When one or more mental illnesses in addition to a substance abuse disorder are present within the same person this is known as co-occurring disorders. Previously known as dual diagnosis, co-occurring disorders are very prevalent in the United States. The largest etymological study completed on co-occurring disorders revealed that about half of all people who have a mental illness will also develop a substance abuse disorder within their lifetimes. The same is also true for those with addiction disorders, almost half of these individuals will face some kind of mental disorder within their lifetimes. These numbers translate to the state level as well.
Missouri is a state in the Midwestern United States and is home to over 6 million people, making it the 18th most populous state in the nation. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), from 2014-2017, the annual average of Missouri's teens and youth ages 12-17 who reported using marijuana within the past month was 5.4%, or about 25,000 individuals. The report also showed that 10.9% of Missouri's teen and adolescent population reported using alcohol within the past month. During 2013-2017, the annual average number of teens aged 12-17 who reported experiencing a major depressive episode in the past year was 13.7%, or 62,000 teens. Among the teens who reported having depression, about 45.6% received treatment for their mental health. Adults in Missouri reported using illicit drugs in the past year at the rate of 4.6% during 2013-2017. 39.8% of all adults in Missouri reported that they engaged in binge drinking behavior in the past month; this percentage works out to roughly 258,000 people on a monthly basis. SAMHSA also reported that Missouri's adult population is being diagnosed with a serious mental illness at the rate of 5.8% each year, or about 38,000 people annually. Of these people with a serious mental illness, only about 48.1% received mental health treatment. In a single-day count on March 31, 2017, 21,914 Missouri residents were enrolled in a substance abuse treatment program.
A person with a mental illness such as bipolar disorder, schizophrenia, PTSD, borderline personality disorder, depression, or anxiety disorders may reach for a drug or a drink to numb the symptoms they are experiencing. In the event this occurs, it is known as self-medicating behavior and it is the most common way that a person develops co-occurring disorders. Another way co-occurring disorders develop is because substance abuse causes and/or exacerbates symptoms of mental illness. For example, drinking heavily can increase a person's risk of developing depression. This is not to say that drinking causes depression, but that it increases the risk that depression will develop. The fallout from substance abuse can cause anxiety and depression also. For instance, one's drug and alcohol abuse may shatter personal relationship or ruin one's finances.
There are also genetic risk factors involved in developing mental illness as well as substance abuse disorders. Genes that are affected by the chemicals in the drugs people are abusing also affect whether or not a person will develop a mental illness. A person can be genetically predisposed to developing a mental illness, yet the illness may never appear until the genes are affected by an outside force such as drugs and alcohol.
It may not be completely obvious that someone is suffering from co-occurring disorders. This is due to the interrelatedness of the disorders. Symptoms of a mental illness can look like symptoms of intoxication or withdrawal and vice versa. There are some symptoms of drug and alcohol intoxication that mimic what a mental illness looks like. For instance, some marijuana users develop delusional thought which can look like schizophrenia. There are some signs and symptoms which should be flagged if they are observed.
If these symptoms are present in yourself or a loved one, it is extremely important that help is sought out immediately. Through the help of medical professionals, there is hope for treatment and recovery.
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Over the last 40 years, incredible advancements have been made in terms of treating patients with co-occurring disorders. Through the research of dedicated medical experts, it has been determined that the best treatment for co-occurring disorders involves using an integrated approach. This means that patients will be treated for all existing mental illnesses and addictions at the same time, ideally by the same staff of multidisciplinary medical professionals. Patients are given tailored treatment plans to fit their specific needs as an individual. The many combinations of mental illnesses and addictions that exist makes the need for individualized plans apparent. Although there are many different plans, most treatment plans for co-occurring disorders follow a similar trajectory which includes detoxification, inpatient rehabilitation, transitional housing and continuing care.
Detox centers specialize in moderate to severe withdrawal symptoms from drugs or alcohol. Withdrawal symptoms that are painful and dangerous should only be handled by a team of professionals. There is a great risk in attempting to detox without medical supervision. In detox centers, patients receive pain medication to alleviate some of the more painful symptoms that they can experience when they are in the withdrawal stage. Severe nausea and gastrointestinal symptoms can also be very dangerous due to the risk of dehydration. Detox staff will be able to administer the proper amount of fluids in order to ensure that each patient remains healthy and safe. Patients are monitored around the clock to ensure that their body is responding well to withdrawal, in addition to making sure patients are psychologically well during the process. Most people are able to detox from a drug or drink in 3 days, however they are able to stay 5 or 7 days if needed.
One of the most effective ways to administer treatment for addiction and mental illness is through residential rehabilitation centers. These types of fully immersive treatment experiences offer a variety of treatment options as well as provide the advantage of completely removing a person from their previous environment. A complete interruption of one's life is advantageous because the novelty allows a person to open themselves up more fully to the treatments being offered to them.
A very effective method of treatment that is used to treat co-occurring disorders is cognitive behavioral therapy (CBT). CBT techniques show patients how to observe their own thought patterns and learn to identify patterns which do not serve their best interests. Once these patterns have been observed and identified, patients are then taught techniques to replace them with new and healthy patterns of thought. The new thought patterns positively influence new and healthy behaviors, replacing the old, toxic behaviors.
Other than CBT, individual or group talk therapy is also an effective treatment for co-occurring disorders. More often than not, patients are harboring unresolved trauma. Through talk therapy, patients are able to work through this trauma and get to a good place mentally regarding these painful events in their lives. They are fully supported while they are working through these memories.
Combining the power of pharmaceuticals along with the psychotherapy has been shown to have very good outcomes for patients with co-occurring disorders. The types of medications available to those with substance abuse disorders are limited due to the risk of a new addiction being formed. Despite this, there are many medications available for these patients that can work wonders in their lives.
Once a person has completed their individualized treatment plan, they may be encouraged to seek out joining a transitional housing community. It is well documented that the risk of relapse is much higher for those who return directly back to their previous living situations when compared to those who move into transitional housing. The decreased risk of relapse is connected to the many services provided in supportive housing environments as well as the structure that these communities provide for patients. Residents of transitional housing are able to take advantage of psychotherapy, occupational therapy and case management as well as enjoy a degree of autonomy.
Recovery is not finished when treatment is done. Patients must participate in their own recovery once they have completed their full program. Continuing care means that patients continue to attend therapy sessions and take medication. It also means that they should seriously consider becoming a member of a peer-to-peer support group. These types of groups have proven invaluable for those in recovery because of the unique bond that is created among individuals with a shared life experience. Meeting and being supported by people who know exactly what you are going through can be a very healing process.
References
https://store.samhsa.gov/system/files/missouri-bh-barometervolume5-sma19-baro-17-us.pdf
https://www.ncbi.nlm.nih.gov/pubmed/2232018/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179595/
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