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Finding the Right Treatment for Co-Occurring Disorders

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You are more than your diagnosis. That’s true no matter what, whether you have a substance use disorder or cancer. And the goal of rehab isn’t just to treat your illness; it’s to help you heal every aspect of yourself. For some clients, that means finding a treatment program that specializes in co-occurring disorders.

Having a co-occuring disorder, or a dual diagnosis, just means that you’ve been diagnosed with more than one condition. In the context of rehab, the term is generally used for clients with multiple mental health concerns. For example, you may have a substance use disorder as well as anxiety, depression, PTSD, bipolar disorder, personality disorders, or schizophrenia. This is not an exhaustive list. Approximately 50% of people with substance use disorders have dual diagnoses ((Nimh » substance use and co-occurring mental disorders. (n.d.-a). Retrieved October 8, 2021, from https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health)).

It’s technically true that anyone with more than one condition has a dual diagnosis. For example, a client might have both depression and diabetes. However, when a rehab facility offers a dual diagnosis treatment program, it’s safe to assume that they’re referring to conditions that relate to mental health. Substance use disorders and other mental health conditions generally have complex, multifaceted relationships. As such, people with multiple diagnoses can benefit from specialized forms of treatment.

Risk Factors for Co-Occurring Disorders

Substance use disorders are often related to certain mental health diagnoses ((Abuse, N. I. on D. (–b). Why is there comorbidity between substance use disorders and mental illnesses? National Institute on Drug Abuse. https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/why-there-comorbidity-between-substance-use-disorders-mental-illnesses)). It’s important to remember that every person’s experience is unique, and these correlations aren’t necessarily causative. However, there are some well-documented risk factors that can make someone more likely to experience these co-occurring conditions.

Mental Health Concerns Can Make Substance Misuse More Likely

Mental health conditions, including substance use disorders, tend to run in families. Experts believe this is due to a combination of genetic and environmental factors. Studies have found that “as much as half of a person’s risk of becoming addicted to nicotine, alcohol, or other drugs depends on his or her genetic makeup ((Abuse, N. I. on D. (2019, August 5). Genetics and epigenetics of addiction. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/genetics-epigenetics-addiction)).” However, life experiences also play a major role. Your diet, stress levels, physical activity, and any history of trauma can also contribute to substance misuse. According to experts, “that old saying ‘nature or nurture’ might be better phrased ‘nature and nurture’ because research shows that a person’s health is the result of dynamic interactions between genes and the environment.” Environmental conditions can also play a role in the development of mental illness ((Schmidt, C. W. (2007). Environmental connections: A deeper look into mental illness. Environmental Health Perspectives, 115(8), A404–A410.)).

Research has clearly linked substance use disorders with mental health. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “People with mental illness are more likely to experience a substance use disorder than those not affected by a mental illness. ((Co-occurring disorders and other health conditions. (n.d.). Retrieved October 8, 2021, from https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/co-occurring-disorders))” However, it’s not simply the case that mental health diagnoses can cause substance misuse. The reverse can also be true.

The Impact of Substance Use Disorders on Mental Health

Substance misuse changes brain chemistry. Active substance use has a short-term impact on a person’s mental and emotional state, but it doesn’t end there. Long-term drug use can also “lead to both short- and long-term changes in the brain, which can lead to mental health issues. ((Abuse, N. I. on D. (2020, June 15). Mental health effects. National Institute on Drug Abuse. https://www.drugabuse.gov/drug-topics/health-consequences-drug-misuse/mental-health-effects))” This can contribute to the development, or progression, of mental health conditions.

It’s not unusual for people to develop substance use disorders in response to mental or physical pain ((Nimh » substance use and co-occurring mental disorders. (n.d.-a). Retrieved October 8, 2021, from https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health)). And research has found that “people with a mental disorder, such as anxiety, depression, or post-traumatic stress disorder (PTSD), may use drugs or alcohol as a form of self-medication. However, although some drugs may temporarily help with some symptoms of mental disorders, they may make the symptoms worse over time. Additionally, brain changes in people with mental disorders may enhance the rewarding effects of substances, making it more likely they will continue to use the substance.”

