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What Are Co-Occurring Disorders?

Co-occurring disorders are when one person has two or more medical illnesses or mental health disorders. They can begin at the same time, or overlap and begin at different times.

The terms dual diagnoses and comorbidities also refer to conditions that co-occur. Often the two conditions interact and make each other worse.

In addiction treatment, co-occurring disorders refer to someone who has a substance use disorder (SUD) and a co-existing mental health disorder.

For example, an alcoholic that suffers from depression or anxiety has co-occurring disorders.

People with co-occurring disorders experience varying levels of severity in their disorders that change over time. Many experience more severe challenges and might require longer, more intensive treatment to manage their disorders.

Causes & Risk Factors

Co-occurring conditions that involve substance abuse disorders and mental health issues are common.

Approximately half of the people diagnosed with a mental health disorder will experience a co-occurring substance use disorder and vice-versa.

Research suggests three reasons for this:

Shared risk factors

Certain genes may contribute to both SUDs and mental health disorders. For example, there is a gene that makes some people more susceptible to mental health disorders as an adult if they use marijuana frequently as a child.

Also, environmental factors, like stress or trauma can cause genetic changes. These can get passed down and increase the risk of both mental disorders and SUDs.

Mental health disorders are a risk factor for SUDs

It is not uncommon for someone to treat their own mental health symptoms with drugs or alcohol. Self-medicating can lead to addiction.

In addition, certain brain changes due to mental health disorders may enhance the effects of drugs. This could potentially increase the likelihood of addiction

Substance abuse can contribute to mental health disorders

Substance use changes the way the brain functions. This could lead to the development of mental health disorders. It may also trigger undiagnosed mental health disorders.

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Alcoholism & Common Co-Occurring Disorders

The most common types of co-occurring disorders for those with an alcohol use disorder include:

Depression

Approximately one-third of all people who struggle with alcohol consumption have major depression.

In most cases, depression appears first. Many people use alcohol to self-medicate symptoms of depression. However, alcohol is a depressant and tends to exacerbate an existing depression disorder. It also increases the risk of suicide.

Anxiety

People with anxiety sometimes use alcohol to feel calmer. Alcohol cessation, or hangovers, can trigger panic and insomnia. This increases a person’s risk of overdrinking to ease anxious feelings.

Anxiety disorders with an increased risk for AUD include:

  • Generalized anxiety disorder
  • Panic disorder
  • Post-traumatic stress disorder (PTSD)
  • Social anxiety disorder
  • Agoraphobia and other phobias

Posttraumatic Stress Disorder (PTSD)

PTSD has been linked to high rates of alcoholism. Many studies have shown the link between alcoholism and veterans.

Many people who undergo trauma turn to alcohol to ease symptoms of anxiety, irritability, and depression.

Bipolar Disorder

Bipolar disorder, formerly known as manic depression, causes extreme mood swings. These manifest as extreme emotional highs, mania or hypomania, and lows, or depression.

Some people self-medicate these mood swings with alcohol. Alcohol moderates manic phases because it is a depressant. It can also provide temporary relief for depression.

Schizophrenia

Schizophrenia triggers delusions, hallucinations, disorganized thoughts, speech, and behavior, lack of motivation, and absence of emotional expression. 

One study found that people with schizophrenia experience a 33 percent higher risk of developing AUD. 

In some cases, people with schizophrenia use alcohol to self-medicate. In others, alcohol abuse may trigger schizophrenic symptoms.

ADHD (Attention Deficit Hyperactivity Disorder)

People with ADHD are more likely to develop an alcohol use disorder than people without. Multiple studies have found ADHD to be very common among patients being treated for alcoholism or other substance use disorders.

People with ADHD are prone to impulsive behavior. This may be one reason for the strong connection.

Also, alcoholism and ADHD are both genetic. They may share similar genes. So a child with ADHD is likely to develop an AUD if their parent has one.

Eating Disorders

Studies have shown that alcoholism and drug use are common behaviors among people with eating disorders. Unfortunately, the reason is not well understood. However, it is very common among patients in treatment for an eating disorder.

Other psychiatric disorders linked to substance abuse include:

  • Antisocial Personality Disorder
  • Borderline Personality Disorder
  • Avoidant Personality Disorder
  • Paranoid Personality Disorder
  • Obsessive-Compulsive Disorder

Dual Diagnosis vs. Co-Occurring Disorders

Dual diagnosis and co-occurring disorders are somewhat similar. Dual diagnosis occurs when someone has two or more disorders simultaneously. 

It’s often used in reference to mental illness and substance addiction. It also applies to all combinations of physical conditions, whether or not they are linked with alcoholism or other substance use issues. For example, someone can have a dual diagnosis of diabetes and high blood pressure.

Co-occurring disorders are a type of dual diagnosis. The term is most often used in reference to mental health disorders linked to substance use.

The difference between the terms is the relationship between the disorders. In a dual diagnosis, the cause of the medical issues might be substance abuse, but they are two separate diagnoses. 

In the case of a co-occurring disorder, mental illness and drug and alcohol addiction are directly linked. The effect of alcohol on the brain leads to or worsens a mental health disorder. A mental health disorder can also lead to the development of an alcohol use disorder (alcoholism).

