A co-occurring disorder, or dual diagnosis, occurs when a person has a substance use and mental health disorder simultaneously. This can include a single mental illness or more than one.
A substance use disorder can include abuse or addiction to alcohol or any other drug. In certain cases, a person may struggle with addiction to two substances or be addicted to one and abuse another substance occasionally (polydrug abuse or addiction). Research shows that drugs (including alcohol) can make the symptoms of a mental illness more severe.
The combination of these two conditions can worsen the behavioral, emotional, physical, medical and social issues that accompany each individual condition. Because of this, and in order for effective care to be delivered, treatment providers must recognize the ways each condition affects the other in every client.
The best treatments for co-occurring disorders deliver integrated care that blends therapies for both conditions into one, individualized treatment plan. The most effective dual diagnosis treatments adapt behavioral therapy, medications as needed and peer support groups to each client’s specific health and medical needs. This personalized approach helps a person heal from the mental health and substance use disorders on a physical, mental and emotional level.
Types Of Co-Occurring Disorders
People who have a mental health problem have a higher likelihood of developing a substance use disorder than those who don’t have a mental illness. The National Institute on Drug Abuse reports “that persons diagnosed with mood or anxiety disorders are about twice as likely to suffer also from a drug use disorder (abuse or dependence) compared with respondents in general.”
Examples of mental disorders that may occur with substance abuse or addiction include:
- anxiety disorders (generalized anxiety disorder, social anxiety disorder, etc.)
- attention deficit hyperactivity disorder (ADHD)
- bipolar disorder
- depressive disorders (clinical depression, perinatal depression, etc.)
- dissociative disorders (depersonalization disorder)
- eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, etc.)
- obsessive-compulsive disorder (OCD)
- personality disorders (antisocial personality disorder, borderline personality disorder, etc.)
- post-traumatic stress disorder (PTSD)
Depending on the condition and the circumstances surrounding it, a mental illness may happen only once, occur several times throughout a person’s life or affect a person on a chronic basis. Certain mental disorders, like anxiety and ADHD, can begin very young, while others, like schizophrenia and psychotic disorders, arise more frequently in early adulthood. Anxiety disorders impact the greatest number of Americans, with depressive disorders following second.
While all mental disorders can cause varying degrees of impairment, serious mental illness cause impairment so severe that one or more major life activities in a person’s life are seriously altered. Examples of serious mental illness include bipolar disorder, major depression, and schizophrenia. People with serious mental illness may be more at risk of developing a substance use disorder.
Signs Of A Co-Occurring Disorder
Between the various types of mental illness, there are numerous combinations of co-occurring disorders. Certain drugs of abuse are more prone to create certain symptoms or forms of mental illness. Further, even a single mental health disorder may have somewhat different symptoms from case to case.
Because of these variables, the exact symptoms and impact of a dual diagnosis can significantly vary from one person to the next. With this in mind, it can be helpful to know the broad signs and symptoms of a substance use disorder and mental illness if either is suspected.
General symptoms of a substance use disorder include:
- unexplainable and sudden behavioral changes
- alienating loved ones and adopting new “friends” (people who supply or use drugs)
- a person is unable to control or limit the amount of drug used
- a person claims they need the drug to function normally
- lying about drug or alcohol use
- stealing alcohol or drugs
- risk-taking behaviors
- a person develops a tolerance for a drug (needing more of it to create the desired effect)
- withdrawal happens if a person stops using the drug
General symptoms of a mental health disorder include:
- trouble concentrating
- severe mood swings
- pushing friends and family members away
- losing interest in social events
- suicidal ideation (thoughts of suicide)
Certain symptoms of mental illness can overlap with those of alcoholism or drug addiction. For this reason, it can be difficult to distinguish the symptoms of each disorder without the assistance of a trained professional or a clinical assessment. A correct and thorough diagnosis is a key part of creating and delivering treatment that is appropriate to each person’s unique needs.
In addition to an alcohol and drug screening tool, an in-depth clinical assessment should also work to identify any forms of mental illness that may be present. This evaluation will help treatment providers to design and implement targeted, dual diagnosis treatment.
The Connection Between Mental Illness And Addiction
Addiction is itself a form of mental illness. As substance abuse progresses to addiction, the drug causes changes in the brain that leads to cravings and compulsive drug use. Several forms of mental illness, including anxiety and depression, cause disruptions in the same brain locations where these changes occur. Normalizing brain function as best as possible with the aid of medications and behavioral therapies is a key component of rehabilitation from a mental health and substance use disorder.
Either a mental health or substance use disorder may develop first. While these disorders are not always related to the other, in many cases they do have a strong connection to each other. Drug and alcohol abuse can aggravate an existing mental illness or cause new symptoms or a disorder to develop. In the most severe of cases, a person may develop a mental illness primarily because of their substance use disorder.
Undiagnosed, untreated or undertreated mental illness can lead a person to self-medicate with drugs or alcohol. Many forms of addiction first began as a person used drugs or alcohol to cope with the symptoms of their mental health disorder.
Self-treating a mental illness with drugs or alcohol is dangerous, ineffective and in many cases, these behaviors can cause the mental illness to become more severe and disabling. As a person uses a substance to cope or numb symptoms of their mental illness, the substance abuse can cause greater mental and emotional instability, thus worsening the mental illness even more.
When this happens, many people respond by increasing their drug or alcohol intake, a behavior which can push them closer to addiction. Without the proper behavioral health treatments, these patterns can lead to the compulsive patterns of drug seeking and using that accompany addiction.
Dual Diagnosis Addiction Treatment
In order to maximize the potential of treatment, and to offer each client the greatest therapeutic benefit, individuals with co-occurring disorders are best treated in a dual diagnosis addiction treatment program.
Failing to treat co-occurring disorders can put a person’s health and well-being at risk. According to the Substance Abuse and Mental Health Services Administration, “the consequences of undiagnosed, untreated, or undertreated co-occurring disorders can lead to a higher likelihood of experiencing homelessness, incarceration, medical illnesses, suicide, or even early death.” Many of these states can be themselves risk factors for continued substance abuse. Seeking prompt treatment for a dual diagnosis can reduce the risk and harm caused by these and other issues caused by addiction.
The exact path through treatment and into recovery varies from client to client. Dual diagnosis treatment is multi-faceted. Each step and therapy used is adapted to a person’s specific medical and behavioral health needs.
Treatment for a co-occurring disorder typically combines medications with behavioral therapies. The goal of this combined approach is to treat acute symptoms while identifying and addressing the underlying causes of addiction. For many people, the most effective treatment plan includes both a medical detox and rehabilitation.
During a medically supervised inpatient detoxification, a person is monitored by trained clinicians 24/7 while their body cleanses and is weaned from their drug of abuse. After a person’s body has stabilized, and withdrawal symptoms have subsided, a rehabilitation program is highly recommended.
Due to the intensive nature of many co-occurring disorders, inpatient drug rehab is often preferable to outpatient treatment. The residential format of this program gives a person consistent access to medical and mental health care so that they have the highest opportunity for physical and mental wellness.
Having a co-occurring disorder can make life overwhelming. It can also make it difficult for a person to find good health, stability and personal fulfillment. A comprehensive and individualized dual diagnosis treatment program provides an environment that nurtures emotional and physical healing and balance, while also encouraging personal development.
National Institute on Drug Abuse — Research Report Series: Comorbidity: Addiction and Other Mental Illnesses
Substance Abuse and Mental Health Services Administration — Co-occurring Disorders