Also known as dual diagnosis, co-occurring disorders are defined as when one or more substance abuse and a mental health disorders are present at the same time within an individual. Co-occurring disorders are common nationwide, with the most reliable study reporting that almost half of all people with substance abuse issues also have a mental illness. The reverse is also true, about 50% of all individuals with a mental illness also have a substance abuse disorder. According to a study done by Blue Shield of Massachusetts, about 236,000 adults living in Massachusetts had co-occurring disorders in 2016. The report showed that only about 13% of adults served by Massachusetts state institutions had co-occurring disorders. This number is extremely low and shows that those with co-occurring disorders are underserved.
Massachusetts is the most populous state in the New England region of the United States with just under 7 million people living there. Considered the birthplace of America, it was home to the second colony ever created in America. Almost 4% of all adults in Massachusetts are currently living with a serious mental illness. Of these individuals, only about 53% receive treatment for their mental illness. This leaves over 46% of mentally ill individuals in Massachusetts without any treatment whatsoever for their disorders. From 2014-2017 according to the Substance Abuse and Mental Health Services Administration (SAMHSA), each year, about 13.5% of teens in Massachusetts reported having used alcohol in the past month. This works about to about 66,000 youth and adolescents ages 12-17 each year. Alongside these substance abuse numbers, SAMHSA also reported that 12.7% of Massachusetts teens reported having experienced a major depressive episode within the past year during 2013-2016.
Through research, there are several factors that have been determined to contribute to co-occurring mental illness and substance abuse disorders. The genes that dictate the development of mental illness and addiction disorders are shared by both disorders. This means that environmental stressors affecting these genes may act as a catalyst for both types of disorders. For instance, if an outside factor caused a mental illness to develop within a person it is entirely possible that the same stressors also triggered addiction behaviors.
In a majority of cases, however, co-occurring disorders develop because of an untreated or mistreated mental illness. People who have untreated mental illness seek out drugs and alcohol to help alleviate the symptoms they are experiencing. This form of self-medication is harmful because it quickly creates a dependency on a substance that turns to an addiction. Soon, these individuals find they cannot endure their daily lives without using the substance, effectively creating a more serious problem.
Abuse of substances also makes mental illnesses worse, exacerbating the symptoms that were originally present. For example, if a person with depression continually engages in binge drinking behavior, this could trigger a major depressive episode where their depression is greatly magnified and worsened. There are also cases of substance abusers who develop a mental illness due to the harmful effects that toxic drugs have on the brain. Changes made to the brain by outside chemicals can be irreversible and extremely damaging.
One of the most challenging aspects of co-occurring disorders is diagnosing them. This is due in part to the fact that side effects of drug or alcohol use often look like symptoms of a mental illness. Substance abuse confounds any mental health diagnosis, so it takes a great deal of training to be able to pick out which disorders are at play within an individual with co-occurring disorders. The average person does not need to be able to identify the specific disorders in order to help someone. There are observable signs and symptoms that may indicate co-occurring disorders.
These are some symptoms that, if present within yourself or a loved one, should be flagged as problematic. Medical attention should be sought so that assistance can be provided as soon as possible.
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Though certainly challenging, treatment and recovery is possible for these individuals. Great strides have been made in the last 40 years within the medical community when it comes to treating patients with co-occurring disorders. In the 1970s, clinicians began to observe that individuals with a mental illness and a substance abuse disorder were actually an unique population and therefore required unique care. This observation lead to many large scale studies involving people with co-occurring disorders and thus data started to be collected and analyzed. It was found that the methods that were being used were largely ineffective for these individuals and were causing negative outcomes in people's lives. Through this research it was determined that the most effective method for treating co-occurring disorders is the integration of mental health and addiction treatments. Using an integrated model means that all disorders are treated at the same time. Treatment will ideally be provided by a multidisciplinary team of medical professionals working in the same space. Individualized treatment plans are carefully crafted, using much the same main process which includes detoxification, inpatient rehabilitation, transitional housing, and continuing self-care.
There are cases in which detoxification will be recommended. These are the cases in which the withdrawal symptoms from a substance are extreme and will require medical supervision in order for the person to safely remove the substance from their body. Often times, patients' bodily systems have been ravaged by a toxic substance and so they are more vulnerable than the general population. Great care must be taken to ensure that these people are safe when they are detoxing from their drug of choice. Tapering doses of a drug may be appropriate for safety reasons. All patients within a detox facility will be monitored on a continual basis so that they are physically as well as psychologically supported during a painful time in their lives.
Treatment for substance abuse and mental illness is provided at inpatient rehabilitation facilities. These specialized care centers are equipped to provide immersive treatment and around the clock care. Once an individual completes the intake process, they will live at the facility for the determined amount of time. Patients will undergo their individualized treatment plan which often includes cognitive behavioral therapy (CBT), individual or group talk therapy, biofeedback, art therapy, medication and occupational therapy.
CBT has been found to be very effective for treating addiction and mental health issues. Patients are able to create healthy thought patterns and replace their toxic thought patterns, enabling them to think and act in a different way. Another form of psychotherapy is talk therapy. Talk therapy is a great way to work through past trauma and heal emotional pain. These sessions can be individual or in a group setting. Both types of talk therapy have been found to be effective in different ways.
Transitional housing communities are available for those who need a certain level of support before entering back into society at large. Patients who have completed their rehab program are encouraged to take advantage of the services provided within these communities. Services such as occupational therapy, psychotherapy, case management, transportation to work and doctor appointments, and peer support make living a much more manageable option for those who may be at a vulnerable point in their life.
Continuing self-care is crucial to the recovery process. Patients will be connected with peer support groups who provide a wonderful network of support for those in recovery. It is often the relationships made with one's peers that are the most meaningful when facing addiction and mental illness. The healing that can be provided by someone who knows what it is like to experience these things is unmatched in the medical community. On the other hand, recovering addicts have reported that helping another person in a similar situation helps to keep them on the path to recovery. Peer support groups provide a mutual benefit for all involved. In addition to building a network of peer support, patients are strongly encouraged to continue attending therapy and taking the medication that may have been prescribed to them. Although formal treatment may be complete, the journey to recovery is a life-long journey.
References
https://www.mass.gov/files/documents/2019/05/01/COD%20report.pdf
https://bluecrossmafoundation.org/sites/default/files/download/ publication/BH_basics_Final.pdf
https://www.rtor.org/directory/mental-health-massachusetts/
https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/Massachusetts-2018.pdf
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