The increased risk factors for those suffering from substance abuse disorders has been well documented. These risks are amplified further when individuals are experiencing mental illnesses at the same time. In cases like these the disorders are referred to as co-occurring or dual diagnosis. Dual diagnosis patients have been shown to have more persistent and severe symptoms of their disorders, have an increase rate of suicide, and tend to be more resistant to treatment than those without co-occurring disorders. People with co-occurring disorders also tend to have more social, financial, and legal problems that those without. National surveys have revealed that people who are diagnosed with a mental disorder were about 2.5 times more likely to develop an addiction disorder. Additional studies done in 2001 and 2003 found that the mental illness most likely to co-occur with a substance abuse disorder is bipolar disorder, with 47.3% of people with bipolar being treated for addiction as well.
Minnesota is a state in the Upper Midwest, Great Lakes, and northern regions of the United States. One unique distinction that the state has is that over 55% of its 5.6 million residents live in the Minneapolis-St. Paul metropolitan area, also known as the "Twin Cities". A report published by the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2017 shows that an annual average of 10.3% of Minnesota's adolescents and teens used alcohol for the first time and an annual average of 5.3% of Minnesota's youth population reported using marijuana for the first time from 2013-2017. Alongside these data are the adolescents and teens who reported having a major depressive episode, which is 12.3% or 51,000 young people each year. Of these adolescents and teens who reported having a major depressive episode, about 52% received treatment. 2.2% of all Minnesotans over 12 years old reported illicit drug use in the past year, according to the same 2017 report; this works out to be about 100,000 people. Among adults aged 18 and older in Minnesota, the annual average of receiving a diagnosis for a serious mental illness within the past year was 4.3% in between 2013 and 2017. 4.3% of the adult population in Minnesota works out to be about 178,000 people each year being diagnosed with a serious mental illness. Of the people being diagnosed each year with a serious mental illness, about 54% ever received any mental health treatment from the state of Minnesota. Although this is higher than the national average of 47.4%, many people with a mental illness are going untreated each year in Minnesota.
It has yet to be determined if mental illness causes substance abuse or if the opposite is true. Currently, it is understood that mental illness and substance abuse share a complicated and synergistic relationship. The term synergy is used to describe the relationship because when these types of conditions co-occur, the result is an amplified version of both, not just simply two separate conditions operating within an individual.
Mental illness and substance abuse share many of the same risk factors which explains why they co-occur at such a high rate. For one, mental illness and substance abuse share some of the same genes. Therefore, if an outside stressor affects a gene associated with a mental illness it is entirely possible that addictive behavior may also be triggered. It is also common for a person who has an undiagnosed and untreated mental illness to reach for drugs and alcohol in an attempt to self-medicate. They may be experiencing painful or negative symptoms that they wish to alleviate. Self-medication almost always leads to addiction and it should be avoided.
Substance abuse can also bring out more serious symptoms of an existing mental illness, whereas prior to using a substance they symptoms may not have been noticeable. These types of subtle, non-intrusive symptoms are also referred to as sub-clinical. However, it is possible for these symptoms to be exacerbated through substance abuse so that they become more severe and become unmanageable.
In the event a person is suffering from co-occurring disorders, there will be some signs and symptoms that become apparent. The average person may not be able to discern what disorders are present within an individual. The specific disorders do not need to be diagnosed at this early stage. Flagging these signs and symptoms are what is most important in order to start the process of recovery. The following symptoms may indicate co-occurring disorders.
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In the last 30 years, research has shown that the best treatment for co-occurring mental illness and substance abuse disorders involve integrated care. Integrated care involves treating all disorders that are present within a patient at the same time. Using this approach has been proven to improve patient outcomes significantly. In addition to the treatments being integrated for all disorders, care will ideally be provided by a multidisciplinary team of medical professionals within the same facility. Patients should also be provided with an unique, tailored treatment plan to fit their individual needs. Treatment plans often include detoxification, rehabilitation, transitional housing and continuing care.
Detoxification facilities specialize in safely removing a person from a harmful substance. In moderate to severe addiction cases, the withdrawal symptoms that patients experience can be harmful as well as very painful to endure. Patients who check-in to a detox center are able to receive the care and medications they may need in order to humanely remove the drugs or alcohol from their body. In some cases, tapering doses of the substance may be required. Detox patients are monitored around the clock to ensure their physical and psychological safety through the entire process. The time it takes to completely detox varies from person to person, but the most common lengths of time are 3, 5 and 7 days.
Once detox has been completed, the next step for many in recovery is to check into an inpatient rehabilitation facility. Inpatient rehab centers are residential facilities that offer a wide variety of treatment modalities and options for recovery. Most rehab centers focus on cognitive behavioral therapy (CBT), individual or group talk therapy, pharmacological therapy, art therapy, and biofeedback in order to treat those with co-occurring disorders. CBT has been shown to be particularly effective when combined with certain medications for people with co-occurring disorders. Medications can pose a challenge in these cases, since dual diagnosis patients are restricted in the medication they are able to take due to addictive behaviors. There are some wonderful medications that work for dual diagnosis patients that can be utilized with success, however.
In addition to receiving treatment within residential rehab facilities, patients also have the advantage of being completely removed from their everyday living situation. This complete immersion allows a person to focus completely on recovery during their stay. The stress of everyday life is removed, leaving space for the treatments to work.
Patients who have completed their rehabilitation programs are encouraged to take advantage of transitional housing. Transitional housing communities are a great way for those in recovery to take small steps toward complete independence, while preventing relapse. The support that is provided within these communities allows patients a degree of autonomy while providing the structure that is so beneficial for those who may be in a vulnerable state. The services provided by specially trained staff include group or individual therapy, occupational therapy, transportation to appointments, case management, and general supervision. In addition, there are affordable options for those in recovery who are getting back on their feet.
The road to recovery does not end with treatment. It is up to the person in recovery to stay vigilant and participate as much as possible in their own recovery. Continuing care has been proven to help prevent relapse once patients are cleared to return back to their everyday lives. Attending therapy sessions and continuing to take medications is crucial for success. Peer support groups are also available and patients are encouraged to seek them out. Building relationships with like-minded people who are supportive of each other is one way to participate in one's own recovery. Supporting another person who is going through some of the same experiences is beneficial for both parties.
References
https://www.biologicalpsychiatryjournal.com/article/S0006-3223(04)00739-5/fulltext
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/208671
https://store.samhsa.gov/system/files/minnesota-bh-barometervolume5-sma19-baro-17-us.pdf
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