Co-Occurring Disorders

When you have both a substance abuse problem and a mental health issue such as depression, bipolar disorder, or anxiety, it is called a co-occurring disorder or dual diagnosis. Dealing with substance abuse, alcoholism, or drug addiction is never easy, and it’s even more difficult when you’re also struggling with mental health problems, but there are treatments that can help. With proper treatment, support, and self-help strategies, you can overcome a dual diagnosis and reclaim your life.

Understanding dual diagnosis or co-occurring disorders

In a dual diagnosis, both the mental health issue and the drug or alcohol addiction have their own unique symptoms that may get in the way of your ability to function, handle life’s difficulties, and relate to others. To make the situation more complicated, the co-occurring disorders also affect each other and interact. When a mental health problem goes untreated, the substance abuse problem usually gets worse as well. And when alcohol or drug abuse increases, mental health problems usually increase too.

What comes first: Substance abuse or the mental health problem?

Addiction is common in people with mental health problems. But although substance abuse and mental health disorders like depression and anxiety are closely linked, one does not directly cause the other.

  • Alcohol or drugs are often used to self-medicate the symptoms of depression or anxiety. Unfortunately, substance abuse causes side effects and in the long run worsens the very symptoms they initially numbed or relieved.
  • Alcohol and drug abuse can increase underlying risk for mental disorders. Mental disorders are caused by a complex interplay of genetics, the environment, and other outside factors. If you are at risk for a mental disorder, drug or alcohol abuse may push you over the edge.
  • Alcohol and drug abuse can make symptoms of a mental health problem worse. Substance abuse may sharply increase symptoms of mental illness or trigger new symptoms. Alcohol and drug abuse also interact with medications such as antidepressants, anti-anxiety pills, and mood stabilizers, making them less effective.
Addiction is common in people with mental health problems

According to reports published in the Journal of the American Medical Association:

  • Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse.
  • 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.
  • Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.

Source: National Alliance on Mental Illness

It can be difficult to diagnose a substance abuse problem and a co-occurring mental health disorder such as depression, anxiety, or bipolar disorder. It takes time to tease out what might be a mental disorder and what might be a drug or alcohol problem.

Complicating the issue is denial. Denial is common in substance abuse. It’s hard to admit how dependent you are on alcohol or drugs or how much they affect your life. Denial frequently occurs in mental disorders as well. The symptoms of depression or anxiety can be frightening, so you may ignore them and hope they go away. Or you may be ashamed or afraid of being viewed as weak if you admit the problem.

Just remember: substance abuse problems and mental health issues don’t get better when they’re ignored. In fact, they are likely to get much worse. You don’t have to feel this way. Admitting you have a problem is the first step towards conquering your demons and enjoying life again.

  • Consider family history. If people in your family have grappled with either a mental disorder such as depression or alcohol abuse or drug addiction, you have a higher risk of developing these problems yourself.
  • Consider your sensitivity to alcohol or drugs. Are you highly sensitive to the effects of alcohol or drugs? Have you noticed a relationship between your substance use and your mental health? For example, do you get depressed when you drink?
  • Look at symptoms when you’re sober. While some depression or anxiety is normal after you’ve stopped drinking or doing drugs, if the symptoms persist after you’ve achieved sobriety, you may be dealing with a mental health problem.
  • Review your treatment history. Have you been treated before for either your addiction or your mental health problem? Did the substance abuse treatment fail because of complications from your mental health issue or vice versa?

If you’re wondering whether you have a substance abuse problem, the following questions may help. The more “yes” answers, the more likely your drinking or drug use is a problem.

  • Have you ever felt you should cut down on your drinking or drug use?
  • Have you tried to cut back, but couldn’t?
  • Do you ever lie about how much or how often you drink or use drugs?
  • Have your friends or family members expressed concern about your alcohol or drug use?
  • Do you ever felt bad, guilty, or ashamed about your drinking or drug use?
  • On more than one occasion, have you done or said something while drunk or high that you later regretted?
  • Have you ever blacked out from drinking or drug use?
  • Has your alcohol or drug use caused problems in your relationships?
  • Has you alcohol or drug use gotten you into trouble at work or with the law?

Signs and symptoms of common co-occurring disorders

The mental health problems that most commonly co-occur with substance abuse are depression, anxiety disorders, and bipolar disorder.

  • Feelings of helplessness and hopelessness
  • Loss of interest in daily activities
  • Inability to experience pleasure
  • Appetite or weight changes
  • Sleep changes
  • Loss of energy
  • Strong feelings of worthlessness or guilt
  • Concentration problems
  • Anger, physical pain, and reckless behavior (especially in men)

  • Feelings of euphoria or extreme irritability
  • Unrealistic, grandiose beliefs
  • Decreased need for sleep
  • Increased energy
  • Rapid speech and racing thoughts
  • Impaired judgment and impulsivity
  • Hyperactivity
  • Anger or rage

  • Excessive tension and worry
  • Feeling restless or jumpy
  • Irritability or feeling “on edge”
  • Racing heart or shortness of breath
  • Nausea, trembling, or dizziness
  • Muscle tension, headaches
  • Trouble concentrating
  • Insomnia
Treatment for co-occurring disorders or dual diagnosis

The best treatment for co-occurring disorders is an integrated approach, where both the substance abuse problem and the mental disorder are treated simultaneously.

Recovery depends on treating both the addiction and the mental health problem

Whether your mental health or substance abuse problem came first, recovery depends on treating both disorders.

  • There is hope. Recovering from co-occurring disorders takes time, commitment, and courage. It may take months or even years but people with substance abuse and mental health problems can and do get better.
  • Combined treatment is best. Your best chance of recovery is through integrated treatment for both the substance abuse problem and the mental health problem. This means getting combined mental health and addiction treatment from the same treatment provider or team.
  • Relapses are part of the recovery process. Don’t get too discouraged if you relapse. Slips and setbacks happen, but, with hard work, most people can recover from their relapses and move on with recovery.
  • Peer support can help. You may benefit from joining a self-help support group like Alcoholics Anonymous or Narcotics Anonymous. They give you a chance to lean on others who know what you’re going through and learn from their experiences.

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