What Are Co-Occurring Disorders?

When a person has a substance use disorder (SUD) and another mental health issue, the condition is called a co-occurring disorder. Also referred to as comorbidity or dual diagnosis, co-occurring disorders are more common than you may think. Multiple national population surveys have found that about half of those who experience a mental illness during their lives will also experience a substance use disorder.

The Link Between Co-Occurring Disorders and Addiction

People suffering from a mental illness are more likely to misuse drugs and alcohol, and vice-versa.  A person’s experiences with mental health and substance use disorders tend to be cyclic rather than linear. These conditions perpetuate and exacerbate each other, making the cycle very challenging to break.

How Do Mental Health Issues Trigger Addiction?

Individuals who struggle with mental health issues often use drugs or alcohol to deal with difficult emotions or temporarily numb themselves. Social pressures, stress, and dealing with symptoms that flare up can fuel their substance misuse. For example, a person with depression may cope by going to the bar for drinks.

Drinking in response to stress is only a temporary “fix”—one that comes with dangerous consequences. Over time, individuals can become dependent on self-medicating with drugs and alcohol to make it through the day.

Repeated substance misuse can cause different neurotransmitters—molecules responsible for regulating cell communication—to fluctuate rapidly. When there is an imbalance in the levels of the neurotransmitters norepinephrine, dopamine, and serotonin, it becomes harder for the brain to regulate mood, sleep, and movement.

Ultimately, self-medicating leads individuals to experience more intense psychological symptoms than they would without the use of drugs and alcohol.

How Does Addiction Trigger Mental Health Issues?

The reverse is also true: a person who abuses substances can worsen mental health issues. Long-term misuse of substances changes a person’s mood, behavior and overall functioning. A daily drinker can develop issues from their chronic consumption of alcohol such as insomnia, a depressive mood, or irritability. Stimulants like cocaine can give people paranoia, panic attacks, delusions, and aggressive behavior, and long-term use can cause anxiety disorders.

Substances can bring a dormant disorder to the forefront of the brain. Marijuana, cocaine, and psychedelics can trigger symptoms of schizophrenia. These drugs can’t give people schizophrenia, but those with a predisposition to schizophrenia can activate the disorder in late adolescence and early adulthood. It is exposure to a substance, chronic use, and chemical disruption that makes addiction a powerful trigger for mental health issues.

Common Co-Occurring Mental Health Disorders

Certain mental health conditions commonly occur in tandem with addiction. Below are some common dual diagnoses and the substances frequently associated with the comorbidity:

Generalized anxiety disorder (GAD) – Those with GAD are so caught up in dread that the worry disrupts their normal life. They have such difficulty concentrating, sleeping, perceiving situations as harmless, and relaxing their bodies that they feel out of control of their lives. This vulnerability can lead someone down the path to addiction as they become dependent on alcohol and prescription pills to ease these anxious feelings.

Depression – Depression is a feeling of hopelessness that lasts for over two weeks alongside a lack of energy, a loss of interest in life, and a negative mood that affects ordinary brain functioning. There is a propensity for individuals who suffer from depression to use alcohol to cope. Alcohol however is a depressant and only further exacerbates the symptoms of depression. One in three people with alcohol use disorder (AUD) have experienced a severe episode of depression.

Bipolar disorder – Bipolar disorder is often characterized by a dramatic swing in moods. People with bipolar disorder may experience psychosis and an altered reality during mania, while later combatting extreme fatigue, agitation, and suicidal thoughts during depressive states. Someone with bipolar disorder may use stimulants such as cocaine while in a manic state or lean on alcohol during depressive lows. The most common substances abused are alcohol and cannabis, and 40% of all bipolar patients have substance use disorder (SUD).

Attention deficient/hyperactivity disorder (ADHD) – Individuals that suffer from ADHD experience symptoms ranging from inattention to daily life, hyperactivity, to impulsivity which can lead to struggles in school and at work. Some people believe that using marijuana will help relieve them of their ADHD symptoms; however, there is no research behind this. While initial use of marijuana can relax the mind, chronic use can interfere with day-to-day functioning.

