It is possible for a person to have a mental illness and an addiction at the same time. These cases are referred to as co-occurring disorders. In the past, the most common term was dual diagnosis, however this term is now outdated because of the possibility for a person to have more than one mental illness as well as a substance abuse problem.
When these disorders co-occur, often times they differ in scope and severity. The severity of symptoms also fluctuate as time goes on. Co-occurring disorders present an unique challenge to the medical community and when a person has these disorders at the same time, they often require more intense treatment than people with just one disorder.
Indiana is a state in the Midwest and Great Lakes region of the United States. With a population of over 6.7 million people, this makes the state the 17th most populous state in the union. The people of Indiana are known as Hoosiers.
Marijuana is the most common illicit drug used in Indiana. A report done by the State Epidemiological Outcomes Workgroup (SEOW) in 2017 showed that 5.6% of Indiana's teen population 12-17 used marijuana in the last year and that 16.5% of all high school students use the drug. The state's highest rate of use was among 18 - 25 year-old adults, where 18.7% of this population were marijuana users.
The SEOW also reported that in 2017 one in five adults suffered from a mental illness in Indiana, that is 20% of the adult population in Indiana. 5% of those cases were serious mental illness. It was also reported that 30% of Hoosier teens experienced feelings of hopelessness and despair. Of this population who reported having mental health problems, only about 15% ever received any treatment for it. A quarter of the people who received treatment for a mental illness were diagnosed with co-occurring disorders.
The most common reasons we see these types of disorders co-occurring is because people with symptoms of a mental illness try to self-medicate using drugs and alcohol. Often times the symptoms these people are facings are very uncomfortable and they are trying to find some form of relief. Unfortunately, the drugs do not treat the underlying causes of the symptoms and more often than not cause them to become even worse.
It is also possible for the use of certain drugs to trigger mental illness. Through long term drug use or even after a few times of using, people start to see symptoms of a mental illness come up. Drug use can cause paranoia, hallucinations, delusional thinking, depression and anxiety while a person in intoxicated. As the drug or alcohol wears off, these symptoms may linger and eventually become disordered. For instance, a bout of binge drinking will cause symptoms of depression upon withdrawal, however with enough drinking these depressive symptoms eventually settle in and develop into clinical depression.
There are some mental illnesses and abuse of specific substances that tend to occur together. Examples of these are depression related to alcoholism as well as alcohol and tobacco with schizophrenia. One study showed that schizophrenia has an extremely high correlation with tobacco use, with 70-80 percent of schizophrenics addicted to nicotine.
There is a degree of difficulty in being able to diagnose those who are suffering from co-occurring mental illness and substance abuse disorders. The interconnectedness of the two types of disorders makes it almost impossible for the layperson to differentiate symptoms of one disorder from symptom of the other. It takes special training to pick out what is caused by substance abuse and what is caused by a mental illness. There are, however, some symptoms that can indicate that a person may be experiencing a mental illness coupled with a substance abuse issue.
Another complicating factor is that many people will be in denial that these symptoms are abnormal or that they need help. Despite what the individual may attempt to rationalize, these symptoms are absolutely serious and require a degree of urgency in engaging medical professionals for assistance.
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Despite the significant difficulty and challenge that dual diagnosis presents, treatment and recovery are possible. It has been determined that the best way to treat these co-occurring disorders is to use an integrated approach. This means that the disorders will be treated at the same time, ideally by an unified and multidisciplinary team under the same roof. This method has posed significant problems as facilities and systems for the provision of treatment for substance abuse and mental health were originally separate. It has taken some converted effort on the part of state and local governments to unify these systems to ensure better outcomes for the many individuals who suffer from co-occurring mental health and substance abuse disorders.
Using an integrated approach as the basis for care, providers will create an individualized treatment plan for each patient. While these plans do have their individuality based on the specific needs of each patient, each plan includes many of the same basic methods. Some of these commonly used methods include detoxification, inpatient rehabilitation, supportive housing and continuing care.
Detox is not required for every patient. The need for detoxification will be assessed at intake and is required for people who will suffer great bodily harm if they cease taking a drug or drink. Severe alcoholics must undergo professionally supervised detoxification as do heroin addicts. These are just some examples of instances where detox would be needed. These people will be constantly monitored for biometrics as well as psychological soundness. Safety is the number one priority; patients are safely brought off of their drug of choice in the most painless way possible.
Most everyone who seeks out treatment for co-occurring disorders is directed to a rehab center of some type. The most intense treatment centers are inpatient. These residential rehab centers require that patients live there for a certain period of time. It has been found that 30 days is the smallest amount of time that has been shown to be the most effective. There are some people who require a longer stay in order to reap the benefits of all the treatments offered at their facility. These treatments mostly include psychotherapy and medication. The psychotherapy is administered in a group setting or individually. There are merits to both of these therapy options. Within group and individual therapy, the most effective modality is cognitive behavioral therapy (CBT). CBT works on changing toxic thought patterns that brought a person to this low point in their lives. These thought patterns must be changed in order for a person to recover from these illnesses.
After rehab is complete, many people still need support in order for them to maintain a good level of wellness. A great way to receive this support is to move directly into a transitional house, or supportive housing. Within these types of communities, patients are able to still receive treatment such as psychotherapy, occupational therapy, healthy daily structure, and learn responsibility. These houses also provide an affordable way for a person to step out in to the world while they are trying to get back on their feet. When ready, patients leave transitional housing armed with the tools to survive in their everyday lives and cope with the stressors that will no doubt be waiting for them in their normal lives.
The path to recovery does not end after graduating from transitional housing. Medial professionals stress the importance of people seeking out continuing care on their own. This includes keeping appointments with their therapists and continuing to take the prescription medication that may have been recommended for them to treat their illnesses. Along with these, it is important for an individual to seek out peer support. This peer support is available through self-help groups. These groups exist in large numbers and it is not difficult to become connected to one. Members of these groups tend to be extremely welcoming and helpful, this type of peer support goes a long way in helping someone to live a healthy lifestyle. It is much easier to walk a path when you have kindred people walking right along with you.
References
https://fsph.iupui.edu/doc/research-centers/2017-State-Epidemiological-Report.pdf
https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness
https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/Indiana-2017.pdf
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