Co-occurring disorders refer to mental illnesses and substance abuse disorders that are present within an individual simultaneously. In the past, these individuals were said to have received a dual diagnosis, but this term is largely outdated due to the fact that more than one psychological disorder or addiction may be present. According to the Substance Abuse and Mental Health Services (SAMHSA) National Survey on Drug Use and Health (NSDUH), about half of people who are suffering from mental illness also are facing an addition crisis. Translated into numbers, this means that about 8.4 million people in the United States are dealing with co-occurring disorders of this nature.
SAMHSA provides national and state-level reports on behavioral health. For 2014-2105 SAMHSA reported that 5% of adults ages 18-25 were reported to have a serious mental illness. This number drops to 3% when looking at adults over the age of 26. Broadening the lens to any mental illness, the SAMHSA reported that 19.2% of adults age 18-25 were diagnosed with a mental illness, dropping to 17.2% for adults 26 and older. The same report showed that 53% of adults with any mental illness did not receive any treatment.
The SAMHSA also reported that 11.7% of adolescents and teens aged 12-17 in Kansas experienced a major depressive episode in the past year in 2014-2015. Of these teens and young people with a major depressive episode, 56% went untreated. Teens were reported to make up about 26% of all individuals treated for mental illness in Kansas.
SAMHSA - NSDUH reported a definite upward trend in drug use in Kansas from 2011-2015. Marijuana use in individuals 18 and older in Kansas started at 5.3% in 2011 and was at 7.4% in 2015. There was a downward trend in marijuana use among teens in Kansas with 8.3% using in 2011 to 6.6% using in 2015. The state saw no improvement in the use of all other illicit drugs in Kansas within this same time period. 3.3% of adults 18 and over reported using illicit drugs in 2011 and this number remained the same in 2015. Kansas' youth and teen population was able to do better moving from 4.4% of the population using illicit drugs in 2011 to 3.2% in 2015.
The high correlation between mental illness and substance abuse does not mean that one causes the other, necessarily. This is counter intuitive, but taking a closer look at the relationship between these two types of disorders helps to shed light as to why causation cannot fully be established. There are a few factors to consider.
There are common risk factors that aid the development of both substance abuse and mental illness. The main shared risk factor is hidden within our genes. For example, our genes determine if a drug affects us negatively or positively as well as how long a drug lingers in the body. Specific genes have been identified that predispose an individual to develop certain mental illnesses. Research is currently being done to determine whether or not some of these genes affect the prevalence of both addictive behavior and mental illness. There are also genes that dictate the likelihood that an individual will engage in risky behavior, which would also affect the propensity for drug use. To complicate things even further, research has shown that the same physical areas of the brain are affected by substance abuse and mental illness. Another risk factor shared by both disorders is stress. Exposure to stress has been known to cause a latent mental illness to develop as well as drive an individual to use drugs for relief.
Another way mental illness and substance abuse are related is that mental illness has been shown to contribute to drug use. When a person is experiencing unpleasant effects from their psychological disorder, they are driven to seek out relief. Unfortunately, often times the relief comes in the form of using a substance to numb or eliminate the pain temporarily. While symptoms are relieved in the short term, the long term effects of drug use have a negative effect on the mental illness, making the problem much worse. Often times, it is those individuals with untreated disorders that self-medicate and create an addiction problem for themselves. It is crucial to seek help for any mental illness that may be present.
Finally, substance abuse can lead to the development of a mental illness. Substance use leads to changes in the brain that cause latent mental illness to emerge. As discussed previously, substance abuse and mental illness act on the same physical areas of the brain, so any changes made to those specific areas of the brain by drugs have the potential to affect both types of disorders. Using drugs can affect the brain such that a mental illness and an addiction develops simultaneously.
Understanding the complicated relationship between mental health and substance abuse is key to understanding that diagnosing individuals with co-occurring disorders is difficult. For the average person, it is often impossible to pick out the signs and symptoms that belong to the individual disorders. It is not necessary to do so since there are some symptoms that can be flagged as problematic and indicative that there may be co-occurring disorders at play.
Any of these symptoms should be considered serious and medical attention needs to be sought out.
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Treatment and recovery is possible for people with co-occurring mental health and substance abuse disorders. The most effective way to treat patients with co-occurring disorders is to treat all present illnesses at the same time. This is referred to as an integrated approach. Using an integrated approach, treatment providers will build an individualized plan for each patient using the same general modes of treatment which include detoxification, rehabilitation, housing and continuing care.
The first step on the road to recovery often includes detoxification. Often times the withdrawal symptoms from alcohol or drugs is so intense that coming off is not possible without medical assistance. To do so could mean grave harm to the individual's body and mind. Detoxification centers specialize in safely removing an intoxicant from a patient's body, using tapering doses or painkillers along the way. A caring staff will monitor patients constantly to ensure their physical and mental safety through the detox process.
Becoming free of the alcohol or drug is merely the beginning for most people. Once the physical danger to the body is gone, treatment for addiction and mental illness is provided in a rehabilitation center. Inpatient rehab centers allow patients the time and space for healing. Individuals will attend individual and group therapy and possibly take medication in order to address the underlying causes of their addiction and mental illness. The most effective therapy for these patients is cognitive behavioral therapy, which addresses unhealthy thought patterns. Medication treats the illnesses from within and can be extremely healing.
After completing a rehabilitation program, patients often choose to move directly into transitional housing. These types of housing communities provide services that would not otherwise be available to patients and help to ease them back into society. Examples of the types of services available in supportive housing are psychotherapy, occupational therapy, life-skill building, case management, financial education, transportation to medical appointments, and a safe living environment. Case managers affiliated with these communities are equipped with specific training and are able to help guide and connect individuals with the community-based services they need. Supportive housing communities also provide the benefit of being affordable and can also come at no cost to qualified patients.
Recovery from addiction and untreated mental illness is said to be a life-long endeavor. Just because a patient's time in treatment and supportive housing is finished does not mean that the work is finished. It is up to them to help themselves and maintain the healthy behaviors that helped get them to a better place physically and mentally. Patients are encouraged to continue attending therapy sessions and take their medications as well as engage in peer support groups. Peer support is special because the network of support is provided by people who have experienced many of the same things in their lifetimes. This level of understanding between individuals is unmatched in a clinical setting. It is within these types of relationships that continued healing and recovery is possible. There are many ways to benefit from peer support including meeting up physically with groups as well as finding peer support groups online.
References
https://www.khi.org/assets/uploads/news/14789/understanding-the-mental-health-system.pdf
https://www.kdads.ks.gov/docs/default-source/csp/bhs-documents/kansas-behavioral-health-profile-2018.pdf?sfvrsn=bf7407ee_0
https://store.samhsa.gov/system/files/kansas-bh-barometervolume5-sma19-baro-17-us.pdf
https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness
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