To be well, be well informed.
- What does "co-occurring disorders" mean?
- How many people are affected with co-occurring disorders?
- How do I know if I have co-occurring disorders?
- How does a person develop co-occurring disorders?
- Which mental illnesses are likely to occur with substance abuse?
- If I have a mental health AND a substance use disorder, which gets treated first?
- But, if I get treatment for one of the disorders, won't the other one just go away?
- I've been told that because I'm addicted, I can't take any mood altering drugs. What about medications for my mental health problem?
- How do I find help for myself or a significant other?
- What does "co-occurring disorders" mean?
The term "co-occurring disorders" refers to mental disorders that are independent of
substance use but that occur in an individual with a substance use disorder. In other words, a person with co-occurring disorders has at least one mental health problem and one substance use problem.
Other terms that describe co-occurring mental health and substance use disorders include "dual disorders," Mentally Ill Chemically Addicted (MICA), Mentally Ill Substance Abuser (MISA), Chemical Abuse and Mental Illness (CAMI), and Substance Abusing Mentally Ill (SAMI). Instead of this alphabet soup of terminology, we prefer to describe problems with substances and mental health as "co-occurring disorders" because it is less stigmatizing and because the term "dually diagnosed" implies that there are only two disorders present.
Many of those with co-occurring disorders have more than one mental illness and more than one substance use issue resulting in multiple life problems. The mental health problems in those with co-occurring disorders range from mild depression or anxiety to severe and persistent mental illnesses such as schizophrenia or bipolar disorder. The substance use problems may range from abuse of alcohol or marijuana to dependence on intravenous drugs such as heroin or methamphetamine.
- How many people are affected with co-occurring disorders?
The best estimate is that more than 10 million persons in the United States alone have co-occurring mental health and substance use disorders. About 3 million people with co-occurring disorders have at least three disorders, and about one million people with co-occurring disorders have four or more disorders.
- How do I know if I have co-occurring disorders?
Only a mental health professional (such as a psychiatrist, psychologist, licensed mental health counselor, or a licensed social worker) and/or substance use counselor can diagnose co-occurring disorders.
A professional will ask many questions about your substance use and mental health history and may want to monitor you over a period of time in order to make a correct diagnosis. There are many resources on the internet that can help you to determine whether you may have substance use or mental health problem.
- How does a person develop co-occurring disorders?
There are many ways in which co-occurring disorders develop. The majority of persons with co-occurring disorders report that the symptoms of mental illness began first, and that they used alcohol or other drugs to cope with the symptoms (often known as self-medication). For example, if a person feels depressed, he or she may find that a couple of drinks or a little cocaine makes the depression lift, at least for a while.
When the buzz or the high wears off, however, the person will probably feel worse. The solution may be to drink or use more. The more the person drinks or uses, the worse he or she feels, and the cycle of co-occurring disorders begins.
The cycle becomes more enduring as the individual begins to experience other consequences of substance use such as family discord, employment problems, legal problems, or financial difficulties.
It is interesting to note that for those who have co-occurring disorders, the median age of onset for the mental health disorder is age eleven, while the median age of onset for the substance use disorder is age twenty-one.
The cycle does not have to begin with symptoms of mental illness. For some individuals with co-occurring disorders, the cycle begins with substance use. The substance(s) may trigger a genetic predisposition to a mental illness, or the consequences of substance use may generate depression or anxiety.
Finally, it is possible that the mental health and substance use problems develop independently of each other.
No matter how the co-occurring disorders developed, the symptoms of the disorders interact, typically resulting in increased symptoms of both or all disorders.
- Which mental illnesses are likely to occur with substance abuse?
Any mental illness can co-occur with any substance use disorder. Statistics have shown, however, that those individuals with certain mental health disorders are more likely to also have a substance use problem. Studies have estimated the liklihood of having a substance use disorder for the following mental disorders:
85-90% of those with Post-traumatic Stress Disorder also have a substance use disorder.
About 82% of those with Antisocial Personality Disorder abuse substances.