Post-traumatic stress disorder (PTSD) – PTSD is an anxiety disorder that comes from experiencing a traumatic event. PTSD results in both mental and physical symptoms such as poor concentration, difficulty regulating emotions, and flashbacks to the traumatic event. The psychological distress of PTSD can be so intense that some may self-medicate with alcohol or marijuana to fall asleep, numb themselves, or deal with symptoms of physical pain. Half of those seeking addiction treatment also have PTSD, and PTSD also leads to a higher rate of relapse.

Anorexia nervosa – Anorexia nervosa refers to an eating disorder in which distorted body image issues trigger someone to take drastic measures to lose weight, such as denying themselves food and purging meals. Adderall, cocaine, and nicotine are often abused by anorexic people because a common side effect of these drugs is appetite loss. Women with either a substance use disorder or an eating disorder are four times more likely to develop the other, or vis-versa.

Obsessive-compulsive disorder (OCD) – People with OCD have symptoms of obsessions, compulsions, or both, often associated with environmental triggers. Someone with OCD may have intrusive thoughts about fear of contamination and germs, compulsively complete and recomplete a task again and again like locking a door, or develop motor tics. Alcohol becomes a coping mechanism for the challenging thoughts in an attempt to self-soothe. OCD precedes the addiction more than half the time.

Schizophrenia – Those with schizophrenia may have mood disorders, distorted reality, hallucinations, and delusions.  With these distressing symptoms at the forefront of their mental illness, schizophrenics may abuse a multiplicity of drugs or alcohol. The most commonly used drug by people with psychosis is nicotine to quell anxiety and distract from delusions. Using hallucinogens and stimulants, which are commonly also abused substances, can flare up symptoms of mania and psychosis.

Borderline personality disorder (BPD) – This personality disorder is commonly associated with chronic feelings of emptiness, self-harm tendencies, and impulsivity. Some individuals may have trouble differentiating real from imagined abandonment, convincing themselves that they will be left, leading to intense and unstable interpersonal relationships. People who suffer with BPD are at higher risk of developing alcohol dependence. 78% of people with BPD experience addiction because they are more likely to mix two or more substances, called polysubstance use, to self-medicate.

Treatment for Co-Occurring Disorders

Finding an addiction treatment program that addresses both the substance use disorder and the mental health disorder simultaneously is crucial for true, long-lasting recovery. If only one disorder is treated, the other will encourage relapse to occur. Treatment plans from mental health professionals who understand how addiction and mental illness are intertwined are a vital part of receiving the right help.

Alcohol and drug addiction treatment programs that are equipped to handle psychiatric problems can provide the proper counseling to help a person:

• Understand the causes behind mental illness and addiction and how they interact
• Identify and address triggers
• Better manage emotions
• Implement wellness therapies to help reduce symptoms of mental illness
• Motivate lifestyle changes

Battling addiction on its own is already challenging enough, but add a second mental illness, then your symptoms may become almost unbearable. Help is available. With the right treatment and care, you can heal your overall well-being and live a happy and fulfilling life free from substances.

Transcript

A co-occurring disorder is when an individual suffers from both substance abuse as well as a mental disorder. The most common mental disorders include: anxiety, bipolar disorder, depression, OCD, PTSD, and schizophrenia. Approximately 9 million Americans suffer from co-occurring disorders. Only 7 percent receive treatment for both disorders. Co-occurring disorders increase the risk of poverty, illness, homelessness, and incarceration.

Unfortunately, they can be difficult to diagnose. Often, symptoms of substance abuse can mask symptoms of mental illness, and symptoms of mental illness can mask symptoms of addiction. This leads to a cycle of self-destruction. Because both disorders are so closely intertwined, treating just one disorder will not cause the other to improve. It is crucial that both be treated at the same time, using what is known as integrated treatment.