Addiction can wreak havoc on every aspect of your life, but imagine how much more destructive this disease can be when it’s accompanied by mental illness. Substance abuse combined with a psychiatric disorder is known as a dual diagnosis, or co-occurring disorders. Mental illness can make the course of addiction worse, increasing the likelihood of injury, incarceration, hospitalization, overdose or suicide. By the same token, a co-occurring psychiatric disorder makes the process of recovering from addiction all the more challenging.
The dual diagnosis treatment philosophy holds that rehab services should be fully integrated with psychiatric care to give the client the very best shot at success. Understanding co-occurring disorders and recognizing their symptoms can help you take that first step toward healing.
Are Co-Occurring Disorders Common?
Co-occurring mental illness and addiction is not uncommon. In fact, statistics consistently show that co-occurring disorders are the rule rather than the exception. The National Institutes of Health estimates that up to 60 percent of Americans with a substance use disorder also suffer from mental illness. The Division of Pharmacologic Therapies, a department of the Substance Abuse and Mental Health Services Administration, states that as many as 10 million individuals in the US meet the criteria for at least one mental health disorder as well as a substance use disorder. Some of the most common psychiatric conditions seen in people addicted to drugs or alcohol include:
A debilitating psychological condition characterized by symptoms like sadness, hopelessness, despair, isolative behavior, appetite changes, and suicidal thoughts almost daily for at least two weeks.
A mood disorder marked by extreme fluctuations in emotional states and energy levels. The two predominant states are mania, a cycle of excessive activity and impulsive behavior, and depression, a period of reduced energy and low mood.
A series of disorders that includes generalized anxiety, social phobia, obsessive-compulsive disorder, post-traumatic stress disorder, and panic disorder, among others. Anxiety disorders are distinguished by unrealistic, compulsive fears and worries, combined with avoidance of stressful situations and physical symptoms of extreme stress.
Attention Deficit Hyperactivity Disorder (ADHD)
A neurobehavioral disorder marked by poor attention span, excessive activity, restlessness, impulsive behavior, and distractibility. ADHD is typically diagnosed in young children, but the condition frequently continues into adolescence and adulthood.
A serious brain disease that affects the individual’s perception of reality, causing episodes of extreme dissociation and psychotic episodes. Schizophrenia can cause hallucinations, delusions, verbal incoherence, abnormal body movements, periods of unresponsiveness (catatonia), and severe paranoia.
A personality disorder is a chronic, rigid pattern of thinking and behavior that interferes with the individual’s ability to lead a normal, satisfying life. Common disorders in this category include borderline personality disorder, antisocial personality disorder, and avoidant personality disorder.
Eating disorders like anorexia nervosa, bulimia, and binge eating disorder are serious forms of psychological illness with a high rate of physical debilitation and mortality. Individuals with these disorders also have a high rate of alcohol and drug abuse.
Causes of Mental Illness and Addiction
When you explore the roots of mental illness and addiction, you’ll find that these conditions arise from many of the same sources. Although the exact reasons for mental illness and substance abuse remain unknown, the two disorders have certain origins in common:
Genetic background. Genetic factors account for up to 60 percent of the risk of developing alcoholism,according to Alcohol Alert, a bulletin published by the National Institute on Alcohol Abuse and Alcoholism. Your genes also play a role in psychiatric disorders like depression, bipolar disorder and anxiety, all of which are seen more often in close relatives.
Socio-environmental issues. Your home environment and the culture you grow up in can affect your chances of developing either a psychiatric disorder or a substance abuse problem. Highly stressful environments or traumatic conditions are likely to cause psychological distress, which increases the risk of substance abuse.
Neurological abnormalities. Brain imaging studies show that addicts, alcoholics and individuals with mental illness have structural abnormalities in the areas of their brains that regulate mood, judgment, decision-making, and other important functions. In addition, the brain chemicals that control emotions, energy levels, sleep and appetite — such as dopamine, serotonin and norepinephrine — are often out of balance in people with co-occurring disorders.
There are a number of risk factors that predispose certain individuals to both addiction and mental illness, notes the Missouri Department of Mental Health. These factors include economic poverty, chronic unemployment, difficult family relationships, childhood abuse, and a personal history of trauma. These stressful life situations increase the risk of isolation and self-destructive behavior — both of which contribute to addiction, depression and anxiety.
Which Comes First?
Why is mental illness so common in people struggling with drug or alcohol abuse? The complex relationship between addiction and mental illness has multiple causes:
- Drugs and alcohol can cause some forms of mental illness.
