When someone has a substance use disorder (SUD) and a mental health disorder, they are said to have a co-occurring disorder or a dual diagnosis. Co-occurring disorders are best treated simultaneously, as they can each, in turn, trigger the other. Coordinated treatment helps the person see the relationship between their SUD and mental illness and sustain long-term recovery from both.
Which Came First?
Co-occurring disorders can work in several ways. Sometimes the person develops an addiction to drugs or alcohol, and that addiction changes the brain in a way that makes a person likely to develop a mental health disorder. Other times, the mental health disorder spurs substance use, as people look for a way to relieve their mental and emotional pain.
In addition, addiction and mental disorders share common risk factors, like family history and genetics, as well as environmental factors. Interestingly, the National Institute of Mental Health notes that “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.”
According to a 2021 national survey by SAMHSA (Substance Abuse and Mental Health Services Administration), about 9.2 million adults in the United States have a co-occurring disorder.
SAMHSA also reports that the most common mental health disorders that co-occur with substance use disorder are the following:
- Anxiety and mood disorders
- Schizophrenia
- Bipolar disorder
- Major depressive disorder
- Conduct disorders
- Post-traumatic stress disorder (PTSD)
- Attention deficit hyperactivity disorder (ADHD)
How Do You Know if You Have a Co-Occurring Disorder?
It might be argued that addiction to substances is always, at some point, accompanied by mental health issues. Anxiety is especially prevalent, as people suffering from addiction can find themselves in a world of trouble with finances, relationships, careers, and health. Addiction often begins as a drive to escape something that is too painful to address, so it makes sense that anxiety or depression are often underlying factors.
Still, there are several signs you can look for to help determine whether you or a loved one might be struggling with a mental health disorder alongside addiction.
- Do you use alcohol or drugs to cope with difficult feelings, painful or intense moods, or stressful situations?
- Do you use alcohol or drugs to help you focus?
- Does using substances cause your mood to change (maybe you get more anxious or depressed)?
- Has anyone in your family been diagnosed with a mental health disorder?
- How is your mental health when you’re sober? Do you feel sad, fatigued, anxious, unable to concentrate, or otherwise moody even when you’re not under the influence of substances?
If these signs ring true for yourself or a loved one, talk with your doctor or therapist. An accurate diagnosis is crucial to successful treatment and recovery from both addiction and mental illness.
How are Co-Occurring Disorders Treated?
Substance use disorder and mental health disorders are best treated simultaneously. The treatment team may recommend medical detox from the substance followed by individual and group therapy to address the underlying factors of the addiction. Other aspects of treatment may include medication for the mental health disorder, psychoeducation (learning about how your diagnosis affects you), 12-step programming for the addiction, relapse prevention training, and aftercare support.
What is the Prognosis for Recovery from Co-Occurring Disorders?
Addiction has been defined as a chronic disease, similar to diabetes or arthritis. It can be successfully managed but not cured, and relapse rates are between 40-60%. Mental illness is also considered a chronic illness in that it, too, can be managed well with medication and/or therapy but will remain at play throughout a person’s life. Relapse rates vary depending on the diagnosis. Depression relapse rates can be much higher (up to 85%), for example, than anxiety relapse rates (about 30%).
It can be easy to look at these numbers and feel discouraged. But remember two important truths:
- You are not alone. Many, many people are in recovery from substance use disorder and mental illness, and connecting to a recovery support group can show you that many, many people are doing well in their recovery.
- Relapse is not the end. It can be easy to give up after a relapse or to feel like you’ve failed. Instead, see relapse as part of a larger healing process. Life stressors, changes in your body’s response to medication, and other factors might mean that you need to adjust your treatment plan. A relapse indicates that it’s time to reach out to your treatment team and recovery support groups to reevaluate.
If you or a loved one is struggling with an addiction that may be complicated by a mental health disorder, Miramont Behavioral Health can help. We serve adolescents and adults at our facility in Middleton, Wisconsin, with both inpatient and outpatient treatment options. Don’t give up hope. We can help you find the path to sobriety, mental health, and overall well-being.
