Terms used in addiction treatment programs can sometimes be a little tricky to understand, and at times, the terms are imprecise enough that they seem to cause confusion. For example, the term “co-occurring disorder” applies when a person has more than one condition at the same time. The phrase seems to suggest that one condition is of prime importance, while the other is just along for the ride and might disappear when the primary problem has been addressed. In reality, both conditions are of equal importance, and often, they must be treated at the same time in order for the person to find real and lasting relief.
Delving into Definition
The “co-occurring disorders” term typically applies when a person has a drug addiction issue and an underlying mental illness, and unfortunately, this is remarkably common. For example, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), about 4 percent of all adults have a co-occurring disorder along with a substance abuse issue. As a result, it’s remarkably common for people to believe that this term applies only to a single mental health issue that exists in tandem with an addiction issue. In reality, the truth is much more complicated. For example, some people with co-occurring disorders have multiple mental health issues all at the same time. A person might have anxiety and anorexia alongside an addiction, for example, or a person might have depression and bulimia with no addiction at all. The term, when used properly, applies to multiple conditions impacting a person at the same time, and it’s not limited to just one pairing or just addiction. Even a physical impairment could qualify as a co-occurring disorder, and according to SAMHSA, 68 percent of adults with a mental illness also have a medical condition.
In Psychology Today, experts suggest that a proper co-occurring disorder diagnosis takes place when the multiple conditions can be established independently. People who abuse psychedelic drugs, for example, can become paranoid and suspicious while under the influence, and when they’re intoxicated, they can seem as though they might have a mental illness. When these same people are sober, however, those symptoms of illness seem to fade away. For this reason, it’s not unusual for mental health experts to avoid providing a firm diagnosis of a co-occurring disorder until the person has moved through the detoxification process. At this point, addictive drugs aren’t clouding the picture and it’s easier for experts to see what’s really going on. Even when the person is sober, however, it can be difficult to determine how the problems came together inside the same person. In fact, the prompts can differ dramatically from person to person.
Mental Illness Caused by Addiction
Drug abuse and addiction have been linked to a variety of mental health conditions, including:
- Suicidal thoughts
In some cases, the addiction causes a form of brain damage that could lead to disordered thinking. For example, the National Institute on Alcohol Abuse and Alcoholism reports that alcohol tends to target systems deep in the brain that regulate stress responses. When these systems aren’t working as they should, a person might feel intense anxiety almost all the time, and that could merit a diagnosis of an anxiety disorder. The mental illness, in this case, is caused by the addiction.
Similarly, the National Institute on Drug Abuse reports that marijuana use has been linked to the development of schizophrenia in some people. Studies suggest that people like this have a genetic propensity to develop schizophrenia, but when they’re exposed to marijuana, they have a little trigger that can allow the mental illness to grow and blossom. It’s possible that these people would have never developed full-blown schizophrenia without the introduction of marijuana, suggesting that the drug use leads to the mental illness.
Examples like this demonstrate how chemical changes caused by addiction can lead to brain dysfunction, and therefore, mental illness. The more intense the level of damage, the more likely the mental illness might be. Unfortunately, when the addiction issue is addressed and gone, the damage left behind might remain, as might the mental illness. Just because the addiction came first doesn’t mean that the addiction is the only thing that must be treated. Once a mental illness is in play, it must also be treated and respected so the person can truly heal.
Addiction Caused by Mental Illness
In some cases, the mental illness can lead to addiction issues. For example, the Treatment Episode Data Set from 2010 found that 31.6 percent of college students with co-occurring mental illnesses and addictions focused on prescription drugs as their substances of choice. In some cases, these students were prescribed drugs to help them deal with their conditions and they then began abusing their drugs. In other cases, these students may have turned to drugs to help them cope with their symptoms. For example, people with anxiety disorders may feel tense and alert almost all of the time.
If people like this could access benzodiazepine drugs, they could soothe their distress and ease their minds, but they might also feel a little addictive boost of euphoria, and an addiction could blossom. The mental illness came first here, but the addiction it causes could be quite strong.
In other situations, living with a mental illness can be so depressing and so overwhelming that the substance abuse seems like a reasonable solution to ease pain and suffering. For example, people with bulimia may feel ashamed of their behaviors, and they may feel unable to talk to anyone about their thoughts and their concerns. If these people drink socially, however, they may feel more relaxed and at ease, and if they vomit after a binge on drinking, that purging is socially accepted. They could feel a sense of belonging that’s been denied to them due to their mental illnesses, but an addiction to alcohol could quickly follow.
Addictions can also make mental illness symptoms more striking and severe. For example, the National Alliance on Mental Illness reports that people with depression can sometimes become suicidal when they’re intoxicated with a depressant like alcohol. Similarly, people with schizophrenia can develop severe and persistent symptoms of psychosis when they’re under the influence of marijuana, even if their condition had been under control before they began the addiction process. The chemicals inside the drugs play on the same damaged receptors inside the brain, and the addiction and the mental illness play off of one another in a perfect storm that leads to misery in the impacted person.
Physical Problems at Play
People who abuse drugs can develop a variety of ailments, including:
- Infections at the injection site, if the person uses needles for drugs
- Chronic constipation due to opiate drugs
- Nasal bleeding, if the person snorts drugs
- Heart palpitations
Similarly, mental illnesses can cause people to eat too much or too little, and in some cases, people with mental illnesses develop specific phobias about foods and this makes any kind of mealtime difficult and fraught.
These physical problems are also vital to address, as they could lead to intense feelings of sadness and loss, and the pain a physical problem can cause can lead people back into an addiction or make an underlying mental illness much worse.
Growing Stronger With Time
If left in place, co-occurring disorders tend to strengthen one another. The cycling of intoxication and sobriety can make mental illness cycling much worse, for example, or the isolation caused by one type of stigmatized mental illness can make a case of depression all the more intense. It’s clear that multiple issues seem to cause increasing amounts of pain, and these problems are difficult for people to overcome on their own without help. Unfortunately, SAMHSA reports that only about 7.4 percent of people with co-occurring disorders of mental illness and substance abuse get help for both conditions. In fact, about 55.8 percent of these people get no treatment at all, SAMHSA reports. That’s a shame, as treatment really can make a big difference in the lives of people who are impacted in this way.
A co-occurring disorders treatment program provides therapies for all of the conditions that impact the person, and the therapies are interwoven so the person gets care for all of the problems concurrently. Care like this is deeply personalized, as not everyone has the same conditions in the same ratios, and the treatment can bring about big results. At Futures of Palm Beach, for example, we provide care for people who have both eating disorders and addiction issues, and at times, our clients also have depression, anxiety disorders and more. We provide all of our clients with a thorough screening when they come to us, so we know just what kind of help they might need, and our clients report that they learn so much with us and experience a deep transformation as a result of our care. If you’d like to know more about our approach, please call us.