Taming Two Dragons at Once: Co-Occurring Disorders
Co-occurring disorders is a term for what used to be known as dual diagnosis. Generally speaking, it means that a person is struggling with two distinct and recognizable disorders, each of which would normally be treated on their own, but which for people who have both, is better treated together.
One of the two diagnoses is often a Substance Abuse disorder of some kind.
The second diagnosis is usually a mental health disorder, such as Post Traumatic Stress Disorder, Major Depression, or Bipolar Disorder.
Both dragons must be tamed and dealt with, as they are distinct from each other, and yet interact with each other in a way that is negatively reinforcing.
Diagnosis of co-occurring is sometimes a bit trickier than normal diagnosis. This is because substance use disorders also generate psychiatric symptoms like depression, anxiety, and psychosis, so it can be hard for a practitioner who doesn’t know your full history to know what she’s looking at.
The use of a substance may also mask the presence of a symptom that would otherwise be visible. For example, many women with anxiety disorders, such as panic disorder or PTSD, have been using alcohol for its anxiolytic, or sedative, effects, to the point where the underlying constant state of anxiety may be hidden from her own awareness.
The classic ups and downs of bipolar disorder, for example, can also resemble the highs and lows of stimulant addiction. That’s why Villa Kali Ma takes a cautious, supportive approach to diagnosis, making sure we’re understanding what exactly is plaguing you before we dive in to helping you overcome it.
For a woman who comes to realize and accept that she has two things going on at once, a mental health issue as well as a substance abuse issue, it is generally recommended that she go to a place where she can get treatment for both at once, from the same staff. It doesn’t usually work to get treatment for one and then the other, because each one of the disorders interferes with progress in treatment of the other.
Negative interactions between the two disorders occur because each triggers the other: psychiatric symptoms, like getting depressed, set a woman with depression up for being triggered to use. At the same time, a relapse in her substance use disorder will trigger her depression. It’s a narrow strait she has to pass through, on both sides – treatment for each is full of triggers for the other.
For example, it’s normal to experience a phase of feeling down when in withdrawal from substances. All people in substance abuse treatment will likely feel a bit discouraged or down as they face the task of their recovery.
For a woman who has major depression to begin with, however, that withdrawal-induced depression can easily compound into a walloping major depressive episode complete with suicidal feelings.
Likewise, the same woman may be making progress in her substance abuse treatment, doing well in her recovery, when she suddenly experiences an episode of her major depression. The profound pain of her mental illness can easily trick her into returning to her drug of choice for relief.
A woman with co-occurring disorders will need to become deeply aware of two major dragons that she needs to tame, dragons that sometimes team up together and attack her from different sides at once.
A big part of taming dragons is getting a fairly good handle on what exactly their qualities are. Maybe one dragon has wings and poison venom, and another breathes fire and has a spiky tail. When teamed up together, you’re facing a duo that together flies, breathes fire, poisons you and hits you with a spiky tail.
It is important to acknowledge that a woman who has made it this far in life with a co-occurring disorder has a very strong soul and spirit. She has lived with two dragons where most of us have barely managed to handle just being alive and handling “normal life”. Her very existence is an accomplishment.
She must call on that strong spirit of resilience in side her to become gritty and street smart about what she’s facing. She has to lose any lingering naïveté about the full cunning and baffling power of her substance addiction dragon, and at the same time understand the vagaries and tricks of her mental illness dragon. A big part of recovering, therefore, is what’s called “psycho-education,” or basically getting an advanced degree in the natures of her dragons. She must learn all about how each disorder behaves, mastering knowledge of the symptoms, triggers and signs of its return, warning signs of relapse and what cures exist. She must learn to call out the voices of each disease – the addict that lies to her in one way, and the disorder that lies to her in another.
Some common dragon pairings make sense when you look at how they interact. Anxiety disorders tend to go with addiction to anxiolytics, such as panic disorder with alcoholism. Bipolar disorder tends to team up with polysubstance abuse, which makes sense because the opposite nodes of the bipolar psychiatric experience will push a woman to self-medicate with different substances, depending on whether she is in “up” or “down” mode. Major depression hooks up with stimulants, such as cocaine. People with schizophrenia are often at high risk for poly substance abuse as well, which makes sense when you consider the complexity of their symptoms.
In each of these scenarios, you can see how the two dragons work together to pull a woman down. The substance of choice on the one hand temporarily alleviates the pain of the symptoms. Cocaine creates high energy, euphoric and speedy feelings that override the specific slow, low pain of depression. On the other hand, the backlash – the payback of that drug – is identical in feeling to the original symptom. For anyone using cocaine, whether or not they had depression to begin with, depression is a withdrawal symptom. Likewise if you didn’t know what anxiety was yet, going through withdrawal from alcohol will make it abundantly clear what that is.
You can see here that this is quite a consciousness trap. Women are plagued with certain symptoms that they cannot find relief from. In search of relief, they turn to substances. The substance helps in the short term, then heaps more of their symptoms on them. To boot, the substance isn’t a reliable solution due to tolerance – over time, the woman’s brain adapts to the substance and no longer receives any benefit, but has nevertheless become dependent on it simply not to go into painful withdrawal.
A woman with co-occurring disorder is called to heroism on two fronts – she is a powerful being who will need to become a savvy and skilled warrior for her recovery. As she understands each illness and the way they interact with each other negatively, she becomes extremely tough, a force to be reckoned with.
It is helpful to come to a place which treats both disorders at once, with the same therapists and same healing milieu. That way she can form bonds of trust with staff and peers who accept and understand the entire picture of her experience.
It is vitally important to be able to speak freely about the truth of her psychiatric symptoms, be they hearing voices, urges to kill herself, or terrible onslaughts of panic attacks. It is helpful to be in an environment where the dual nature of her dragons is understood, and where there is extra compassion and support for the double task that she is up against. She will need to have the support of qualified staff and loving peers to help her develop coping skills, strategies, mottos, and make personal meaning of her challenges and story of heroic recovery from them.
A lot of dealing with co-occurring disorders is learning daily actions that can be used to soothe oneself from any kind of stress, pain, urge or trigger. Another piece is developing and lovingly sticking to a structure that helps a woman feel safe and contained in a space that protects her from the hurricane winds of her illnesses when they rise. A third piece is being around a community of people who completely get it, who accept her with her particular soul challenges that she has without stigmatizing or judging her, who understand and forgive her temporary set backs and failings as she learns the art of dragon taming.
Last but not least, a woman with co-occurring disorders will most likely benefit from some way of understanding her experience through a spiritual or existential outlook, whether this is relying on her God source, however she comes to know that source, or whether she finds other words and ways to know a power that is bigger and stronger than her double-headed dragon, who can intervene, intercede, and aid her when she is at her weakest.
A Villa Kali Ma, we follow a daily structure for healthy living that entrains a woman to habits that support recovery from co-occurring disorders. We also provide her with a treatment team that understand her experiences and teach her the coping skills she can use to soothe herself and to survive attacks from her substance disorder and her mental health disorder. Finally, we share contexts and practices that she might like to use to develop a connection to a personal version of spirituality, that can support and sustain her.
If you think you might suffer from co-occurring disorders, we at Villa Kali Ma can help you figure out what’s going on with you, and collaborate with you to design a treatment course that will address your specific challenges.
Please know that your co-occurring disorders are esteemed and respected at Villa Kali Ma, that we see you as twice as heroic rather than twice as disordered. And when you have tamed your two dragons, we will be honored to know your twice-as-powerful self.