What Are Co-Occurring Disorders?
Addiction to drugs or alcohol, also known as “substance use disorder,” is a long-lasting and often recurring medical condition that’s characterized by compulsive use of substances despite devastating consequences.1 But sometimes addiction is just one of multiple mental health issues a person is struggling with at once, which can make diagnosis and treatment even more complex.
In this article, we’ll discuss co-occurring disorders, their risks and association with addiction, and how to get help if you or someone you love is struggling with substance abuse alongside another mental health disorder.
What Are Co-Occurring Disorders?
When more than one illness occurs in an individual each is said to “co-occur” with the other, implying an interaction between the illnesses that may make one or both worse.2 For example, someone with a history of injecting heroin might have a co-occurring illness like HIV or hepatitis C.
When another mental health condition exists alongside a substance use disorder, it is considered a “co-occurring disorder.” This is actually quite common; in 2020, an estimated 17 million adults aged 18 or older had both a mental illness and at least one substance use disorder in the past year, according to the National Survey on Drug Use and Mental Health.3
The American Society of Addiction Medicine defines addiction as a “chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.”4 Interactions between these factors are also involved in other mental health disorders, so it’s not surprising that there’s a high rate of co-occurrence.
Common Co-Occurring Disorders
A handful of mental illnesses are commonly seen or associated with substance abuse. These include:5
- Generalized anxiety disorder.
- Post-traumatic stress disorder (PTSD).
- Bipolar disorder.
- Attention-deficit hyperactivity disorder (ADHD).
- Psychotic illness.
- Borderline personality disorder.
- Intermittent explosive disorder.
Eating disorders (specifically anorexia nervosa, bulimia nervosa, and binge eating disorder) also occur more frequently with substance use disorders vs. the general population, and bulimic behaviors of binge eating, purging, and laxative use are most common.6 In fact, bulimics commonly exhibit multiple drug use disorders and have high rates of alcoholism.7
Co-Occurring Disorders and Substance Abuse: Risk Factors
The high rates of substance abuse and mental illness occurring together doesn’t mean that one caused the other, or vice versa, even if one came first.8 The relationship and interaction between both are complex, and it’s difficult to disentangle the overlapping symptoms of drug addiction and other mental illness.
There are common risk factors that contribute both to the development of a mental illness as well as substance use and addition:8
- Genetic vulnerabilities and epigenetic influences: Genes that influence the action of brain chemicals that carry messages from one neuron to another (i.e., neurotransmitters), such as dopamine and serotonin, can be affected by drugs and commonly dysregulated in mental illness. A person’s environment, such as one that causes chronic stress, or even diet, can interact with genetic vulnerabilities or biological mechanisms that trigger the development of mood disorders or addiction-related behaviors.8
- Brain region involvement: Addictive substances and mental illnesses affect similar areas of the brain and each may alter one or more of the multiple neurotransmitter systems implicated in substance use disorders and other mental health conditions.8
- Stress: Elevated stress levels may lead to decreased behavioral control and impulsivity that may contribute to mental health issues or the development of substance use.8
- Trauma and adverse childhood experiences: Post-traumatic stress from war or physical/emotional abuse during childhood puts a person at higher risk for drug use and makes recovery from a substance use disorder more difficult.8
In some cases, a mental health condition can directly contribute to substance use and addiction. Drugs may temporarily reduce symptoms of a mental illness, but they can also make mental health issues worse. Cocaine, for example, may worsen symptoms of bipolar disorder and contribute to its progression.8
Finally, substance use may contribute to developing a mental illness by affecting parts of the brain disrupted in the same way as other mental disorders, such as anxiety, mood, or impulse control disorders.8
How to Treat Co-Occurring Disorders
Because the presence of one or more mental illnesses alongside a substance use disorder can complicate the diagnostic and treatment process for each condition, the standard of care for treating co-occurring disorders is an integrated treatment model.9 This means physicians, psychiatrists, therapists, counselors, case managers, and other specialists all work together as a team to treat both disorders at the same time, setting the same goals and keeping the treatment plan consistent. Greenhouse offers a specialized treatment program for co-occurring addiction and mental health conditions.
Integrated treatment models usually incorporate a combination of evidence-based psychotherapies, , and treatment medications (as needed).
Common Medications Used for Co-Occurring Disorder Treatment
When a person is suffering from co-occurring mental health conditions, doctors may recommend certain treatment medications to treat or manage both disorders.
