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Co-occurring Disorders

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When a person has a drug or alcohol problem and a mental health disorder, they are suffering from a co-occurring disorder (also known as dual diagnosis or dual disorders). Substance abuse without a co-occurring disorder is actually rare, as other disorders are so often tied to substance abuse. It’s unknown whether mental illnesses cause substance abuse problems or vice versa. Symptoms of one or both disorders can range from mild to severe.

3 Important Facts

  • More than half of adults with severe mental illness also have a substance use disorder.
  • Compared with people who have just one disorder, people with co-occurring disorders have more severe emotional, medical and social problems.
  • Although the term “co-occurring disorders” sounds like two disorders, it can be more than two. An estimated 3 million people with COD have three or more disorders.

Signs to look for

  • Substance abuse disorder
  • Psychiatric disorder
  • Life disruption
  • Symptoms vary

Symptoms of co-occurring disorder (COD) include the symptoms of a substance use disorder and the symptoms of a psychiatric disorder. The symptoms will vary, depending on the combination of disorders. For example, someone may have a cocaine addiction and a personality disorder. Or a person could have an alcohol dependency and depression or anxiety. The mental health disorders most commonly found in co-occurring disorder patients include mood disorders, personality disorders, anxiety disorders, and psychotic disorders. Keep in mind that the symptoms will vary depending on the combination of disorders, but the social, financial, emotional, and medical aspects of a person’s life are likely to be significantly impacted by all disorders involved.

Next steps

Effective treatment for COD simultaneously targets the substance use disorder and the co-occurring mental disorder(s). Good treatment plans address the fact that the co-occurring substance abuse and mental health issue(s) interact in a way that can create a compounded effect. This means that new issues are generated not as the direct outgrowth of either substance abuse or mental illness, but of their interaction with each other.

It is not uncommon for those with co-occurring disorders to be treated only for either substance abuse or for the co-occurring mental illness. When only the substance abuse is treated, the patient may be prone to relapse because of unresolved mental health issues, which may have led to substance abuse in the first place. In the case of patients who are treated only for mental illness, undetected drug and alcohol issues may persist and progress after treatment, leading to a reemergence of mental illness symptoms. When withdrawing from substance use, some patients with co-occurring disorder exhibit obvious psychotic behaviors normally associated with other mental illnesses, leading to misdiagnosis. These patients may be given treatments that are not appropriate or even harmful, and their underlying addiction may go untreated.

Many professionals believe that patients with COD require an integrated approach to treatment. This means that treatment is delivered by a single team of caregivers whose approach to treatment is philosophically congruent, intensely collaborative and well-coordinated. As much as possible, substance abuse treatment and mental health treatment should be delivered seamlessly by a single team. This interdisciplinary team should include professionals with medical, psychiatric, substance-abuse, and mental-health expertise. Generally speaking, this level of treatment coordination is best delivered in a residential setting so that the entire operation supports an integrated approach.

Since residential treatment is not sustainable for the long term, it represents only the first of a multi-stage process. Following an intensive, integrated program of intervention and treatment, patients with co-occurring disorder need a program of aftercare that includes assistance building a self-managed program of community support. A multi-stage approach to treatment that includes aftercare and community-based resources is critical for preventing relapse and maintaining gains made in residential treatment. In addition, optimal care for patients with dual diagnoses includes family work at every stage of treatment. Since the family operates as a powerful system, it is typically either a vehicle for or obstacle to long-term recovery. For this reason, as much of the family system as possible should be involved in every stage of treatment in order to achieve and sustain success.

Common Q and A

How does a person develop co-occurring disorder?

Co-occurring disorder can develop in multiple ways. Most commonly, people with COD report that they first experienced the symptoms of the mental illness, and then used drugs or alcohol to cope with the symptoms.

What are the most common mental illnesses for teens with substance abuse?

Any mental illness can co-occur with substance abuse in teens and adults. However, teens with conduct disorder, oppositional defiant disorder, and ADHD are seven times more likely to have a substance use disorder. Teens with depression are four times more likely and teens with anxiety are twice as likely.

Won’t treating one disorder make the other go away?

No. Effective treatment requires that all present disorders are treated at the same time. Chances of recovery are significantly reduced when only one disorder is treated.

How is a diagnosis of co-occurring disorder made?

A mental health professional can diagnose co-occurring disorders. They will take the person’s psychiatric and substance abuse histories to make a proper diagnosis and formulate a treatment plan.