Substance Use

Co-Occurring Disorders

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In the complicated area of mental health, co-occurring disorders stand out as an especially interesting area of study. These are people who are dealing with more than one mental health problem at the same time.

This shows how complexly different mental illnesses can interact with each other and make each other’s symptoms worse. (1) To fully understand co-occurring disorders in the American population, we need to learn more about how different diagnoses, like substance use disorders along with mood or anxiety disorders, can become intertwined, forming behaviors and thought processes that affect each person in their own way.

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What is a Co-Occurring Disorder?

A co-occurring disorder is a combination of two or more disorders a person faces simultaneously. For instance, if you are already facing a substance use disorder and you have anxiety, depression, or bipolar disorder, you are suffering from co-occurring disorders. (2)

Co-occurring disorders are greatly emphasized when discussing drug abuse due to one fact: addiction, withdrawal, detox, and recovery are all closely related to co-occurring disorders in nearly every situation. 

For example, someone suffering from anxiety might be compelled to self-medicate, leading to substance misuse. Now, they have a co-occurring disorder of anxiety and substance use disorder.

Anxiety may be the root cause of the substance use disorder, but now, a complex treatment plan will be required to ensure one does not worsen the other.

For someone who has anxiety and substance use disorder, quitting a substance could worsen their anxiety. Even for people who don’t suffer from anxiety, the withdrawal and detoxification process often induces anxiety, at least in the short term.

That’s why co-occurring disorders should shape your treatment plan. (3)

Beyond anxiety, other co-occurring disorders that will impact how you detox and recover from substance use include depression, schizophrenia, bipolar disorder, and more. In short, any mental illness deserves careful attention for someone pursuing drug recovery.

Symptoms & Treatment

Co-occurring disorders are defined as any combination of mental health conditions that a person is experiencing at the same time. In the world of drug addiction treatment, co-occurring disorders may be worsened by the withdrawal and detoxification process, and they may also put a person at a higher risk of relapse. (4)

The signs indicative of co-occurring disorders often blend characteristics from each condition, making diagnosis complex.

Common indicators include:

  • Persistent Mood Swings: Fluctuations that seem excessive, even for known mood disorders, could signal underlying issues.
  • Increased Substance Use: Escalating reliance on substances in someone with a diagnosed mental health issue may indicate an attempt to self-medicate additional undiagnosed problems. (5)
  • Social Withdrawal: A pronounced retreat from social activities or relationships often characterizes overlapping psychological challenges.
  • Changes in Cognitive Functioning: Difficulties concentrating and remembering tasks not previously characteristic of an individual suggest something deeper between conditions.

Specialized programs offer comprehensive care designed to tackle both addiction and mental health issues together rather than treating them separately.

  • Medication Management: A careful evaluation is necessary to prescribe medication effectively, considering how different drugs might interact and impact multiple conditions.
  • Behavioral Therapies: Techniques such as cognitive behavioral therapy (CBT) are effective for various disorders by helping individuals develop coping strategies and modify negative thought patterns and behaviors. (6)
  • Support Systems: Establishing support networks, including family therapy and peer groups, is necessary for long-term recovery success. These include shared experiences and encouragement within safe environments.
  • Holistic Practices: Incorporating mindfulness meditation, yoga, and nutrition into treatment plans helps to fight relapse.

Navigating symptoms and treatments requires patience and perseverance from healthcare providers and patients alike. With the right combination of therapies and support, achieving balance and recovery is possible.

The Role of Co-Occurring Disorders in Treatment

Whenever someone is admitted to a facility for substance use disorders, the first thing they should be asked is whether they have any other mental or behavioral health concerns. If you enter a facility and a provider does not ask you this question to inform your treatment program, you should seek out experienced clinicians who can adjust your plan accordingly. (7)

Without knowing about co-occurring disorders, no practitioner can deliver integrated treatment that prioritizes your mental, emotional, and physical health. What’s more, without knowledge of co-occurring disorders, there will likely be risk factors they did not consider, including long-term implications if the detox process is not approached correctly.

To ensure substance abuse treatment is successful and reduces the chance of relapse, you should tell your treatment provider of any disorders you have or think you may have.

Whether or not you’ve been officially diagnosed, inform your provider about symptoms of any mental health issues you’re currently experiencing or have experienced over the past few years.

These include:

  • Depressive disorder
  • Generalized anxiety disorder
  • Eating disorders
  • Mood disorders 

How Are Co-Occurring Disorders Addressed?

You will accomplish two things by making your treatment team aware of co-occurring disorders. First, they will take any associated risk factors into account to make sure that the drug detoxification and drug recovery process go as smoothly as possible, reducing discomfort and lowering your risk of relapse. (8)

However, treatment facilities don’t just aim to “work around” your co-occurring disorders as they treat your drug or alcohol addiction. Rather, they aim to treat your co-occurring disorders simultaneously, starting with your substance use disorder and also addressing any other medical conditions.

