As of 2018, over 9 million people in the United States were identified as struggling with a co-occurring disorder. Co-occurring disorders are also known as dual diagnosis. As both names imply, a person who meets this criteria has more than one problem at work. The presence of both, substance abuse and an underlying mental health disorder, are affecting the ability of the individual to function successfully in society.
It is often a difficult task to determine which of the problems came first. Poor mental health increases the tendency of a person to abuse substances, and substance abuse contributes to poor mental health. The presence of mental health disorders in a person who is under the influence is so entangled, that practitioners who are responsible for diagnosing and treating the individuals who are presenting with co-occurring disorders and symptoms can end up getting it wrong.
A person with a primary substance problem can end up with a diagnosis of a major mental disorder, or a person who is suffering from a mental disorder can fail to receive adequate treatment for it. Both errors can result in long term consequences for the person who is improperly diagnosed.
The newest version of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) has included an entire category for substance-induced disorders. These specific diagnoses range from mild mental health problems, to severe impairments experienced while under the effects of a substance.
The symptoms can be produced by both intoxication and withdrawal, and are specified by the particular type of drugs which are present in the system at the time that the mental health disorder signs are observed. Qualifiers for these disorders can include:
- Substance-induced depression
- Disruption in sleep
- Obsessive-compulsive behaviors
If a person is exhibiting these mental health disorder symptoms while under the influence of a substance, it is often the more conservative, less permanent, route to diagnose from this angle.
Exploring the Interaction of Co-Occurring Disorders & Substance Abuse
Several studies have aimed to sort out this chicken-and-egg scenario. Anxiety, conduct, and bipolar disorders are the most widely observed as preceding the behaviors of substance abuse and addiction, while panic disorders are often developed as a result of using a substance. The presence of depression can manifest both before, and after, any substance use occurs.
The presence of mental health disorders in childhood may also play a large role in developing a substance abuse issue later in life, leading some professionals to believe that better recognition and treatment for disorders in children is a key factor in reducing the amount of addicted adults.
In the field of psychology, drug abuse is often referred to as an attempt to self-medicate. In the absence of structured mental health support, a person may attempt to find relief from unpleasant thoughts and emotions through partaking of illicit and over-the-counter substances. Both the presence of diagnosable mental health disorders – and the presence of stress – have been associated with self-medicating behaviors.
As most addicts are well aware, there is a downside to this approach. Many of these substances carry with them devastating consequences. Relationships are ruined, jobs are lost, and physical health is decimated through prolonged use of drugs or alcohol.
Every year, 88 thousand people are involved in alcohol-related deaths, while another 70 thousand die from the effects of other drugs. With self-medication, it is nearly impossible to control either the dosages, or the content, of the substances which are being introduced to the body. In the absence of a controlled prescription, is all too easy to exceed the intended amounts.
Some of the most common mental health conditions which are self-medicated include anxiety, depression, and psychosis. On the other hand, some of the most impairing side effects of drug and alcohol abuse include anxiety, depression, and psychosis.
Examining the issue from this perspective can shed light on the futility of attempting to treat mental health symptoms through addictive behaviors. While you are attempting to escape the problems, you are simultaneously creating them. This illustrates the core problem of co-occurring disorders.
Newer Perspectives on Addiction Treatment
The conventional approach toward treating substance abuse involved a primary focus on getting the person detoxed, and back to his or her normal state of functioning, before even beginning to address the presence of a mental health disorder. It was believed that no real progress could be made toward mental health as long as the substance was playing a part in controlling the thoughts, feelings, and behaviors of an addicted person.
People who arrived for mental health treatment while under the influence of drugs or alcohol would be turned away and told that they needed to get clean, first. It is now understood that utilizing this approach can be a disservice to someone who is in need of help.
Current treatment favors an integrated approach, where a person is assisted in removing the effects of a substance from his or her life while simultaneously engaging in support to address the mental health symptoms which are underlying the addictive behaviors. A combination of substance abuse treatment methodologies, talk therapy, and psychiatric medications is currently considered the most effective method of alleviating symptoms of co-occurring disorders.
If you suspect that your addiction is related to an unresolved difficulty in mental health functioning, it is important to work with professionals who are aware of the complicated dynamics involved. It could be the case that you are not ready to give up your addiction, knowing that to do so will result in your being required to face life situations which you are not equipped to handle.
It could be the case that you have a strong desire to get rid of the addiction, but your mental health symptoms keep dragging you back down the path of escapism through using the drugs or alcohol. Receiving treatment from an integrated team of professionals is likely to be your best tactic for getting at the root of your problems and eliminating your dependence on drugs or alcohol, for good.