When an individual has one or more mental illnesses combined with a substance abuse disorder, this is defined as co-occurring disorders. These cases were previously referred to as dual diagnosis, but this term has since been considered in accurate because it is possible for more than one mental illness and more than one substance abuse disorder to be present at the same time within the same individual. Co-occurring disorders of this nature are common in the United States. Research has shown that over half of the people diagnosed with a mental illness will also face substance addiction within their lifetimes. Conversely, roughly half of all addicted individuals will develop a mental illness at some point in their life.
Maryland is a state in the Mid-Atlantic region of the United States and has a population of about 6 million people. With its sandy dunes and lofty peaks, the variety of its landscape earns Maryland the nickname America in Miniature. According to a report put out in 2015 by the Substance Abuse and Mental Health Services Administration (SAMHSA), about 42,000 teens and adolescents reported having used marijuana in the past month. This makes up about 9.2% of Maryland's population of teens and youth. Maryland teens were also reporting using alcohol at the rate of 12.1%. This means that in 2015, about 55,000 teens reported using alcohol within the past month. Alongside this illicit drug and alcohol use by teens in Maryland, around 11% or 50,000 adolescents ages 12-17 reported experiencing a major depressive episode within the last month in 2015. Of these youth with depression, only about 44.4% received any treatment for their illness. This leaves over half of depressed teens never receiving any type of treatment at all. Adults in Maryland reported being diagnosed with a serious mental illness at the rate of 3% in 2015. This works out to be about 139,000 adults aged 18 or older. Of these adults with a serious mental illness, only about 43% received treatment, leaving almost 60% of these individuals with an untreated serious mental illness.
Understanding why these types of disorders tend to commonly co-occur has been a focus of the medical professionals working the field. Great strides have been made in working toward this goal of understanding, but experts still do not have a complete understanding of the relationship between the two disorders. It has been shown that the two types of disorders share connections to certain genes, which causes the disorders to share genetic risk factors. For example, if the gene connected to schizophrenia is affected by the chemicals in marijuana, this would mean that if the person uses marijuana, their schizophrenia would no doubt be affected in some way in terms of the genes involved. Substances can even physically change genes so that they express themselves differently had the substance not been introduced. If a person is genetically predisposed to developing a mental illness, it may be that the use of a substance triggers the onset of the illness. This does not happen in every case, however, and therein lies the problem of causality.
There are situations where a person who is mentally ill may be unaware of their illness but are experiencing unpleasant symptoms. Undiagnosed and untreated mental illness is common way that co-occurring disorders come to be in an individual. A person who is wanted to avoid symptoms and find some relief may turn to a drug or drink to self-medicate. Temporary relief is no doubt provided, but this soon creates a dependency on the drug or alcohol. Dependencies often lead to addiction and so the person is no longer only dealing with their mental illness, but they now also have an addiction to deal with.
Side effects and withdrawal symptoms of drug and alcohol abuse can mimic the symptoms of mental illness. This is one of the challenges that clinicians face when it comes to diagnosing co-occurring disorders of this nature. It is next to impossible to tease out which symptoms belong to which disorder in complex cases. If it is difficult for trained professionals, then the lay person may feel helpless when it comes to discerning the disorders that may be at play with themselves or a loved one. The good news is that specific diagnosis is not required in order to get help. Simply flag the general and common signs and symptoms that someone is suffering from a co-occurring disorder.
These signs are definitely red flags and should be carefully considered. For those who are exhibiting these types of behaviors and symptoms, it is best to be safe than sorry. Medical care should be sought out immediately.
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The positive outcomes and advancement of care for co-occurring disorders that we enjoy today have roots in curious clinicians in the 1970s. Medical professionals started to observe the complex relationship between these two types of disorders and realized that a huge change in the health system was needed in order to serve the massive population of people who were being diagnosed annually. The medical field now considers an integrated approach the most effective way to treat co-occurring disorders. An integrated approach requires that all disorders present within an individual be treated simultaneously, preferably by a multidisciplinary staff of experts working under the same roof. Using an integrated method as a basis for care, treatment providers will create an unique treatment plan for each individual based on their unique needs as a person. These plans include a combination of detoxification, inpatient rehabilitation, transitional housing and continuing care.
Detoxification is needed for people whose addiction is so severe that they cannot physically stop taking the drug without risk of bodily harm or even death. Specialized detox centers are equipped to provide patients with tapering doses of the drug as needed in order to safely assist a person to stop using. Patients are also administered pain management medication in order to address the acute symptoms of withdrawal, many of which are extremely painful to endure without sedation. Under constant supervision, patients are heavily supported through this painful detox process.
Treatment for mental illness and substance abuse can be found within the walls of inpatient rehabilitation programs. Patients will be assigned a combination of therapies which have been proven to be effective in treating addiction and mental illness.
Cognitive behavioral therapy (CBT) helps to address toxic patterns of thought that are at play in a person's subconscious mind that contribute to unhealthy behaviors. Patients who are treated with CBT are given the chance to interrupt these patterns and incorporate new, healthy patterns of thought to change the way they think and ultimately the way they behave. The goal is to eliminate the behaviors that lead to using drugs and possibly the avoiding of their mental health treatments.
IN addition to CBT, talk therapy is also a very effective treatment for co-occurring disorders. Patients may attend individual or group sessions for talk therapy, but the end goal is the same. The goal is to talk through the patient's traumatic experiences and bring healing to those areas of the psyche that are being affected.
To treat mental illness, there are medications that are used to address the chemical imbalances within the brain related to the illness. These psychological medications have proven to be very effective in the treatment of a wide variety of psychological disorders.
After treatment, many patients would benefit from the supportive environment that transitional housing has to offer. Like a stepping stone, these communities allow recovering patients to ease back into society in a safe manner. Many services are provided within supportive housing that would not be available otherwise. These services include case management and occupational therapy. These communities are designed to help individuals get back on their feet.
After having received treatment and support, it is imperative for patients to continue caring for their addiction and mental illness disorders on their own. Continuing care involves CBT, talk therapy, and participation in peer support groups. Peer support groups are groups in which individuals with similar life experiencing rally around each other, proving a safety net of support for each other. Recovering support from someone who understands exactly what you are going through is an unique and healing experience. Recovering addicts have reported that this peer support keeps them grounded because of the true comradery that exists within the groups.
References
https://www.samhsa.gov/data/sites/default/files/Maryland_BHBarometer_Volume_4.pdf
https://store.samhsa.gov/system/files/sma13-3992.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966471/
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