Treatment for co-occurring disorders may consist of a range of interventions, as people with co-occurring disorders often need additional support. For instance, if certain environmental factors are a trigger for one of your disorders, hospitalization in an inpatient treatment facility may be advisable.

Ultimately, what dual diagnosis treatment looks like varies from one individual to the next. What’s most important to remember is that a substance use problem or alcohol use disorder are very real mental health conditions and are worthy of the utmost care.

What Are the Dangers of Co-Occurring Disorders?

If you have a co-occurring disorder, it will be front-and-center in the recovery process from the moment you enter detox. If you have certain conditions that would amplify the typical effects of withdrawal or put you at risk of worsened or long-term changes to your health, your provider will likely suggest a medical detox. (9)

While the drug detoxification process is a natural and unavoidable part of recovery, a medical detox will utilize various proven medications and therapies to ease the discomfort.

For instance, the detox process often results in:

  • Intense craving
  • Mood swings
  • Anxiety

Those with a pre-diagnosed anxiety disorder may suffer greatly if their detox is not supported in other ways. Those with a condition like post-traumatic stress disorder may find that the detox isn’t just more uncomfortable, but their condition worsens in the long term, especially when common feelings like helplessness are triggered.

Failing to accommodate for co-occurring disorders during the detoxification process can lead to long-term health implications, not to mention a higher chance of relapse if a person is trying to detox on their own without medical supervision. Additionally, co-occurring disorders will continue to be addressed long after detox. (10)

Throughout the recovery process, your team should be working with you to understand how your co-occurring disorders are impacting you and perhaps worsening your symptoms.

Even those with no history of schizophrenia may experience psychosis when recovering from a severe addiction to a substance like opioids. It is paramount that their team anticipates these common side effects and finds ways to mitigate them.

What Are the Treatment Options for Dual Diagnosis?

If you have a dual diagnosis of substance use disorder and any other disorder, you have a number of treatment options available. Generally, you’ll begin by finding a facility that specializes in substance use disorder.

Based on the severity of your other conditions, you’ll need to compare the types of treatment you will receive at different treatment centers. (11)

Here’s a brief overview of how your care may be approached if you have a co-occurring disorder:

  • Inpatient programs like hospitalization are most commonly recommended for those seeking substance use disorder treatment when they are also experiencing other disorders. These programs offer more acute, short-term treatment before transitioning into one of the lower levels of care listed below.
  • Residential facilities are also considered inpatient, but not in a hospital environment. Residential facilities consist of living in a home-like environment with others who are recovering from drug use. Not all residential facilities have the specialized support staff you may need to address your dual diagnosis, so you must ask. (12)
  • Partial hospitalization programs are offered as a step down from the inpatient level of care. They are designed to maintain structure and continue the recovery process in a safe environment. Residing in housing provided by the treatment center or at home, patients attend group therapy 5-6 days per week.
  • Intensive outpatient programs provide more flexibility than the above options because they allow you to continue living at home. However, these programs are only effective if you have a safe home environment and a strong support network. You’ll also need to be able to attend multiple appointments each week for group, solo, and/or family therapy and visits with specialists.
  • Outpatient programs are the least intensive of all treatment paths, and they are not safe or effective for those dealing with serious mental illness. An outpatient program may be loosely structured, so while more flexible, it requires a major commitment on the part of the patient. Generally, this type of treatment is most common for adolescents living at home with a supportive family. (13)

Medication Treatment Options for Dual Diagnosis

Medication treatments for people with a dual diagnosis—those who are dealing with both mental health diseases and substance use problems—are carefully designed to deal with the complicated way that their symptoms interact with each other. This level of accuracy in managing medications is very important because it helps people stay healthy and lessens the chance of making either condition worse.

  1. Psychiatric Medications: For underlying mental health conditions such as depression, anxiety, or bipolar disorder, antidepressants (SSRIs, SNRIs), mood stabilizers, and antipsychotics are commonly prescribed. These medications aim to balance neurotransmitter levels in the brain, alleviating symptoms contributing to distress and potentially reducing reliance on substances. (14)
  2. Substance Use Disorder Medications: In parallel, specific treatments targeting addiction are a crucial element of the recovery process. Options include buprenorphine and methadone for opioid dependencies, naltrexone for alcohol, opioids, and nicotine replacement therapies for smoking cessation. Each is designed to lessen cravings and withdrawal effects, supporting a smoother transition towards sobriety.
  3. Non-Stimulant ADHD Treatments: For those with co-occurring ADHD and stimulant misuse concerns, non-stimulant alternatives like atomoxetine and guanfacine offer symptom relief without a high abuse potential. (15)

Ultimately, a successful approach to dual diagnosis involves a collaborative effort between the patient and healthcare provider, ensuring that any prescribed regimen addresses individual needs and harmonizes with various aspects of their treatment plan.