Around 71% of persons with Bipolar Disorder use substances
About 50% of those with Schizophrenia also use substances.
Adolescents who have Conduct Disorder, Oppositional Defiant Disorder, or Attention Deficit Disorder are up to seven times more likely to have a substance use disorder than those without these disorders.
Adolescents with depression are four times as likely to use substances
Adolescents with anxiety are twice as likely to use substances compared to adolescents without depression or anxiety.
- If I have a mental health AND a substance use disorder, which gets treated first?
Neither….or both. Treatment for mental health and substance use issues for those with co-occurring disorders should happen AT THE SAME TIME. This simultaneous treatment is referred to as integrated treatment. Truly integrated treatment involves treating both (or all) disorders as if they were components of one disorder, just as they are components of one person. Integrated treatment focuses on the interaction between or among the disorders.
Co-occurring disorders have been treated in the past in either a sequential or a parallel manner. Sequential treatment means that the individual received either mental health or substance use treatment first, followed by treatment for the other issue. Parallel treatment means that the mental health and substance use disorders were treated at the same time, but separately. There were many problems with sequential and parallel treatment including the individual receiving mixed messages from different treatment providers and being left to figure out for him or herself what to do.
- But, if I get treatment for one of the disorders, won't the other one just go away?
No. You need treatment for both (or all) of the disorders, and at the same time. Here's an example: let's say you are depressed and you use cocaine as a way (but not a good one) to cope with the depression. It's likely that you have become addicted to cocaine. If you stop using cocaine, the depression won't go away because it was there in the beginning. If you tried to get treatment for the depression, but continued to use, you'd likely not learn any new coping skills for the depression – why would you, your old coping skill is probably still working, and working much more quickly than any new coping skills or any medication would work. So in the end, you'd still be depressed and still be addicted.
Here's another example: say you've been drinking for years now, and the drinking has caused chemical changes in your brain, has caused legal and financial trouble, and led to a divorce. These events have caused you a great amount of anxiety and you find you're having panic attacks quite often. Quitting the drinking is a great start, but sobriety probably won't get your spouse back or make you a lot of money quickly. You'll still be anxious and need treatment for the anxiety. If you quit drinking first but still have panic attacks, how long do you think you'll stay sober? Probably not for long; you'll likely go back to drinking because of the discomfort of the panic disorder.
The bottom line is that if you have co-occurring disorders, you need treatment that addresses ALL of your issues simultaneously, or your chances of recovery are greatly reduced.
- I've been told that because I'm addicted, I can't take any mood altering drugs. What about medications for my mental health problem?
The idea that addicted persons cannot take psychiatric medications because they won't really be clean and sober is false and dangerous. There is a big difference between alcohol and street drugs and medications that are prescribed by a psychiatrist. It is typically not recommended that persons with co-occurring disorders or with substance use disorders take potentially addictive medications such as benzodiazapines or opiates (although that decision needs to be made on an individual basis), but most psychiatric medication is not addictive; taking it will not jeopardize your sobriety. In fact, taking the medication may help you remain free from alcohol and other drugs.
Think of it this way – if you are addicted to methamphetamine, and have schizophrenia which makes you hear voices, are you better off continuing to hear those voices or better off taking an antipsychotic medication and not hearing the voices? Which option would more likely lead to relapse with methamphetamine?
If you find yourself being pressured to stop taking your psychiatric medication because someone thinks you're not clean and sober while taking it, provide that person with some education about the medication (you can get pamphlets and other information from your doctor). If that person or persons continue to pressure you, consider whether he or she really is a supportive person in your overall recovery.
You might also want to read some of Dr. Ken Minkoff's ideas about medication management for those with co-occurring disorders.
- How do I find help for myself or a significant other?
There are many ways to find help. A good place to start may be at www.findtreatment.samhsa.gov. This web site provides descriptions of substance use treatment programs in the United States; the description will indicate whether the program provides treatment for persons with co-occurring disorders.
You can also check your local telephone book for mental health and/or substance use treatment programs and inquire about treatment for co-occurring disorders, or call your state's Health and Human Services for a referral.
