Co-Occurring Disorders: Information and Treatment Guide

What Is a Dual Diagnosis?

A dual diagnosis refers to the clinical situation in which a person has both an addiction and a mental illness at the same time.³ The term ‘dual diagnosis’ is not as widely used as it once was, with the phrase ‘co-occurring disorders’ becoming increasingly common.

Comorbidity is another term used to talk about addiction and mental health disorders. Like co-occurring disorders, it means two conditions present at the same time in the same person.³ However, the concept of comorbidity emphasizes the potentially adverse interaction of the two conditions.³ For example, addiction to certain drugs can cause or worsen existing mental health issues and, conversely, a mental illness may worsen the course of an addiction.

Mental Disorders That Co-Occur With Substance Abuse

Any mental illness can co-occur with drug or alcohol abuse, but certain mental health disorders co-occur at higher rates.

Mood and anxiety disorders are especially common among people with addictions.^4,5 People with mood and anxiety disorders are 2x as likely to have a substance use disorder compared to people without these disorders.⁵

Are Developmental Disorders Considered Mental Disorders?

Developmental disorders begin in early childhood.² They can affect a child’s emotional state, physical growth, and intellectual abilities.² Some developmental disorders, like autism spectrum disorder, are also diagnosed as a mental disorder.² When we talk about co-occurring disorders, however, we are not generally talking about developmental disorders.

Why Substance Use and Other Mental Disorders Co-Occur

Substance use and mental health disorders may co-occur for several reasons. First, many of the same risk factors contribute to both conditions.³ People with these specific risk factors have higher chances of developing co-occurring disorders. For example, trauma is one experience that significantly increases the risk of developing mental health issues, such as post-traumatic stress disorder (PTSD) and addiction.³

Second, having a mental health disorder can lead people to self-medicate, which involves using drugs or alcohol to cope with their symptoms.^3,4 Some people may also turn to substances to ease the side effects of their psychiatric medications.³

People with mental health disorders may also experience changes in brain activity that can enhance the rewarding effects of drugs and reduce the awareness of negative consequences, making eventual addiction development more likely.³

Lastly, in some cases, addiction can lead to the development of mental health issues. Substance use can bring on changes to brain structure and function that may be similarly involved in the development of certain mental health disorders, like anxiety, depression, bipolar disorder, and schizophrenia.³ When these changes arise, a person may be more at risk of developing a mental health disorder.

Common Co-Occurring Disorders

The clinical presentation of different co-occurring disorders will vary. The following is a short list of some of common mental illnesses (and their main symptoms) that may occur alongside addiction.

Depression

Depression involves experiencing either depressed mood or loss of interest or pleasure, as well as some or all of the following symptoms at least over the course of a 2-week timeframe:²

• Depressed mood most of the day, nearly every day
• Significant weight loss/gain that is not attributed to changes in diet
• Insomnia/hypersomnia
• Fatigue nearly every day
• Feelings of worthlessness and guilt
• Difficulty thinking and concentrating
• Thoughts of suicide

Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder, or GAD, is marked by excessive worry that occurs for most days than not over a period of at least 6 months.² Symptoms of this specific disorder include, but are not limited to, the following:²

• Restlessness or being on edge
• Muscle tension
• Being easily fatigued
• Irritability
• Difficulty falling or staying asleep
• Problems concentrating

Attention-Deficit/Hyperactivity Disorder (ADHD)

ADHD is defined as a persistent pattern of hyperactivity, impulsivity, and difficulty holding attention.² People with this condition may find that their symptoms interfere with their functioning and developments and can include the following:²

• Makes careless mistakes
• Difficulty maintaining attention
• Fails to finish school work or other responsibilities
• Forgetfulness
• Fidgets frequently
• Runs or climbs when inappropriate
• Difficulty playing games quietly
• Being seemingly “driven by a motor”
• Often intrudes or interrupts others

Bipolar I Disorder

Bipolar I disorder is a mood disorder that includes severe highs and lows, known as manic and depressive episodes.² During manic episodes, symptoms can include the following:²

• Inflated self-esteem
• Decreased need for sleep
• Flight of ideas
• Excessive talkativeness
• Easily distracted
• Participation in activities with high risk, such as shopping sprees and poor sexual decisions

Depressive episodes can be marked by the following symptoms:²

• Depressed mood most of the day, nearly every day
• Diminished interest in previously enjoyed activities
• Significant weight loss or gain that is not attributed to diet
• Psychomotor agitation
• Problems concentrating
• Thoughts of suicide

Borderline Personality Disorder (BPD)

Personality disorders are long-standing patterns of thinking, feeling, and behaving that affect a person’s life and relationships.² People with BPD may experience symptoms that include the following:

