Someone with substance abuse disorder (drugs or alcohol) and mental illness (depression, PTSD, anxiety, OCD, etc.), the diagnosis is called a co-occurring disorder. Any combination of mental health disorders and substance abuse or addiction qualifies for this diagnosis (sometimes referred to as a dual diagnosis), such as alcoholism and depression, anorexia and cocaine dependence, post-traumatic stress disorder and heroin addiction, prescription drug dependence and anxiety, and more.
For the purposes of treatment, it is recommended that clients receive intensive medical and therapeutic intervention and care for both disorders at the same time. This allows them to manage the symptoms caused by the mental health disorder without abusing drugs and alcohol and worsening those symptoms — or allowing an untreated mental health disorder to increase the urge to drink or get high. Comprehensive care that begins during detox and continues through aftercare treatment and support is the best way to build a new life in recovery from co-occurring disorders.
Others may seek out drugs and alcohol in an attempt to “self-medicate” a mental health issue that develops in early adulthood or that develops out of an injury or trauma later in life. Still others may first develop an addiction problem that grows so severe that it causes mental health issues or triggers the onset of symptoms that may otherwise have remained dormant.
Addiction is defined as both a physical dependence and a psychological dependence upon a drug or multiple drugs, including alcohol. Physical dependence is characterized by a tolerance to the drug of choice (e.g., needing an increasingly larger dose in order to experience the desired effect), and psychological dependence is defined by cravings for the drug or obsessing over getting and staying high.
According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), substance dependence is a single disorder that is measured on a spectrum from mild to severe and classified according to the substance of choice, with the exclusion of caffeine, which cannot be the subject of a substance abuse/addiction disorder diagnosis. For example, someone struggling with an alcohol problem may be diagnosed with alcohol abuse disorder or alcoholism depending upon the severity.
The diagnostic criteria for almost all substance abuse disorders are the same, according to the DSM-5. There are 11 symptoms that can signify a substance use disorder, and in order to be diagnosed with a mild drug abuse disorder, the person must exhibit two or three of these symptoms.
The National Alliance on Mental Illness (NAMI) reports that the 11 symptoms that characterize a substance use disorder include a pattern of substance abuse that leads to:
DSM-5 is the industry standard in the US for identifying the characteristics of any mental health disorder. For each mental health disorder, DSM-5 offers the diagnostic criteria sets, the classification information, and an explanation of the disorder. The diagnostic criteria set includes the symptoms that must be exhibited by the individual and the period of time that those symptoms must be an issue as well as the symptoms and disorders that must be ruled out prior to diagnosing a person with the disorder in question.The specifics of each mental health disorder will be defined by a range of symptoms at different severity levels impacted by the unique experience of the individual. Though everyone lives with a certain level of anxiety, depression, and other common mental health symptoms from time to time, experiencing symptoms that are severe enough to intrude on daily life and relationships for an ongoing period of time often indicates a mental health diagnosis.
In some cases, a mental health disorder predates the development of a drug or alcohol abuse disorder; in other cases, addiction becomes an issue first and mental health symptoms are not apparent until later — sometimes, they are triggered or worsened by drug use.
Everyone is different and there is no one cause of addiction, though living with a mental health disorder may increase the likelihood of developing an addiction disorder — and vice versa.
In most cases, a combination of issues may contribute to the development of addiction and/or mental health disorders, including:
Sexual abuse, physical abuse, natural disaster, and wartime experiences — exposure to trauma and near-death experiences can contribute to the urge to use drugs and alcohol as a coping mechanism as well as the experience of significant mental health issues, such as depression, post-traumatic stress disorder, anxiety, and more.
Growing up or living in a home or other environment that is permissive of heavy drug use may contribute to the development of a substance abuse disorder
Use of certain drugs and alcohol in high amounts as well as other significant life experiences, like developing a chronic illness, may contribute to the development of mental health symptoms.
Living with both a mental health disorder and substance abuse or addiction is a deadly combination. The poor lifestyle choices associated with these two disorders often translate into early and/or sudden death for the individual if no treatment is received.
Some common life-threatening issues that co-occur with a mental health disorder include:
Thus, addressing all disorders that contribute to the lifestyle choices that may hasten an early death is imperative for those who are living with co-occurring disorders. Integrative treatment offers a range of treatment services to the individual, providing the person with everything necessary to heal on all levels. Specific services will vary depending upon the needs of the client but may include resources to assist in lifestyle changes in addition to directed addiction and mental health treatment.
Recommended lifestyle changes that promote health and wellness at an integrated treatment program may include:
In this way, clients receive everything they need to get back on track, return to work, rebuild relationships at home, and build a strong support network in recovery.