This has a synergistic effect: emotional pain leads to substance misuse, which in turn increases emotional pain. As a result, many people find themselves caught in a cycle of unsustainable behavior, in which their attempts to self-soothe only amplify their distress.

Substance misuse, like many other mental health conditions, can become an all-consuming experience if it’s left untreated. Ultimately, it affects your mental health, your behavior, your relationships, and every other aspect of your life. In the midst of this crisis state, it can be difficult to even imagine life without these coping mechanisms. And this entire cycle is often accelerated for those with co-occurring disorders.

Breaking the Cycle

When you have a mental health diagnosis—whether or not it’s been officially diagnosed—it can be a struggle to find healthy coping mechanisms. Illicit substances can temporarily relieve the symptoms of mental illness, and unfortunately, they can also be more readily available than more appropriate prescription medications.

Many people find it difficult to admit that they have a problem, either with substance misuse or mental health in general. If you’re not ready to seek help, it’s unlikely that you’ll receive adequate medical care. However, you may be able to access illicit substances in a less formal way, without consulting a medical provider. Unfortunately, this accessibility is only possible due to a lack of expert oversight. Self-medicating can only get you so far.

Even with the best of intentions—for example, the conscious goal of self-medicating—substance misuse can impair your judgement. This makes it difficult to know whether your behavior has become problematic. “When an individual develops a mental illness, associated changes in brain activity may increase the vulnerability for problematic use of substances ((Abuse, N. I. on D. (–b). Why is there comorbidity between substance use disorders and mental illnesses? National Institute on Drug Abuse. https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/why-there-comorbidity-between-substance-use-disorders-mental-illnesses)) by enhancing their rewarding effects, reducing awareness of their negative effects, or alleviating the unpleasant symptoms of the mental disorder or the side effects of the medication used to treat it.”

You can receive professional help for co-occuring disorders at rehabs that offer these types of treatment programs, such as Futures Recovery Healthcare in Florida.

Substance Use Disorders and Trauma

Regardless of your reasons for substance misuse, unhealthy behaviors can cause further trauma. In fact, some clients report developing PTSD in response to their substance use. This can even be true for people who never experienced severe trauma before developing a substance use disorder.

Victoria Abadi, Addiction Therapist, writes, ”when a person is using a substance or behaviour addictively they often experience more trauma ((Abadi, V. (2016, October). CAN ADDICTION CAUSE PTSD. https://www.qni.org.uk/wp-content/uploads/2016/10/1_Victoria_Abadi.pdf)). This trauma may be caused by putting themselves in dangerous situations, behaving in a way that doesn’t reflect their moral compass, or feeling psychologically unstable due to the cocktail of chemicals and experiences.”

In addition, substance misuse often has a negative impact on relationships, including those with friends, family, and even work colleagues. If your relationships are damaged as a result of your behavior, you may experience the trauma of losing touch with a person you care about or rely on. This becomes a vicious cycle, and gives many people more reasons to continue engaging in unhealthy behavior.

As painful as this pattern can be, there is always hope for healing. Many people struggle with trauma as the cause or result of substance misuse. And many medical providers have experience in helping clients move forward. Alex Spritzer, Family Addiction and Psychiatric Nurse Practitioner at The Hope House Scottsdale, is one such therapist. Spritzer says,

“I believe that at the heart of many addictions is a trauma base. From that trauma base, there’s other psychiatric symptoms present. That might include anxiety, insomnia, a racing mind or mood swings–these are often psychiatric symptoms people look to abate when they’re using substances. In the dual diagnosis process, figuring out the reasons why people use [substances] is very important.”

The Hope House Scottsdale in Scottsdale, Arizona.

Finding the Right Type of Treatment for You

By their very nature, dual diagnoses are highly complex ((Abuse, N. I. on D. (–a). What are some approaches to diagnosis? National Institute on Drug Abuse. https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/what-are-some-approaches-to-diagnosis)) and unique to every client. And it can be difficult to “disentangle [their] overlapping symptoms.” For that reason, personalized treatment can be very helpful for people healing from multiple conditions.

