal Therapy is a form of one-on-one therapy with a qualified counselor or therapist. Like any other therapy, treatment goals are set, and the therapist helps the patient achieve these goals.
Group Therapy is a part of integrated treatment and includes 12-step support groups and other forms of peer support that focus on specific aspects of addiction.
Family Therapy helps addicts rebuild relationships damaged during addiction and plays a significant role in the therapy process. Family therapy empowers family members to connect with treatment that helps begin the healing process.
Supportive Housing is a combination of housing services and other services intended as a cost-effective way to help people love more stable. Supportive housing is a common aftercare approach used to help recovering addicts who have completed a co-occurring disorder treatment program.
Psychotherapy also known as talk therapy and is when a person speaks with a trained therapist in a safe and confidential environment. The process helps addicts work through underlying issues connected to their addiction.

CONTRIBUTORS TO THIS ARTICLE

Marcel Gemme, DATS - Author

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Marcel Gemme has been helping people struggling with addiction for over 19 years. He first started as an intake counselor for a drug rehabilitation center in 2000. During his 5 years as an intake counselor, he helped many addicts get the treatment they needed. He also dealt with the families and friends of those people; he saw first-hand how much strain addiction puts on a family and how it can tear relationships apart. With drug and alcohol problems constantly on the rise in the United States and Canada, he decided to use the Internet as a way to educate and help many more people in both those countries. This was 15 years ago. Since then, Marcel has built two of the largest websites in the U.S. and Canada which reach and help millions of people each year. He is an author and a leader in the field of drug and alcohol addiction. His main focus is threefold: education, prevention and rehabilitation. To this day, he still strives to be at the forefront of technology in order to help more and more people. He is a Licensed Drug and Alcohol Treatment Specialist graduate with Honours of Stratford Career Institute. Marcel has also received a certificate from Harvard for completing a course entitled The Opioid Crisis in America and a certificate from The University of Adelaide for completing a course entitled AddictionX: Managing Addiction: A Framework for Succesful Treatment.


Michael Leach, CCMA - Medically Reviewed on September 17, 2021

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Michael Leach is a Certified Clinical Medical Assistant, who has over 5 years of experience working in the field of addiction. He spent his career working under the board-certified Addictionologist Dr. Rohit Adi. His experience includes working with families during their loved one’s stay in treatment, helping those with substance abuse issues find treatment, and teaching life skills to patients in a recovery atmosphere. Though he has worked in many different areas of rehabilitation, the majority of his time was spent working one on one with patients who were actively withdrawing from drugs. Withdrawal and the fear of going through it is one biggest reason why an addict continues to use and can be the most difficult part of the rehabilitation process. His experience in the withdrawal atmosphere has taught him that regardless of what approach a person takes to get off drugs, there are always mental and emotional obstacles that need to be overcome. He believes having someone there to help a person through these obstacles can make all the difference during the withdrawal process.