Substance Abuse and Mental Health in Colorado

Individuals that have one or more mental illnesses combined with a substance abuse issue are considered to have co-occurring disorders. This diagnosis is given when at least one disorder of each type can be determined independently of the other and not attributed to a cluster of symptoms resulting from one. As of 2018, Colorado had a population of about 5.9 million people. It is estimated that each year, 250,000 people require treatment for mental illness in Colorado. Of these individuals seeking treatment, about 10% have co-occurring mental health and substance abuse disorders, according to the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2016. More generally, within the United States as a whole, SAMHSA reported in 2012 that 8.4 million Americans suffer from co-occurring mental health and substance abuse disorders. Although fewer studies exist on dual diagnosis among teens and young adults, the available research shows adolescents with substance use disorders show high rates of co-occurring mental illness. It has been reported that more than 60% of adolescents in substance use disorder treatment programs also were suffering from mental illness.

Topography of Mental Illness in Colorado

An estimated 832,000 adults living in Colorado are facing some type of issue with their mental health. This makes up about 20% of the state's total population. According to Mental Health America's 2019 report, 450,000 of these individuals are not receiving any treatment for these issues. This staggering number of untreated and unchecked mental illness is at the center of many of the state's primary challenges. These challenges include poverty, domestic violence, homelessness and personal/family crises.

There are also challenges within Colorado's criminal justice system as it relates to behavioral health. In recent times, the largest state institutions that provides behavioral health services in Colorado are the state's jails and prisons. The Colorado prison system falls short when it comes to effective behavioral health treatment, to say the least. Patients may be treated for acute symptoms but are not provided with the rehabilitation that they need in order to thrive. This "Band-Aid" type of treatment overwhelmingly results in individuals ending up right back in jail or prison, thus creating a grim cycle within the state of Colorado. This cycle not only harms the individuals in desperate need of rehabilitation, it also is harmful for the state's economy as public resources are mishandled within this cycle. These resources can be used in a much more efficient manner if there were a proper system for treating behavioral health issues in place. The reliance on the jail and prison system to do so is a recipe for failure. This is where dedicated behavioral health practitioners come in. Centers dedicated to treating mental health are an invaluable asset to any community. Not only do they provide treatment for debilitating mental illness, these programs also remove a burden from an economic standpoint within a community.

Why do mental health issues and substance abuse co-occur?

Although mental health and substance abuse disorders can be present in an individual at the same time, this does not mean that one caused the other. Researchers have yet to pinpoint the true cause of many of these types of disorders. However, research has been able to show clear correlation between these two types of illnesses. It is also difficult to determine which of these disorders came first, this is a real life "chicken or the egg" conundrum. Common co-occurrence can be attributed to several factors.

The first is that both of these types of disorders share the same risk factors. Genetic research has shown that there are specific genes that correlate with the development of mental health issues and substance abuse issues. For instance, someone may have the gene that predisposes them to develop schizophrenia. Many of these types of genes are shared by these two types of disorders. Many times, it is then environmental factors that cause these illnesses to develop in predisposed individuals. For instance, a person who is predisposed to developing schizophrenia may smoke marijuana which then causes the schizophrenia to manifest whereas if that person never picked up that joint the disease may never have developed. If a person is heavily using a substance, this will no doubt exacerbate any mental illness that is present within that person.

The second way mental health and substance abuse can co-occur is because many people who are suffering from a mental illness turn to drugs and alcohol in an attempt to self-medicate. For example, a person who has an undiagnosed and therefore untreated anxiety disorder may be desperate for relief from the symptoms they are experiencing. The person will then seek out a form of relief within using a drug or drinking alcohol. They might soon find themselves dependent on these forms of temporary relief, creating a substance abuse issue which would now be co-occurring with their underlying mental illness. The two issues exacerbate and compound the other, creating a complex cluster of symptoms.

There are a handful of mental illnesses that co-occur with a substance abuse disorder more commonly than others. According to a 1997 study, Researchers are not yet certain of the reasons these illness lead to substance abuse and vice versa. These include the following disorders:

Although the reasons why these disorders more commonly co-occur with substance abuse, research has shown a significantly higher correlation among these.

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What are the signs and symptoms of a dual diagnosis case?

Many times, it is tough to determine which symptoms can be attributed to mental health and which are attributed to substance abuse. This is the main challenge with diagnosing co-occurring disorders of this type. In general, there are signs and symptoms that can be used as a guideline to identifying a person who may be facing co-occurring mental health and substance abuse disorders.

Symptoms vary from person to person, however there are some symptoms that are more common than others and should be flagged. If you or a loved one are experiencing symptoms of this type it is crucial that medical attention be sought immediately.

What are the treatment options for co-occurring mental health and substance abuse disorders?

It is apparent that there are challenges when it comes to treating patients with a mental illness and a substance abuse disorder. For starters, these patients have a higher rate of HIV infection, relapse, hospitalization, and risk of suicide that do other populations according to recent research. Furthermore, involvement in the criminal justice system further complicates treatment for those with co-occurring disorders. Even with these challenges, recovery is still very possible with the right treatment approaches.

Universal treatment approaches are not appropriate for those with co-occurring disorders; they simply do not work. Patients require individualized treatment plans if there is to be a chance at a positive outcome. This means that different illness, cognitive abilities and substance addictions and combinations thereof will be taken into consideration when a treatment plan is being formulated. In addition, it is essential that treatment providers take an integrated approach when formulating treatment plans. Research has shown that both mental health and substance abuse disorders must be treated simultaneously in order to effective treat a patient presenting with a dual diagnosis. It is also valuable for the patient's own perceived needs and opinions to be evaluated and taken into consideration during this process. Once a treatment plan is created, then an individual will begin their abstinence from the substance as well as therapies for their mental illness. Abstinence may not be simple for some patients. There are some substances that cause painful and life threatening withdrawal symptoms. These must be addressed in a formal medical environment, and handled by specially trained staff. Safely bringing a patient off of a substance should be a top priority. Since treatment for co-occurring disorders is a long-term endeavor, continuing care is paramount to success. It may even be that treatment is never complete, with an individual needing to continue working on their recovery for the remainder of their lifetime. To ensure that care is continued, the treatment plan must account for transitioning back into society. This often takes the form of supported housing also known as "half-way" houses. These types of living situations provide a safety net for vulnerable patients just finishing a structured treatment program. It provides a level of structure while allowing for an individual to participate in society. Patients will receive vocational support as well ask continued therapies for their mental illness and substance abuse problems.


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