Signs and Symptoms of Co-Occurring Disorders

Prior to rehab, many people aren’t even aware that they have co-occurring mental health conditions. It can be especially complicated to find out whether this applies to you, because the symptoms of some mental health concerns can be caused by “[physical] illness, medications, or substance abuse. ((Chronic mental illnesses—An overview | sciencedirect topics. (n.d.). Retrieved October 8, 2021, from https://www.sciencedirect.com/topics/medicine-and-dentistry/chronic-mental-illnesses))” However, there are certain warning signs that may indicate the presence of multiple mental health concerns.

The team at White River Manor notes that “those living with co-occurring disorders will find daily functioning difficult, if not impossible. While symptoms are often complex and can vary in severity, there are some common signs of dual diagnosis including:

  • social withdrawal: isolating from friends, family, and those who offer support
  • sudden changes in behaviour (including engaging in risky or violent behaviours)
  • changes in appetite and sleep patterns (including insomnia or excessive sleep)
  • inability to concentrate and confused thinking
  • intense or prolonged feelings of despair, hopelessness, and worthlessness
  • anxiety issues that can only be relieved by certain behaviours or rituals
  • difficulty staying in employment or meeting other responsibilities
  • trouble maintaining relationships because of erratic behaviour or mood swings
  • dramatic shifts in moods or energy levels and an inability to control emotions
  • use of drugs and alcohol as coping mechanisms for any of the above, despite the dangers.”

If these symptoms describe your experience, you may want to consider a rehab program that specializes in co-occurring disorder treatment. Before choosing one facility over another, talk to the admissions team to learn more about what types of treatment they offer.

Questions to Ask your Provider About Co-Occurring Disorder Treatment

Because treatment of co-occurring disorders is so individualized, it’s important that you find a clinical team that can support you, specifically. Ideally, your clinical team will have experience treating not only substance use disorders, but every diagnosis that applies to you. For example, a rehab facility that specializes in treating clinical depression may or may not have the right resources for a client with ADHD. In order to find the right program, you may have to take an active role in advocating for yourself during the admissions process. Here are some questions you can ask the admissions team at a rehab center to see whether they can provide the support you need:

  • How do you evaluate clients for dual diagnoses?
  • If I complete detox at your facility, will I be reevaluated for co-occurring disorders before beginning inpatient treatment?
  • Which specific mental health concerns do you treat most often?
  • Which mental health diagnoses does your staff specialize in treating?
  • What experiences does your team have in treating my specific diagnoses?
  • What types of therapy do you offer for various co-occurring disorders?
  • Do you create individualized treatment plans for each client? If so, how involved is the client in co-designing their treatment plan?
  • For clients with dual diagnoses, how do you integrate different types of therapy to address each person’s unique needs?
  • Do you prescribe psychiatric medication for clients with dual diagnoses?
  • How do you manage medications for clients detoxing from substance misuse?
  • How do you help clients with co-occurring disorders plan for ongoing mental health care after residential rehab?

Diagnosing Co-Occurring Disorders

The first step in healing, as always, is to go through a thorough evaluation process to determine the best course of treatment. For people with multiple mental health concerns, this process can be complex.

Remember that there’s no one-size-fits-all solution for healing. Although you may consult with your medical team before you arrive at rehab, your treatment plan will likely change over time. This is especially true for people who undergo medical detox before starting a rehab program. Once you complete detox and stabilize your physical health, your emotional state may change significantly, making reevaluation necessary.

