There are different groupings of mood disorders in the DSM-5, paraphrased as follows:
- Bipolar: This category includes a bipolar episode as well as bipolar disorder (and its different grades). A hallmark of bipolar disorder is that a person experiences episodes of mania and then depression, or the other way around. There are different grades, bipolar disorder being the most severe, depending on various factors, such as the intensity and length of the episodes.
- Depressive: Within this classification, a clinician will find guidance in the DSM-5 on how to diagnose a person with a major depressive episode or major depressive disorder.
- Less severe mood disorders: These include less intense conditions, such as dysthymic disorder (a milder form of major depressive disorder) and cyclothymic disorder (a milder form of manic depression/bipolar disorder). Treatment is advisable.
- Substance-induced mood disorders: In this category, the emergence of the mood disorder is contingent on drug use.
- Additional categories: These include adjustment disorder with depressed mood, major depression due to a health condition such as Parkinson’s disease, and other conditions for which depression is a symptom.
Each of these mood disorders has their own discrete set of symptoms (often referred to as specifiers or criteria). In some instances, a person may develop a mood disorder without any specific episode, such as drug use, being involved. When there is no episode to trigger symptoms of a mood disorder, the cause will typically relate to both genetics and the environment. In other instances, a person may have a specific experience that triggers an underlying and dormant mood disorder, or the episode may cause brain damage (such as due to drug use) that causes a mood disorder to manifest.
When people experience both a substance use disorder and a mood disorder (or any DSM-5-recognized mental health disorder), they are said to have co-occurring disorders and will require treatment that can accommodate this dual diagnosis.
Despite research efforts, when individuals have a mood disorder and a substance use disorder, it is particularly challenging to determine how they are interrelated (i.e., whether they are causally related or correlated). Further, it is difficult to discern whether a person with co-occurring disorders began using drugs to cope with the mental health disorder or because features of the mental health disorder prompted them to use drugs (e.g., cognitive impairment that leads a person to engage in risky behavior or not adequately assess risks).
To further complicate matters, it may be that each disorder manifests from a similar biological and/or environmental source (i.e., separate disorders with a shared origin). There are even some researchers who posit that one disorder may underlie co-occurring disorders. In this conceptualization, the mood disorder is one manifestation of the underlying parent disorder and the substance abuse is another.
According to the National Institute on Drug Abuse, mood disorders, including bipolar disorder and depression, are among the most likely to co-occur with a substance use disorder. According to one study of individuals diagnosed with a mental health disorder, of those who had a mood disorder, 32 percent also had a substance use disorder. The percentage rose for study participants who had bipolar disorder; of this group 56 percent had a substance use disorder.
Although researchers may not know how mood disorders and substance use disorders are interrelated, it does appear that treatment for a mood disorder may alleviate a person’s cravings for drugs. It is also known that treating either condition can improve both conditions, while leaving one untreated can cause both to worsen. For this reason, it is universally advised that a person with co-occurring disorders receives treatment that can target and relieve each condition. A person may receive a diagnosis of co-occurring disorders in different clinical settings, such as a drug rehab program that has a psychiatrist on staff (or works in conjunction with one nearby), directly from a psychiatrist in a private office, or at a hospital that has a psychiatric department. A full medical and psychiatric intake must be conducted in order to determine the appropriate course of treatment.
Again, it is universally accepted in the fields of addiction treatment and psychiatry that a person with co-occurring disorders should seek treatment that can accommodate a dual diagnosis. The treatment tracks for each disorder are integrated. For instance, a person who is diagnosed with major depressive disorder and an alcohol use disorder will typically be treated with the most current and prevailing medications and therapies (e.g., cognitive therapy, behavioral therapy, or a combination of both) that are regularly used for each disorder. In other words, in this example, the major depressive disorder will be treated with any effective available and appropriate medications (such as Campral for withdrawal from severe alcohol use disorder) while therapy can address the emotions underlying of the mood disorder and substance abuse. In short, there are usually not specific approaches to treat specific combinations of co-occurring disorders but rather a layering of treatments used to heal and manage each disorder.
According to the National Alliance on Mental Illness, the following are some necessities of treatment that accommodates a dual diagnosis:
- Treatment must be tailored to the individual’s needs, as there is no one-size-fits-all approach.
- Treatments for each disorder must occur simultaneously and in a complementary fashion.
- Inpatient treatment is generally advisable but outpatient treatment is always recommended over no treatment.
- Treatment with medications for each disorder can be effective and should be considered depending on the advisement of the attending doctors.
- During and also after treatment at a rehab facility, it is advisable that the recovering person attends 12-Step meetings.
While a co-occurring mood disorder and substance use disorder can present complexities in treatment, these conditions can be managed, and the recovering person can experience significant relief from their symptoms.
According to a paper published in Science and Clinical Practice, one effective treatment approach is to maximize the recovering person’s exposure to behavioral therapies. These types of therapies have at least a twofold benefit. First, a recovering person can learn strategies to gain greater control over self-regulation of emotions and impulses. Second, learning how to cope with disturbances to one’s mood in a healthy way can prevent one from turning to drug use. While medications can be effective, and even necessary, they are not sufficient. Therapy (including cognitive therapy, not just behavioral therapy) can and often does provide a person with the skills and tools to self-manage their co-occurring disorders on a day-to-day basis.
For individuals who have not yet received a full evaluation of their symptoms, receiving a diagnosis of a mood disorder and substance use disorder can come as a great relief because it signals that recovery can begin. Many individuals cope with co-occurring disorders in isolation, but there are many mental health professionals, medical professionals, and caring supportive service providers who have dedicated their lives to providing help. It is crucial to bear in mind that however burdensome a mood disorder and drug abuse can be, treatment can improve every facet of one’s life.