When one or more mental illnesses in addition to a substance abuse disorder exists within the same person, these are referred to as co-occurring disorders. There are a multitude of different combinations of co-occurring disorders possible due to the many mental illnesses that exist. Co-occurring disorders are very common among Americans, with just about half of all people with a mental illness also facing an addiction disorder.
Prior to the 1970s, people with co-occurring disorders were not treated with any special considerations or treatment methods. These patients were experiencing overwhelming negative outcomes due to the lack of a working knowledge about how the two disorders work within the body and mind.
Montana is a state in the Northwestern United States and has a few nicknames such as "The Big Sky State" and "The Treasure State". It is the fourth largest in area and 8th least populated state in the nation with about 1 million residents. Marijuana use among teens in Montana was reported to be at a rate of 9.2% annually by the Substance Abuse and Mental Health Services Administration in 2017. The same report shows that 11.8% of teens in Montana reported using alcohol within the past month. In terms of the mental health of adolescents and teenagers in Montana, SAMHSA reported that 11.4% of teens experienced a major depressive episode within the past year in 2017. Of the young people who reported experiencing depression, only about 41.1% received mental health care for their depression.
Adults in Montana reported using marijuana at the rate of 36.7% within the past year in 2017 and also reported binge drinking within the past month at the rate of 47.3%. The average annual rate of alcohol abuse disorders in Montana's adult population was 13.8% according to the same report. The annual average of adults diagnosed with a serious mental illness in Montana was 6.6% and only about 47.8% of those people ever received treatment for their mental illnesses.
The most common way that a mental illness co-occurs with a substance abuse disorder is due to self-medicating behavior. Self-medication is a very harmful method for dealing with untreated symptoms of a mental illness. Not only does self-medicating quickly turn into addiction, but the side effects of drug use can make the symptoms of the mental illness even worse. For these reasons, self-medicating should be avoided as a method for dealing with mental illness. Another reason that mental illness and substance abuse tend to co-occur is that exposure to certain chemicals in substances affect one's genetic makeup thus activating genes which would not otherwise be turned on. Some of the genes that are affected dictate whether or not a person will develop a mental illness. Studies have also found that early exposure to drugs and alcohol, during the brain's highest developmental stages, affects how the brain develops and increases the risk that an individual will develop a mental illness. The reverse is also true here; mental illness may affect how the brain develops thereby increasing the risk that the person will develop a substance abuse disorder.
The signs and symptoms of co-occurring disorders vary right along with the many combinations of mental illness and addictions that are possible. For example, a person who is addicted to nicotine and is schizophrenic will have drastically different symptoms than a person with clinical depression who is battling alcoholism. There are some signs and symptoms that are more general that can be used to identify whether a person is facing co-occurring disorders.
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Through research it has been determined that the best treatment for co-occurring disorders is through an integrated approach, meaning that all disorders are treated at the same time. It is not manageable to attempt to treat a mental illness before addressing a person's addiction or vice versa. One disorder negatively affects and exacerbates the other. Treating them separately is a losing game. Patients will be evaluated thoroughly and provided with an individualized treatment plan that is tailored to fit their individual needs. Most treatment plans include detoxification, inpatient rehabilitation, transitional living, and continuing care.
During a patient's 3, 5, or 7-day stay in detox, they will be provided with a safe place to weather their withdrawal symptoms. Depending on the severity of the withdrawal, there are a variety of methods that can be used to safely remove a toxin from the patient's body. Often times pain medication is required, but more severe cases may warrant using tapering doses of the toxin in order to avoid shocking the body's systems. Withdrawal from a variety of toxins often involves a degree of dehydration, so patients will be provided with the proper amount of fluid in order to maintain their body's hydration. Patients are monitored around the clock in order to make sure they stay physically as well as emotionally safe while they go through withdrawal.
Residential rehabilitation centers are the cornerstone of the provision of treatment for patients with co-occurring mental illness and substance abuse disorders. These institutions allow patients to completely focus on their recovery, removing them from their normal, everyday lives and the stressors that exist there. In fact, many new patients are restricted from communicating with people outside of the facility in order to ensure that their focus remains on their present condition and the treatments that are being offered to them. These treatments include psychotherapy, talk therapy, medication, art therapy, acupuncture, and biofeedback.
The form of psychotherapy that is the most effective for those with co-occurring disorder is cognitive behavioral therapy (CBT), which provides patients with a bird's eye view of their own thought patterns. This new perspective affords patients the opportunity to change these patterns in favor of more productive ones. Group or individual talk therapy is very beneficial for those who are dealing with unresolved emotional trauma. For so many, these traumas become locked away and are the root cause of many problems in life. Being able to really dig into these issues with a trained professional is extremely healing. These psychotherapies when combines with certain medications have seen positive results when treating dual diagnosis patients. Alternative forms of therapy are also beneficial for some. These include exploring one's inner life with painting, sculpting and music. There are some facilities that offer biofeedback as a healing modality. With biofeedback therapy, patients are hooked up to an electronic monitoring machine which gauges their body function. Patients who need treatment for co-occurring disorders are often in a constant state of stress, which the machine picks up. They are then able to see how certain stimuli affect the body on a stress level, and are able to incorporate relaxation methods in order to learn how to calm themselves and find peace. With the wide variety of treatments available, it is clear the rehabilitation is a great way to approach treatment for co-occurring disorders.
After a patient completes their treatment program within an inpatient facility, they are encouraged to explore the option of transitional living. There are many different types and level of support that these communities offer. It is important to find the right community for each specific patient because some patients will thrive with more support and some will thrive with less support. Transitional housing communities provide services and a safe environment not found in society at large. It is a wise choice for anyone wishing to continue being in recovery and avoid relapse. The types of services offered within supportive housing are occupational therapy, rules and guidelines, case management, therapy sessions and peer support. Supportive or transitional housing provides patients with a lifeline in the world so that they are able to get back on their feet.
After treatment, many people may believe that they have been cured. The truth is that in order to stay in the new and healthy place they have found through treatment is to continue on with their treatment on their own. They can achieve this through therapy, medication and by staying connected within the recovery community. There are many peer-to-peer support groups whose sole purpose is to keep each other sober and walking the right path to support their mental health. It is extremely helpful to have kindred people along on the road to recovery. When someone reaches outside of themselves to help another person, both people are healed. Patients are usually connected in with these types of groups during their stay in residential rehab or transitional housing, so making the connection is already complete. All the patient needs to do is show up and participate within the groups to reap the benefits.
References
https://store.samhsa.gov/system/files/montana-bh-barometervolume5-sma19-baro-17-us.pdf
https://publichealthreviews.biomedcentral.com/track/pdf/10.1007/BF03391702
https://dojmt.gov/wp-content/uploads/Substance-Use-in-Montana-DOJ-FINAL-September-19th.pdf
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