Behavioral Therapy Treatment Options for Dual Diagnosis

Behavioral therapy is one of the most important parts of treating people with dual diagnoses because it provides a flexible and dynamic way to deal with how drug use disorders and mental health conditions are connected. This method of therapy finds the unhealthy habits and ways of thinking that are causing both problems and gives people useful tools for making changes.

For those navigating the complexities of co-occurring disorders, several forms of behavioral therapy have shown effectiveness:

  1. Cognitive Behavioral Therapy (CBT): CBT is instrumental in treating dual diagnosis by helping patients recognize and alter detrimental cognitive distortions and behaviors that fuel their conditions. Through targeted sessions, individuals learn coping mechanisms for dealing with triggers related to both substance abuse and mental health symptoms, thus reducing the risk of relapse and improving emotional regulation.
  2. Dialectical Behavior Therapy (DBT): Originally developed for borderline personality disorder, DBT has proven valuable for a broader range of applications, including dual diagnosis. Its emphasis on mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation skills is particularly beneficial for managing intense emotions and impulsive actions often seen in individuals with co-occurring disorders. (16)
  3. Motivational Interviewing (MI): MI fosters intrinsic motivation within the client to make positive changes while respecting autonomy. It is especially effective in the early stages of recovery, encouraging clients to move towards readiness to engage in further treatments and embrace healthier lifestyle choices.
  4. Contingency Management (CM): CM utilizes a system of rewards and incentives to promote abstinence and other goal-oriented behaviors. Substance users are rewarded for meeting sobriety milestones and attending regular therapy sessions, reinforcing positive behavior change over time. (17)
  5. Family Therapy: Recognizing the impact of addiction and mental illness on the entire family unit, this modality works to improve communication dynamics among members and create a supportive environment at home conducive to ongoing healing.

Each of these approaches can be tailored to the individual’s specific needs, ensuring a holistic and integrated support group strategy for tackling the challenges of dual diagnosis. A comprehensive care plan incorporating one or more types, medication management, and peer support assists with long-term recovery.

How Dual Diagnosis Treatment Works

There is no one-size-fits-all approach to dual diagnosis treatment. Generally, those with co-occurring disorders will opt for either an inpatient or residential treatment facility, as both options provide 24-hour care from staff who fully understand your conditions and needs. (18)

In either of these programs, you’ll sit down with a specialist who will construct a customized treatment plan that utilizes the various services and practitioners on-site at the facility.

Most often, you will participate in a variety of group, individual, and family therapy sessions. Additionally, you’ll meet with specialists based on your specific conditions.

Cognitive behavioral therapy is almost always utilized in the treatment of a substance use disorder because it is fundamental in changing your behavior and helping you control impulses, overcome your addiction, and avoid relapse.

Based on your needs and preferences, you might also be introduced to:

  • Holistic therapies, such as massage therapy, which can be good for relaxation and pain management
  • Physical therapy, which can improve fitness, self-image, self-respect, and self-confidence
  • Skills training, which can help prepare you to transition into a healthy lifestyle where you are more active in your community

Beyond these general guidelines, your treatment plan could take on any shape. It’s also going to adapt as you progress through your treatment, identifying that some therapies are more valuable to you than others or that one thing you thought you would struggle with, such as increased anxiety, has improved tremendously.

Ultimately, what matters is that you’re working with a team of professionals who check in with you regularly and adapt your treatment plan accordingly to ensure you’re getting the best care at every stage of recovery. Additionally, once you have officially “completed” your treatment plan, they should develop an aftercare program to help you manage your conditions, avoid relapse, and continue working towards your goals.

Take The First Step Toward Treatment

Co-occurring disorders have a complex relationship where one can worsen the other. For anyone seeking help with substance use disorder, it’s crucial to work with a team that will discuss your past and current symptoms, help you receive an official diagnosis for any existing disorders, and give you the best possible treatment based on your unique needs.

Are you ready to take the next step toward dual diagnosis recovery? At Zinnia Health, our caring staff are dedicated to helping individuals overcome their substance use issues and get on the path to learning new coping methods and tools that will allow them to lead the lives they want.

Reach out to Zinnia Health today for more information. Call (855) 430-9439 to speak with our healthcare providers about co-occurring substance use disorders and treatment for co-occurring disorders.


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Ready to get help?
(855) 430-9439
Why call us? Why call us