What is a Co-Occurring Disorder?

A co-occurring disorder refers to an individual who has two (or more) mental health or medical conditions at the same time. Their onset may not have been the same, but they exist in tandem now. Substance abuse disorders are often found to be co-occurring with mental health disorders. 

Those who find themselves with a co-occurring disorder may not even realize it. This is why it is so important to have a thorough understanding of what it means to be dually diagnosed – and seek treatment specific for both. 

Substance Use Disorders

There are different types of substance use disorders that can find themselves side-by-side with a mental health disorder. Most commonly, substance use and substance dependence. 

Alcohol or drug abuse occurs when the use of a substance interferes with daily responsibilities, such as functioning at work, interpersonal relationships, daily responsibilities at home, and so forth. It may also be diagnosed if the use of substances takes place in dangerous situations or if it worsens a medical condition.

Alcohol or drug dependence is when physical addiction sets in. This is more severe than abuse. Those using may find that it is next to impossible to quit or abstain from substance use. A heightened tolerance and physiological dependence are usually also present. A tough withdrawal is usually inevitable at this stage. 

Mental Health Disorders

Mental health disorders are common on their own. A large number of the population will, at some point in life, either personally experience mental health disorders or know someone who has. These may be mildly bothersome or may interfere greatly with one’s quality of life. This is largely due to some symptoms being mild and manageable, but without treatment, these symptoms can also be severe and out of control. 

What is a Co-occurring Disorder?

According to the Substance Abuse and Mental Health Services Administration, a 2019 survey revealed that, in the U.S, 9.5 million people between the ages of 18 and 25 were diagnosed with both a mental health and substance abuse disorder. Only 7.8% of these people (or 742,000) received treatment for both disorders simultaneously. 

When it is determined that someone with an addiction has a mental health condition, it is recommended that both disorders be treated together. The inverse is also true: someone with a mental health disorder who is found to also have a substance abuse problem should seek treatment for both diagnoses simultaneously. This is referred to as dual-diagnosis. 

It doesn’t matter which issue arose first. One illness may appear and aggravate the other. An individual could have never experienced symptoms of a mental health disorder until he or she started using certain substances, for instance. 

Thorough research by the National Institute on Drug Abuse has determined that there are three possible reasons that explain the prevalence of co-occurring disorders. These include: 

1. Self-Medication. Those who are suffering from a mental illness may not know how to properly handle the symptoms. And when the symptoms become too much to handle, it is common for individuals to turn to drugs and alcohol to soothe them. Unfortunately, this only masks the symptoms and, in fact, can make the entire situation worse. 
2. Chemical Changes in the Brain from Drug Use. Using a substance can alter the chemicals in the brain. The most common areas to be disrupted are the areas of the brain connected to mood, anxiety disorders, impulse control, and even the manic symptoms associated with schizophrenia. Changing the chemicals due to substance use can trigger the onset of a mental disorder.
3. Common Risk Factors for Both. There are many similarities in risk factors when it comes to mental illness and substance use. Situations that include certain environmental factors or trauma make someone more susceptible to developing co-occurring disorders. 

The Most Common Co-Occurring Disorders

There is no limit on the mental illnesses that surface alongside a substance use disorder. Any condition can appear, but there are a few very common mental health conditions that seem to be more common than any others, including: 

• Anxiety disorders. Anxiety can be a pestering condition that can make life heavy to deal with. Drinking or drug use – especially prescription drug use – is often used to calm anxious feelings, especially in social settings. Unfortunately, the addiction starts and anxiety amplifies.
• Mood disorders, such as bipolar disorder or depression. It is not uncommon for someone to turn to drugs or alcohol to feel a bit of joy or pleasure. This is a way to numb the sadness, if only for a moment. It is an artificial relief and only exacerbates the problem.
• Personality disorders. Personality disorders, such as Borderline Personality Disorder, can make a person feel out of control. Many who have it use substances as a means of making the symptoms more controllable.
• Post-traumatic stress disorder (PTSD). PTSD can wreak havoc on the mind of someone who has been through a lot. All too often, these individuals seek relief from drugs or alcohol. Again, it only makes things worse. 

It is pretty easy to see the pattern of needing help, turning to drugs or alcohol for relief, and ending up in a worse position. Substances and mental health conditions aren’t sustainable – especially in the long run. The symptoms will only get worse unless both issues are addressed and treated. 

Treating Co-Occurring Disorders

Diagnosing co-occurring disorders can be tough. Addiction symptoms can sometimes mask mental health disorders and, at the same time, the symptoms of mental illness may mask or impersonate addiction. Though they may be difficult to diagnose, it is necessary to treat both mental illness and substance abuse at the same time. 

Cooccurring addiction treatment should include:

• Multidisciplinary team to address both diagnoses from all angles. 
• A comprehensive treatment program. 
• Individual and/or group therapy. 
• Treatment specific to the substance use disorder. 
• Treatment specific to the mental health disorder. 
• Medical treatment to address any other underlying issues. 
• Lifestyle counseling for positive changes. 
• A high level of support, specialized in both conditions. 

Because mental illness and substance use can become so interdependent on one another, treating one without the other will leave the individuals in a state of vulnerability. An integrative approach to treatment is necessary if you want someone to thoroughly and wholly get better. It is the only way to take a step in the direction of healing.