Integrated treatment is a comprehensive rehabilitation program that offers all the medical, therapeutic, and holistic resources necessary to help clients heal physically, mentally, emotionally, and spiritually. No matter what the mental health diagnosis, but especially if co-occurring disorders are the issue, integrated care is recommended.
Each client should have a unique treatment plan, but for those who are living with both a substance abuse or addiction disorder and a mental health disorder, an integrated treatment plan may typically include the option of:
For many who struggle with addiction to drugs or alcohol, the detox period, or first days and weeks after the cessation of substance use, can be defined by physical and mental withdrawal symptoms. Detox services provide clients with medical support and monitoring if needed to help them stabilize in treatment.
To ensure that all current mental health symptoms are accurately diagnosed, an evaluation is the next step in integrated treatment. Additionally, all other issues that may be an obstacle in the client’s path to recovery are identified.
Based upon the evaluation results and the reported experience of the client, diagnoses are made to help the client better understand and frame past experiences and plan for the future.
A unique treatment plan is created for each client that integrates a range of therapeutic and medical interventions with the goal of empowering the client to heal from addiction, learn how to manage mental health symptoms, and address any personal issues that may be problematic.
One-on-one therapy is the foundation of recovery, providing the client with a safe and confidential forum to discuss past experience, current issues, changes that occur in therapy, and goals for the future. As treatment goals are reached based on the initial treatment plan, the client can work together with the therapist to create new therapy goals and adjust the treatment plan accordingly.
There are different types of groups that may be a part of an integrated treatment program: 12-Step groups, groups that focus on a specific aspect of addiction, a support group for people who share the same mental health issues, groups that help participants deal with a commonly shared life issue (e.g., parenting, legal problems, job seeking, etc.).
Working together with loved ones to rebuild relationships damaged during active addiction and untreated mental health symptoms can play a significant role in recovery, especially if the client will be returning home to live with family members after treatment. Empowering family members to connect with treatment that will allow them to heal in their own ways while also working to help all members to learn positive communication skills.
Before leaving treatment, clients are encouraged to work with a therapist to create a unique aftercare plan. Much like the treatment plan, this should include a unique combination of treatment services that will serve the treatment goals and needs of the client on an outpatient basis during and after the transition into independent living in recovery.
Aftercare services & support
Clients who seek integrated treatment for co-occurring disorders are encouraged to create an integrated aftercare plan that incorporates services that address treatment needs on an ongoing basis. Continued mental health care is recommended as is support building in recovery from addiction and personal therapy as well as whatever holistic and alternative therapies were working for the client during treatment.
There is no mental health disorder that cannot be effectively impacted by integrated treatment. According to Medline Plus, some of the mental illnesses that will benefit from comprehensive medical and therapeutic care include:
An estimated 17.3 million Americans over the age of 12 reported living with an alcohol use disorder in 2013, and about 6.9 million Americans in the same age group reported past year abuse of illicit drugs and/or addiction in a SAMHSA survey.
It is not uncommon for a person to be diagnosed with co-occurring disorders. Those who present with symptoms of a substance abuse or addiction disorder are about twice as likely to also experience symptoms of a mental health disorder as compared to those who do not struggle with drug and alcohol use. By the same token, those who enter treatment for mental health symptoms that indicate a mental health disorder are likewise twice as likely to also be living with a substance abuse disorder.
SAMHSA says that an estimated 8.9 million Americans are living with co-occurring disorders. However, they also report that fewer than 7.5 percent of these people enroll in a comprehensive treatment program that can effectively address those disorders each year.
The most common causes of disability in the US are mental health disorders. This classification of disorder bears the largest disease burden of any disease or disorder. The National Institute of Mental Illness (NAMI) estimates that about one in 17 Americans or over 13 million people in the US are living with a serious mental illness or mental health disorder in any year.
An estimated 9.6 million Americans over age 18 were believed to be living with a serious mental illness (SMI) in 2012 — or about 4.1 percent of all adults in the US. In addition, it is estimated that about 20 percent of American kids under the age of 18 either had at one time or currently have a debilitating mental health problem.
The World Health Organization (WHO) reports that in the US and Canada, it is believed that about 25 percent of all years of life lost to premature death are caused by disability. Part of this number may be attributed to the high rates of suicide connected to mental health symptoms and disorders; about 30,000 Americans commit suicide every year, making the act the 11 th leading cause of death in the US.
Anxiety disorders are some of the most commonly diagnosed types of mental health disorders in the United States. More than 18 percent of Americans over the age of 18 struggle with anxiety, and about 23 percent of these people are diagnosed with a severe case. Incidentally, women are about 60 percent more likely to struggle with an anxiety disorder than men.