• Frantic efforts to avoid abandonment
• Dissociation
• Feelings of emptiness
• Impulsivity regarding potentially self-damaging situations
• Mood reactivity
• Having unstable interpersonal relationships
• Unstable sense of self-image

Obsessive-Compulsive Disorder (OCD)

OCD is a type of anxiety disorder that involves obsessions and compulsions.²  Symptoms of this mental health condition can include the following:²

• Recurrent thoughts, urges, or images that are intrusive or unwanted
• Repetitive behaviors that an individual feels driven to perform and all rules surrounding the behaviors must be done perfectly
• Obsessions and compulsions consume a great deal of time or cause significant distress or impairment

Post-traumatic Stress Disorder (PTSD)

PTSD can develop after a person goes through a traumatic event or sees another person experience a traumatic event.² Symptoms of PTSD often include the following:²

• Avoidance tactics in an effort to avoid upsetting memories about the event
• Intrusive memories of traumatic events
• Nightmares
• Flashbacks
• Feelings of detachment from others
• Persistent inability to experience positive emotions

Schizophrenia

Schizophrenia is a serious mental illness that negatively affects people’s ability to care for themselves, keep up with their responsibilities, and have stable relationships.² People with schizophrenia may experience symptoms that include the following:²

• Delusions
• Hallucinations
• Disorganized speech
• Disorganized behavior
• Difficulty showing emotional expression

Risks Factors for Addiction and Co-Occurring Disorders

Certain factors or experiences can increase the risk of developing a substance use disorder and/or another mental health disorder:³

• Genetics. Research suggests that somewhere around 40–60% percent of a person’s risk of developing addictions is attributable to genetic factors. Genetics can differentially affect how a person reacts to substances, how the body metabolizes certain drugs, and how an individual copes with stress.
• Trauma. People who have had traumatic experiences may develop post-traumatic stress disorder and turn to drugs and alcohol to self-medicate certain symptoms such as anxiety.
• Chronic stress. High levels of stress can affect activity in areas of the brain that are involved in controlling impulses and behavior. Stress may also disrupt normal dopamine signaling in the brain in a way that makes drugs feel more rewarding or pleasurable.
• Certain drugs of abuse. People using or withdrawing from certain drugs, such as cocaine, methamphetamine, and marijuana, may experience side effects, like depression, anxiety, or psychosis.⁵ Using these drugs can also worsen an existing mental health condition.
• Early drug use. Beginning to use drugs or alcohol as an adolescent increases the risk of developing both substance use disorders as well as mental illness.

Why Co-Occurring Disorders Require Specialized Treatment

People with co-occurring disorders can benefit from specialized treatment that addresses both issues at the same time. Integrative treatment is more effective than treating each condition alone.³ Studies have shown that treating only one condition can increase the risk of future relapses.⁴ Getting specialized treatment can ensure that you are getting the comprehensive help that you need to fully recover.

To find out whether a facility treats both conditions, ask their admissions team whether they provide treatment for co-occurring disorders. You can explain that you suffer from a mental illness and want to be sure that you receive treatment for both conditions.

The Dangers of Self-Medication

Self-medication is the act of using drugs or alcohol to cope with negative emotions or troubling symptoms.^3,4 Drugs and alcohol can cause feelings of euphoria and relaxation, which people may seek out in an attempt to temporarily “numb” their emotions.

Even though self-medication can make a person feel better temporarily, it can cause more problems in the long run.⁴ People who self-medicate are more likely to develop a substance use disorder.^3,4

Get Help for Mental Health and Drug Abuse Issues

Getting help for mental health and drug abuse issues at the same time can result in better treatment outcomes than treatment for only one condition.³ Laguna Treatment Center is one facility that provides comprehensive treatment for co-occurring disorders. They offer several different options to meet your needs:

• Medical detoxification. Laguna Treatment Center is Orange County’s first chemical dependency recovery hospital. We offer medically supervised detoxification and, as needed, may utilize medications to manage withdrawal from opioids, alcohol, benzodiazepines, and other drugs of abuse.
• Residential treatment. Laguna provides a temporary live-in treatment option where people can focus on their recovery away from the demands of daily life. During a stay, residents can participate in group and individual therapy sessions, 12-step meetings, and other therapeutic activities, like yoga and meditation.
• Partial Hospitalization Program (PHP). Once a person has completed residential treatment, there is the option to transition to PHP, which offers treatment for 5 hours a day, 6 days per week. This option allows you to continue working on your recovery in a structured environment with the opportunity to slowly integrate back into your daily life.

Laguna Treatment Center specializes in treating co-occurring disorders. Call now to learn more about how we can help.