- Alcohol and drugs are used as a form of self-medication.
- Substance abuse can hide the symptoms of mental illness.
- Psychiatric symptoms can be triggered or aggravated by substance abuse.
- Without a professional psychological evaluation, it is not always possible to determine whether a mental illness precedes a substance use disorder, or vice versa.
Addiction treatment specialists and psychiatric clinicians use professional assessment tools to identify co-occurring disorders. These tests — which are administered at rehab centers or mental health facilities — can be used to determine whether the psychiatric disorder or the substance use disorder came first.
Many of the symptoms of anxiety disorders, mood disorders, and schizophrenia resemble the side effects of drug intoxication and withdrawal. These substance-induced psychiatric symptoms make the diagnostic process more challenging. Some of these intersecting symptoms include:
- Rapid pulse
- Rapid breathing
- Depressed mood
- Mood swings
- Delusional thinking
- Suicidal ideation
Before an individual with co-occurring disorders can be successfully assessed and treated, most therapists recommend a period of detox to clear the mind of chemicals that affect cognition and personality.
Recognizing Co-Occurring Disorders
Recovering from co-occurring disorders requires a great amount of encouragement and a strong, reliable support system. Unfortunately, many people with mental illness and substance abuse problems either go undiagnosed or never get the help they need. Statistics from Psychiatric Services indicate that over 45 percent of adults with a substance use disorder and a serious mental illness, and up to 65 percent of those with a substance use disorder and any form of mental illness, don’t receive any treatment at all.
How can friends and family recognize the symptoms of mental illness or addiction? Here are a few red flags that may point to a co-occurring disorder:
Unusual moods or mood changes. Both substance abuse and psychiatric disorders such as depression or bipolar disorder can cause unusual, intense emotional states. The individual may either become sad, tearful and isolative, or excited, talkative and compulsive. In some cases, moods can alternate without any apparent reason.
Abnormal attitudes or strange perceptions of reality. Personality disorders, psychotic disorders, and certain drugs can alter the way the individual perceives the world. People under the influence of psychoactive drugs may become paranoid, distrustful and violent. Similarly, individuals with antisocial personality disorder, post-traumatic stress disorder, or paranoid schizophrenia can become suspicious and hostile.
Unjustified fears and worries. Anxiety and substance abuse often go hand in hand, and the symptoms of both conditions closely resemble each other. People with anxiety disorders often become restless, agitated, paranoid and unable to focus on daily tasks. Individuals using stimulants or withdrawing from drugs can have many of the same physical and psychological symptoms.
Weight loss or weight gain. Alcohol, stimulants, opioids, cannabis and many other drugs can affect the appetite, causing weight loss or gain. By the same token, depression, anxiety, eating disorders and personality disorders can affect eating behaviors and appetite.
Changes in body image or appearance. Both substance abuse and mental illness can affect an individual’s self-perception, causing changes in the way he or she looks. For instance, depression can cause a loss of interest in grooming or personal hygiene, while obsessive-compulsive disorder or an eating disorder may cause a compulsive preoccupation with one’s body.
Isolation from others. Addiction eventually leads to a detachment from friends and family members as the individual becomes increasingly involved in drugs or alcohol. Depression, agoraphobia, social anxiety disorder, panic disorder and schizophrenia can also create the urge to withdraw from the world.
Moving Forward to Recovery
If you suspect that you or someone you love has a psychiatric disorder, a substance abuse problem or a combination of both, it’s important to get help. Co-occurring disorders can have severe consequences for the individual and his or her loved ones. Depression, anxiety and paranoia can affect motivation, making the individual reluctant to enter rehab. Intervention is often required to help these individuals take the first step toward healing.
Professional treatment programs for co-occurring disorders offer psychiatric treatment and rehab services in the same facility. Care is provided by a single treatment team, and recovery proceeds at the client’s pace. Dual diagnosis treatment specialists are trained and certified in both addiction recovery and mental health, making them uniquely equipped to treat patients with co-occurring disorders. Futures of Palm Beach provides a full range of services for individuals with a dual diagnosis. Starting with a comprehensive psychological assessment, we develop treatment plans that are tailored to the client’s needs.
Founded on 12-step principles, our recovery services include individual psychotherapy, self-help groups, family counseling, behavioral modification training, and alternative therapies. We offer these services in a spa-like setting in Palm Beach County, Florida. The sooner you reach out for help for addiction and mental illness, the sooner you can restore your physical and psychological health. Call us today to learn more about our innovative approach to treating co-occurring disorders.