Major depressive disorder, dysthymic disorder, and bipolar disorder are among the disorders classified as mood disorders. These disorders are diagnosed among an estimated 9.5 percent of American adults over the age of 18, and about 45 percent of these clients have cases that are severe. Again, women are about 50 percent more likely to be diagnosed with mild, moderate, or severe depression, bipolar disorder, and other mood disorders than men. An estimated 14 percent of children between ages 13 and 18 are diagnosed with a mood disorder, with almost 5 percent classified as a severe case.
Antisocial personality disorder, borderline personality disorder, narcissistic personality disorder, and avoidant personality disorder — these are just a few of the many personality disorders that are diagnosed in more than 9 percent of the US population. Though these disorders are characterized by perspectives and behaviors that make it difficult for the person suffering to function effectively with others, it is estimated that only 39 percent of people living with a personality disorder get treatment.
Some of the most deadly mental health disorders are eating disorders (e.g., anorexia, binge eating disorder, and bulimia) because malnutrition and organ failure are common results of caloric and nutritional deprivation. Though it is often believed that teen and adult women are the only people living with eating disorders, an estimated 2.7 percent of children in the US are living with an eating disorder, and an estimated 10-15 percent of people living with anorexia and/ or bulimia are men.
Though it is believed to be an illness that only impacts children, attention deficit hyperactivity disorder (ADHD) is diagnosed among more than 4 percent of American adults and about 41 percent of these cases are classified as severe. Also, 9 percent of children between 13 and 18 are living with ADHD.
An estimated 1 of every 68 children is born with a disorder on the autism spectrum (ASD). Autism is a disorder that can have a wide range of impacts on social, cognitive, and behavioral function through adulthood, and it occurs five times more frequently among males as compared to females.
Depression symptoms may be triggered by acute events (e.g., job loss or threat of job loss, end of a relationship, death of a loved one, etc.) and may be normal, but if symptoms persist for more than six months, treatment is recommended. Treatment may include medications like tricyclic antidepressants (e.g., Prozac, Zoloft) and cognitive and/or behavioral therapies. Holistic treatments that lower stress levels and increase an overall sense of positive wellbeing are recommended.
It is often difficult to diagnose bipolar disorder, especially among those people who experience long mood cycles because the disorder can at first appear to be major depressive disorder or an issue related to substance abuse if that is part of the problem. Once diagnosed, clients will usually be treated with medications that may include antipsychotic medications, mood stabilizers, and/or antidepressants. Cognitive Behavioral Therapy, holistic therapies, family therapy, and alternative therapies may be an effective part of an integrated treatment program for bipolar disorder, especially when co-occurring disorders are in evidence.
Treatment for anxiety disorders will vary depending upon the triggering issues and the specifics symptoms that manifest and are intrusive in the person’s life. Exposure therapy is a form of Cognitive Behavioral Therapy that is very often successful in the treatment of certain anxiety disorders. Other therapy options may increase the client’s ability to manage symptoms or stop them before they start.
Medications may be helpful in this process as well. Benzodiazepines (e.g., Klonopin, Ativan), antidepressants (e.g., Zoloft, Lexapro, Celexa), and beta-blockers (e.g., Inderol) may be prescribed depending upon the situation.
There are different types of PTSD that can develop, and each person’s experience with the disorder may vary based on the inciting event. Some people may experience symptoms that cause them to constantly and/or unexpectedly relive the event. They may have the same physical sensations and uncontrollable flashbacks of the experience, and they may behave erratically and exhibit angry outbursts as a result.
Other people living with PTSD may exhibit avoidant behaviors, making choices that allow them to avoid people, places, or situations that trigger memories of the traumatic event. They may also have memory loss or blackout spots in their memory that disallow them to remember specific details leading up to, during, or after the trauma.
Additionally, people living with PTSD may feel numb and unable to connect with others and/or feel extremely agitated and unable to sleep or relax for fear of what may happen. Many have problems with friends or family, have a hard time holding it together every day at work, and may no longer have any interest in things that once were a source of relaxation or amusement.PTSD treatment may include medication to help manage symptoms of anxiety, insomnia, depression, and/or panic as well as therapy to help process the experience of the trauma and learn how to manage and mitigate symptoms.
About 2.2 million Americans are believed to be living with OCD. Because a range of symptoms may play a role in the compulsive behaviors and emotions associated with the disorder, treatment often includes the use of antidepressant medications and/or anti-anxiety medications as well as Cognitive Behavioral Therapy.