Medications commonly used to treat some of the previously mentioned mental health disorders that commonly co-occur with substance use disorder include:10
- Antidepressants are used to treat various anxiety and mood/depressive disorders. SSRIs (selective serotonin reuptake inhibitors) are typically considered first-line treatment for these disorders, due to overall effectiveness, tolerability, and safety. Alternatives include: SNRIs (serotonin and norepinephrine reuptake inhibitors), MAO inhibitors (monoamine oxidase inhibitors), and tricyclic antidepressants. The SSRIs sertraline (Zoloft) and paroxetine (Paxil), in addition to other antidepressants, are also used to treat symptoms of PTSD.
- Antipsychotics may help control symptoms of mania and hypomania in patients with bipolar disorder, and are also used to treat schizophrenia and other psychotic disorders. In certain cases, smoking and other substances can interact with antipsychotic meds and affect their efficacy. Antipsychotics may also be beneficial for certain patients with PTSD who at least partially respond to SSRIs.
- Mood stabilizers, such as lithium, are considered an effective treatment for bipolar disorder.
- Sedatives, tranquilizers, anxiolytics are a class of drug that includes benzodiazepines. They can be useful in treating panic disorders and are sometimes prescribed for other types of anxiety disorders. But they are prescribed with caution to those with substance use disorders because of their high addiction liability.
- Stimulants are often used to treat ADHD, but may be prescribed with caution for someone with a co-occurring stimulant use disorder, due their addiction potential.
These medicines may be used in tandem with certain medications used to treat alcohol and opioid use disorders. These are the only two types of substance use disorders with FDA-approved medication available.
When prescribing treatment medications, doctors will consider potential toxic interactions between medications and alcohol or illicit drugs (in case of relapse) and typically recommend the agent with the least potential for misuse.10
Medications alone can help reduce symptoms of mental health disorders and may help reduce cravings and the chance of relapse for certain substances, but it is through therapy that individuals can make the most tangible strides toward sobriety and restoring a sense of balance and stable mental health to their lives.
Popular Psychotherapy Treatments for Dual Diagnosis
Integrated treatment for a dual diagnosis, or co-occurring mental health and substance use disorder, has a strong focus on psychotherapy, using various approaches and techniques to address the thought patterns and behaviors that underlie substance misuse. They also work to enhance a person’s motivation to change and can help provide social structure and support.
Some addiction treatment therapies for co-occurring substance use disorder and mental health disorders are:10
- Cognitive behavioral therapy (CBT) is the dominant therapy used to treat substance use disorders. CBT boosts interpersonal and coping skills, as well as approaches that help maintain motivation and support a functional recovery.11 In addition to addiction, CBT is one of the most common and effective evidence-based therapies used to treat anxiety, depression, ADHD, and PTSD.
- Contingency management has proven helpful when treating schizophrenia and ADHD, and is increasingly being used to treat stimulant use disorders.12 This approach incorporates encouragement and other “rewards” for small steps in reducing substance use.
- Dialectical behavioral therapy for substance use (DBT-S) is a therapeutic approach that uses cognitive behavioral therapy strategies in a way that’s specifically designed to promote abstinence for those with co-occurring borderline personality disorder and substance use disorder.
- Integrated group therapy is a group-based behavioral approach specifically used to treat people with co-occurring bipolar and substance use disorders. It addresses the unique interrelationships between bipolar disorder and SUD, and encourages participants to view their conditions as a single disorder (“bipolar substance misuse”).
- Motivational enhancement therapy and motivational interviewing help people resolve their ambivalence about substance use, in order to increase motivation or commitment to change. These techniques can also be helpful in the treatment of schizophrenia and personality disorders.
- 12-Step Facilitation evolved out of traditional addiction groups like Alcohol Anonymous (AA). In addition to addiction, they have also been shown to be effective in treating anxiety and depression (when these conditions co-occur with substance abuse).
How to Get Help for a Mental Health Disorder and Addiction
To get help for co-occurring mental illness and addiction, it’s important to find a professional treatment facility that is equipped to handle dual diagnosis cases.
At our inpatient addiction treatment facility in Grand Prairie, Texas, we specialize in the treatment of co-occurring disorders.
Paying for Co-Occurring Disorder Treatment
Our rehab facility in the Dallas-Fort Worth area offers various ways to pay for co-occurring disorder treatment, including different financing and insurance options.
For more information on using insurance to cover the cost of rehab, contact one of our admissions navigators at . They are available around the clock to answer any questions and discuss next steps.
Or you can check whether we accept your health insurance plan and confirm your benefits by filling out this quick and confidential .