Co-occurring mental illness and substance abuse are more common than is conventionally understood. When individuals are suffering from one or more of these two types of disorders, the disorders are said to be co-occurring. This is also referred to as a dual diagnosis. This group is defined as individuals with at least one substance use disorder in the presence of at least major mental disorder, such as major depression, bipolar disorder, and schizophrenia. When this type of relationship was first observed in the 80s and 90s, clinics were reporting that between 50 and 75 percent of their patients who presented with substance abuse disorders also had a mental illness. Mental health clinics reported that 20 to 50 percent of patients also were struggling with substance abuse. These eye-opening numbers started researchers and scientists to better understand this complex relationship. While we are closer to fully grasping it, questions of concrete causation still exist.
Florida is the southwestern most state in the United States and is surrounded by water. Florida is the third most populous state in US with over 21 million residents. In Florida, the Substance Abuse and Mental Health (SAMH) Program is the single state authority on substance abuse and mental health as designated by the federal Substance Abuse and Mental Health Administration. According to the SAMHSA in 2017, of the 239,000 people treated by the state for mental illness, about 8% of those people had a co-occurring substance abuse disorder.
In 2016, the governor of Florida ordered that an assessment be done on the state's behavioral and mental health systems. In this assessment done by the Florida Department of Children and Families in conjunction with the University of South Florida, it was found that around 60% of individuals with a mental illness within the target counties also were suffering from a substance abuse issue. Furthermore, among the adults with the most state service use and the most serious mental illness, 75% had a co-occurring substance abuse disorder. These numbers are truly staggering. It was determined from this assessment that having a co-occurring substance abuse disorder increased the risk of an adult joining the high intensity resource use population by 84%. The study uncovered that there was a gross lack of documentation when looking at case files of teens and young adults. Further research is needed in that area.
It has been shown through research that individuals suffering from mental disorders are significantly more susceptible to the negative effects of abusing drugs or alcohol. Even ingesting or using a small amount of drugs or drink can quickly destabilize an individual with mental illness and create a worsening of their symptoms. The effect this has is often time extremely destructive for the person as well and their friends and family. In conjunction with this revelation, when a person is dealing with a mental disorder, it is much more difficult for them to abstain from using a drug or drinking alcohol. If they do fall into a dependency on drug, having a mental illness can make it difficult for a person to adhere to a treatment plan due to brain function impairment. These impairments include confusion, poor judgement, memory problems, impulse control issues, attention span shortening, and problems concentrating or making decisions. In addition to exacerbating a mental disorder, substance abuse and/or withdrawal symptoms can also bring on or look like symptoms of mental disorders. This intertwined nature of the two types of disorders creates difficulty in identifying, diagnosing and treating them. Although a lot of progress has been made in the field, there is still a long way to go to perfect the process.
We have explored how mental illness and substance abuse work together within an individual. This relationship can make it difficult for the disorders to be identified. While it may not be possible to ascertain which symptoms are stemming from which disorder, there are some signs and symptoms that may point to the fact that co-occurring disorders may be present in ad individual:
Any of these symptoms may indicate that you or someone you care about is experiencing a mental illness and/or struggling with substance abuse. If these signs and symptoms are present within an individual, it is imperative that medical attention be sought out immediately. Leaving a mental illness undiagnosed and therefor untreated is exceptionally harmful for the individual as well as the community in which they live. Untreated mental illness and substance abuse can be very costly financially as well as personally.
Research has shown that the best way to treat co-occurring illness is to treat them simultaneously. In the past, clinics for mental health and substance abuse were separate, thus causing the need for patients to be treated for the illnesses separately. We now know that mental health and substance abuse absolutely must be treated at the same time, with an unified staff, in order to elicit the best patient outcomes. It is absolutely vital the disorders are treated at the same time.
Common treatments include detoxification, inpatient or outpatient rehabilitation, supported housing and continuing care. Detoxification is required for people who need to be removed from a drug but cannot do so without serious harm to their physical bodies. For this population, there are detox centers specializing in safely and slowly bringing a person off the drug or drink in a completely safe and humane manner. Some drugs and alcohol have extreme withdrawal symptoms that can be very painful to endure. Staff at detox centers are authorized to administer tapering doses of a drug or drink in order to slowly wean the body from the substance.
An individualized treatment plan may include inpatient or outpatient rehabilitation, depending on that individual's needs. It may be that the all-encompassing structure that an inpatient program provides would best serve a patient. There are some people who absolutely thrive in structure and truly do require 24/7 monitoring in order to heal and recover from their illnesses. There are also certain people for whom an outpatient program makes more sense. Outpatient programs are more community based and allow a person to be held up by peers and allows healing to take place through connectedness and peer support.
Whichever path is best, there are therapies that will be utilized in both. One of the most common therapies used to treat co-occurring mental health and substance abuse disorders is Cognitive Behavioral Therapy (CBT). This type of therapy focuses on isolating patterns of thought that contribute to unwanted behaviors and working to change them. Tools used within CBT include therapeutic journaling, writing exercises, thinking exercises, and challenging long held beliefs. Eventually, through this work, people are able to change the way they think, behave and ultimately change the way they feel inside. Truly great strides can be made using CBT. Another effective tool to use in the treatment of co-occurring mental health and substance abuse issues is interpersonal therapy. Interpersonal therapy can help a person work through unresolved trauma within a safe space created by building trust and a positive rapport. Within this space, patients learn how to express emotions in a healthy way.
The power of pharmaceuticals is truly remarkable in treating mental illness and substance abuse problems. There is an array of medications available to treat an illness from the inside out. These medications are an invaluable tool used in treatment settings and can create a level of well-being within a patient that allows healing to occur as well as emotional/psychological breakthroughs.
It is often true that treatment may never be complete for individuals with co-occurring illnesses. Healing and recovery is a long-term goal for most patients. Therefore, continuing care is required. Continuing going to therapy and seeking out self-help support groups is one way that people remain on the path to recovery. There is a wealth of support available if one knows where to find it. The joining of a support group is built in to most individualized treatment plans.
Learning what treatment is best for you or your loved one is easy. Speak to one of our trained counselors and let them guide you to the best treatment options available for your specific needs.