Even if it takes time to find your diagnosis (or diagnoses), it’s important that you stay focused on the present moment, and fully committed to the process of healing. Rehab can be challenging. It’s normal to get tired, or to feel daunted by the task at hand. However, your own dedication to personal growth is absolutely vital. Experts agree that “the patient’s acceptance of a problem and his or her willingness to engage in treatment are important predictors of clinical outcomes. ((Chronic mental illnesses—An overview | sciencedirect topics. (n.d.). Retrieved October 8, 2021, from https://www.sciencedirect.com/topics/medicine-and-dentistry/chronic-mental-illnesses))”

Effective Treatment for Co-Occurring Disorders

In the right rehab program, your commitment to healing will be met by a similar commitment from your treatment providers. Because dual diagnosis treatment requires a multifaceted approach, it’s important to work with a team that can address every aspect of your health.

Co-Occurring Disorders Benefit from Holistic Healing

At Futures Recovery Healthcare, for example, providers stay in close communication with each other about each patient’s progress. They believe that “the integration of patient care — and many other supportive services — can greatly improve long-term patient outcomes. Integrated care is the process of coordinating the efforts of each member of a patient’s care team to enhance individual and systemic outcomes. All members of a patient’s care team collaborate on a regular basis to share information about a patient with the sole purpose of ensuring that health goals are being met, identifying any new conditions or needs, and adding therapies deemed important.”

In many cases, the symptoms of substance use disorders can be easy to identify. However, the symptoms of co-occurring conditions can be much more complex. This can make it harder to define what healing means for you. If you have bipolar disorder, for example, it’s unlikely that the condition will ever simply disappear. However, there’s always hope. During rehab, you can learn to manage your symptoms in a healthy and sustainable way.

Managing Chronic Conditions

Current research holds that many mental health conditions are, at least in part, caused by biological factors. For example, studies have found that bipolar disorder may be the result of a neurochemical imbalance ((MANJI, H. K., QUIROZ, J. A., PAYNE, J. L., SINGH, J., LOPES, B. P., VIEGAS, J. S., & ZARATE, C. A. (2003). The underlying neurobiology of bipolar disorder. World Psychiatry, 2(3), 136–146.)). Other mental health conditions, such as PTSD, are hugely influenced by life experiences and environmental conditions ((Post-traumatic stress disorder. (n.d.). [Text]. Retrieved October 8, 2021, from https://medlineplus.gov/posttraumaticstressdisorder.html)). There is still much research to be done about the etiology of these diagnoses.

Whatever the cause, many mental health concerns are chronic conditions ((Chronic mental illnesses—An overview | sciencedirect topics. (n.d.). Retrieved October 8, 2021, from https://www.sciencedirect.com/topics/medicine-and-dentistry/chronic-mental-illnesses)). It’s possible to manage them using therapy and medication, but it’s counterproductive to assume that someday all your symptoms will simply disappear without ongoing medical treatment. If you’re feeling daunted by this idea, compare your diagnosis to a physical illness. It’s perfectly appropriate for a person with a heart condition to take prescribed medication every day. Ongoing mental health treatment is equally important, and in many cases, equally accessible.

People with any mental health diagnosis can benefit from learning healthy coping mechanisms. If you also have a substance use disorder, those same coping mechanisms can help you manage cravings and keep your physical health in order. During rehab, you’ll learn these skills. After residential treatment, you’ll start putting them into practice in more complex situations.

As you prepare for life after rehab, you’ll not only hone your coping skills; you’ll also start building a support network that can help keep you on track. As Dr. Monika Kolodziej, Program Director, McLean Fernside, explains, “we know that people must learn skills to help them operate in the world and deal with depression, deal with anxiety, as they are also staying away from substances. And we know from studies that groups are an important vehicle.”

You are More than Your Diagnosis

It’s extremely important to find a diagnosis that accurately describes your symptoms. Doing this empowers you to get the help you need, which may include talk therapy, prescription medications, support groups, and appropriate health insurance. However, you are not your illness. You are a whole person, with needs and goals and values that transcend any difficulties you may face.

As you pursue dual diagnosis treatment, remember that rehab is not the end goal of healing. Instead, it is the first chapter of a new story. By learning more about your own emotional experience, you’ll be able to move forward in a healthier and more joyful way.

If you have, or believe you may have, a dual diagnosis, you can learn more about rehab centers that treat co-occurring disorders here.

Reviewed by Rajnandini Rathod

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