Treatment for Co-Occurring Disorders

Treatment for co-occurring disorders is more intensive and requires more attention than when drug addiction occurs on its own. It is essential that people with co-occurring disorders receive treatment for both disorders simultaneously. Failing to diagnose or treat a co-occurring disorder reduces the effectiveness of treatment for alcoholism.

Integrated treatment approaches are best for people with co-occurring disorders. Integrated care includes a combination of the following:

  • Medical detox
  • Medications
  • Therapy and counseling
  • Support groups
  • Aftercare support

One of the challenges of treating co-occurring disorders is medication. Alcohol interferes with many different prescription medications, and the problem is especially severe with psychiatric medications. This means if someone consumes alcohol while taking medication to manage a mental health disorder, potentially fatal symptoms can occur.

It also means detox is especially important before the administration of medication for a mental health disorder. Medications are still effective for treating anxiety, depression, schizophrenia, and bipolar disorder, but staying abstinent from alcohol and other substances is essential.

Cognitive behavioral therapy is one of the most effective treatments for alcoholism. It is especially helpful for those with co-occurring disorders. This therapy is also useful long-term and reduces the risk of relapse. 

Working with a therapist who has experience with a specific mental illness improves a person’s ability to focus on sobriety and improve their overall mental health.

Treatment for Depression and Alcohol Use Disorder

Treatment for depression and AUD begins with detox, ideally in a medically-supervised environment. Once the person’s body is clear of alcohol, he or she will receive a mix of treatment options, including:

  • Behavioral therapy
  • Group counseling
  • Individual counseling
  • Peer support groups
  • Long-term care planning
  • Medication for depression and AUD

Treatment for Anxiety and Alcohol Use Disorder

Once a medically supervised detox is complete, a person struggling with anxiety and alcoholism can receive a combination of treatment options, including:

  • Medication to ease AUD and anxiety symptoms
  • Individual counseling
  • Group counseling
  • Behavioral therapies
  • Peer support group
  • Long-term care planning

Treatment for Bipolar and Alcohol Use Disorder

Following a medically supervised detox, people struggling with bipolar disorder and alcoholism benefit from an integrated treatment approach that includes:

  • Medications such as antidepressants, antipsychotics, and mood stabilizers
  • Individual therapy
  • Group therapy
  • Behavioral therapy
  • Long-term care planning that includes relapse prevention
  • Family therapy

Treatment for Schizophrenia and Alcohol Use Disorder

Treating co-occurring schizophrenia and alcoholism is best done with an inpatient treatment program, at least during the early stages of treatment. Inpatient programs provide round-the-clock medical supervision in a secure and stable environment away from temptations to use alcohol. 

For those with less severe symptoms or who have completed an inpatient program, partial hospitalization programs, or outpatient treatment can offer a bridge between inpatient treatment and a return to regular life.

Long-term treatment for schizophrenia and alcoholism includes:

  • Medication
  • Ongoing therapy
  • Peer support group attendance
  • Long-term care planning and relapse prevention

If you or someone you know is suffering from alcohlism, drug abuse, or a mental health condition, seek help today. Speak with a professional who can tell you about the different treatment plans available.

They can also put you in touch with substance abuse treatment facilities in your area.

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Resources

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“Co-Occurring Disorders | Psychology Today.” Psychology Today, 2019, www.psychologytoday.com/us/conditions/co-occurring-disorders.

“NIAAA Publications.” Nih.Gov, 2017, pubs.niaaa.nih.gov/publications/arh312/155-167.htm.

Yule, M.D., Amy M., and John F. Kelly, Ph.D. “Integrating Treatment for Co-Occurring Mental Health Conditions.” Alcohol Research Current Reviews, NIH, 24 Oct. 2019, www.arcr.niaaa.nih.gov/arcr401/article07.htm?utm_source=niaaa.nih.gov&utm_medium=referral&utm_campaign=Issue-401-Article-7. 

Baigent, Michael. “Managing patients with dual diagnosis in psychiatric practice.” Current opinion in psychiatry vol. 25,3 (2012): 201-5. doi:10.1097/YCO.0b013e3283523d3d https://pubmed.ncbi.nlm.nih.gov/22449766/

Ohlmeier, Martin, et al.,"Comorbidity of alcohol and substance dependence with attention-deficit/hyperactivity disorder (ADHD)," Alcohol and Alcoholism, Volume 43, Issue 3, May-June 2008, Pages 300–304, https://doi.org/10.1093/alcalc/agn014 https://academic.oup.com/alcalc/article/43/3/300/104462

Grilo, Carlos M. et al. “Eating Disorders and Alcohol Use Disorders.” Alcohol Research & Health vol. 26,2 (2002): 151–160. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683826/

Volpicelli, J et al. “The role of uncontrollable trauma in the development of PTSD and alcohol addiction.” Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism vol. 23,4 (1999): 256-62. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6760386/

National Institute on Drug Abuse. “Comorbidity: Substance Use Disorders and Other Mental Illnesses.” Www.drugabuse.gov, National Institutes of Health, Aug. 2018, www.drugabuse.gov/sites/default/files/drugfacts-comorbidity.pdf.

Substance Abuse and Mental Health Services Administration. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health.” SAMHSA.gov, U.S. Department of Health and Human Services, 2020, www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf.

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