When a person is suffering from a mental illness and a substance abuse problem, the disorders are said to be co-occurring. This type of co-occurring disorder has been called dual diagnosis in the past. The term was changed because there are times when multiple mental illnesses are present, therefore the term dual diagnosis is no longer appropriate.
Idaho, located in the pacific northwest, is home to over 1.7 million people. There were over 15,000 people served by Idaho state mental health and substance abuse services in 2017. Of these people, 34% of them were adults with co-occurring disorders. 12% of the people treated through state sponsored services were teens who also had co-occurring mental health and substance abuse disorders.
Behavioral and emotional health issues affect people across the state of Idaho including mental illness and substance abuse disorders. Rates of these types of disorders are higher than the national average. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 270,000 Idahoans are currently living with a mental illness. In addition, it is estimated that 90,000 suffer from substance abuse. When looking at youth and teens ages 12-17 in Idaho, 13% have experienced a major depressive episode already in their lifetimes. Of these adults and teens with mental health and addiction issues, about 45% received treatment. The remaining 55% received no treatment at all, leaving them undiagnosed and suffering from the harmful effects with no assistance.
Idaho is lacking in services needed to help those who suffer from co-occurring mental illness and substance abuse. Public mental health services in Idaho are administered and provided by the Idaho Department of Health and Welfare, Mental Health Services division. Programs approved by the governor of Idaho are working to integrate and improve the provision of mental health and substance abuse treatment.
The interplay between mental health issues and substance abuse pose a challenge in health care. There is often a difficulty in diagnosing people who have mental illness with a co-occurring substance abuse disorder. This is because of the complex relationship between the two when they are present at the same time within an individual. There are several reasons we would see a co-occurrence of this nature. The first is that people with undiagnosed mental illness often try to soothe symptoms by using drugs and alcohol. They may not even be aware that this is the genesis of their addictive behavior. Before they know it, they are in the grip of a major addiction and now have worsened their situation. Another reason that these types of disorders co-occur is that these types of disorders share genetic risk factors. If a person is genetically predisposed to develop a mental illness, use of drugs or alcohol may be the deciding factor in whether or not the illness fully develops. Additionally, the withdrawal symptoms of the drug or alcohol may mimic symptoms of the mental illness present in the individual. Finally, the two types of disorders exacerbate each other. If a person with a mental illness begins using drugs, the neurological and emotional effects of the drug abuse will make an illness so much worse that it originally was. On the other hand, when an addict begins to show signs of a mental illness brought on by drug use, it causes the drug abuse behavior to worsen causing a positive feedback loop where each of the illnesses progressively worsens and symptoms inextricably intertwine.
There are some mental illnesses that more commonly co-occur with substance abuse than others. These include depression, anxiety, PTSD and bipolar disorders. Researchers are not completely sure why these tend to co-occur with substance abuse, however there are certain characteristics that make a person more prone to turn to drugs and alcohol. For instance, if a person is experiencing a depressive episode they may wish to reach for a drink in order to soothe their dark mood. What they may not realize is that alcohol is a depressant on the system, therefore it worsens the condition they were trying to treat. Soon, a dependency on the alcohol is formed and an addiction is soon to follow.
It is often difficult to discern which signs and symptoms belong to which disorder present in a person. As outlined above, this is because the disorders share a lot of the same symptoms and the interplay between the two is sometimes meshed and convoluted. There are some general signs and symptoms that the average person can look for in order to tell if a person is potentially facing a dual diagnosis or co-occurring disorders.
These are some of the more common symptoms that a person may exhibit when they are facing co-occurring mental health and substance abuse disorders. There are more serious signs and symptoms such as confusion, delusions and suicide ideation that should leave no one guessing. If any of these symptoms are present in an individual, it is imperative that they receive immediate medical attention
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Providers have come a long way when it comes to ensuring positive outcomes for people with co-occurring disorders. In the past, clinicians were not properly trained or prepared for cases like these and the common consensus was that the substance abuse would need to be treated before the mental illness could be addressed. This approach was problematic because the differences between these types of patients and the rest of the population was not taken into consideration. Dual diagnosis patients do not react the same way to substance abuse treatment than a person without a mental illness would. For instance, the dual diagnosis patients are mentally ill, so some may not be compliant to what it takes to achieve sobriety. They may also be suffering from confusion and delusions so they may not even realize the gravity or point of the addiction treatment. These people were relapsing at alarming rates, creating negative outcomes across the board.
It was in the 1990s that clinicians and researchers began to notice the negative trend in outcomes for these patients. They devised that an integrated approach would be absolutely necessary if these people were to have a chance at leading healthy lives. An integrated approach would mean that the addiction and the mental illness would be treated simultaneously and by one unified group of care providers.
There is no one right way to treat co-occurring illnesses. Using an integrated approach, licensed clinicians will build a treatment plan on an individual level. Each person that comes in for treatment will need their own treatment plan, as the way the disorders manifest in each person differs. There is a common main trajectory that is often followed, however. This plan includes detoxification, rehabilitation, supportive housing and continuing care.
When a person may potentially experience harmful withdrawal symptoms if they attempt to stop using, they absolutely need to be admitted into a detoxification center. Within the walls of the detox center, they will find a safe place to come off their drug or drink. Pain relieving medication is used to ease the body off of the toxic drugs and alcohol in their system. They may even need to be tapered off in order to get clean. Patients are monitored constantly for their own protection and safety.
There are several options when it comes to rehab. The most intense form is residential treatment, where the patient will live at the facility for a time. The length of time often depends on the severity of the addiction and psychological health of the individual. The most common length of time is 30 days, but there are some cases which warrant a longer stay. While at the rehabilitation center patients will receive treatment for their co-occurring disorders simultaneously. This means that psychotherapy will be used to work on negative behavior patterns ingrained in the addiction as well as medication to support their mental health and treat any diagnosed psychological illness.
When someone gets out of rehab, they are often in a very vulnerable state. The last thing that they need to do is go straight back to their normal lives. It is the stressors and trauma in their normal life that got them into rehab in the first place. Although they will have learned some healthy coping skills in residential treatment, moving into supportive housing gives them a chance to apply them in the real world, with a level of support and structure they would not receive otherwise.
It is often said that the road to recovery is a life-long journey. Just because a person has achieved sobriety and is enjoying a healthy psyche does not mean that they are cured. Addiction is a condition that is absolutely treatable but there is no cure. The same holds true for many psychological disorders. These types of conditions and disorders must be constantly worked on and healed. Many people opt to join self-help support groups, where they will be connected with peers who are going through the same types of things. Building a support network and continuing medication and psychotherapy increases the likelihood of a long term positive outcome for these patients.
References
https://healthandwelfare.idaho.gov/Medical/SubstanceUseDisorders/BehavioralHealthEvents/tabid/3739/Default.aspx
https://www.idahovoices.org/wp-content/uploads/2019/01/IBHA_Behavioral-Health-Facts.pdf
https://acl.gov/sites/default/files/programs/2016-11/Idaho.pdf
https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/Idaho-2017.pdf
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