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Co-Occurring Disorders: Substance Abuse & Mental Illness

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Substance abuse and mental health are among the most common co-occurring disorders. Overcoming substance use disorders can be a challenge. However, it's even trickier when you’re simultaneously battling depressive disorders, anxiety disorders, or another mental illness.

What are Co-Occurring Disorders?

A co-occurring disorder is the combination of co-occurring substance abuse and mental illness in a person. Also known as dual diagnosis or comorbidities, this combination of problems is common among people who require medication-assisted treatment (MAT) for successful care. 

Co-occurring disorders can either surface at the same time or as overlapping symptoms. As per the National Survey of 2018 on Drug Use and Mental Health, around 38 percent of adults over 18 (approximately 95 million people) are affected by co-occurring disorders.[1] 

When combined, the conditions worsen the effects of each other. People with common co-occurring disorders may experience fluctuating levels of severity as their conditions evolve with time. 

Substance Use Disorders (SUDs) Definition

Substance use disorders (SUDs) are progressive illnesses characterized by genetic predisposition and physical/mental changes. They develop from repeated use of substances that influence brain development and activity. This leads to difficulty controlling usage of substances such as alcohol, medications, and other legal or illegal drugs. 

People who struggle with substance or alcohol abuse often also experience:

  • Depression
  • Anxiety disorders
  • PTSD
  • Addiction disorders
  • Schizophrenia
  • Borderline personality disorder 

Studies show that forty-three percent of adults in SUD treatment for nonmedical use of prescription drugs also have symptoms of mental illness, including anxiety and depression. [2]

Mental Illness Definition

Mental illness, also known as mental health disorders, relates to various psychological issues. It's a prevalent mental disorder that affects your mood, behavior, and thinking abilities. 

Some common mental illness conditions are: 

  • Generalized anxiety disorder
  • Eating disorders
  • Personality disorders
  • Depressive disorders
  • Post-traumatic stress disorder (PTSD)
  • Psychotic disorders 

Mental health conditions are common. Over time, they may progress to a severe illness if the ongoing mental health symptoms cause extreme discomfort or affect the brain's function. 

As a result of the above, more than one adult among four living with severe mental health conditions may also have a substance abuse disorder.3

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Common Mental Illnesses Linked to Substance Abuse

Mental illness is the leading cause of substance abuse. The latter often results in self-medication. Co-occurring disorders can pose a severe threat to one’s well being. The condition may lead to critical morbidity, fatality, and difficulty in the entire health system. 

Other common mental illnesses associated with substance abuse disorders include:4

  • Bipolar disorder
  • Attention-deficit / hyperactivity disorder (ADHD)  

Symptoms of Co-Occurring Disorders

People carrying symptoms of co-occurring disorders may often struggle with medical and emotional dysregulation. The results of both include: 

  • Symptomatic relapses 
  • Financial challenges 
  • Social isolation
  • Anxiety attacks 
  • Physical/sexual aggressive behaviors and victimization 
  • Frequent hospitalization 
  • Incarceration 
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Why Are Mental Illnesses Linked to Substance Abuse?

These co-occurring disorders are strongly interconnected. The origin of one’s co-occurring disorder may have a lot to do with genealogy. 

You may be a victim of substance abuse or a mental health disorder because of your genetic history or environment. 

Many people with dysfunctional genetic history are predisposed to developing co-occurring disorders.

Some common risk factors are listed below: 

Genetic Vulnerabilities 

It’s reported that around forty to sixty percent of people's vulnerability to substance abuse is associated with genetics. [5]

Epigenetic Influence

Epigenetics discusses how environmental factors can change our genes and regulate their activities. Trauma (such as sexual abuse), chronic stress, and drug abuse can alter genes and result in brain neurons' poor functioning. All of these conditions can cause changes in behavior. 

Environmental Factors

External (environmental) influences may also contribute to an increased risk of developing a co-occurring disorder. For example, people who grew up with moderate to heavy substance use in their homes are more likely to develop substance issues than will those who didn’t grow up in this type of environment. 

Brain Chemical Involvement

Common co-occurring disorders also hugely affect crucial brain regions. Frequent drug use often disrupts the feeling-initiated area of our brains that controls impulse, decision-making, and emotions. This could potentially lead to the development of distinct psychiatric disorders. 

Which Comes First: Addiction or Mental Illness?

There is no specific order as to which disorder develops first. Any of these can occur depending on the mental condition of the person. 

People with mental illnesses often self-medicate to treat their depression or anxiety, which could result in a substance abuse or alcohol use disorder (AUD). A drug addict could also develop a mental health condition due to their addiction. Paranoia and depression are often experienced by opiate users who worry about their drug supply or getting in legal jeopardy from ‘drug busts.’

Co-occurring disorders are challenging to identify in a standardized manner. Treatment for dual diagnoses vary greatly, as substance addiction may require a different approach than the mental health condition. In addition, certain pharmacologic treatments must be carefully monitored and controlled when there is a co-occurring SUD.

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Diagnosing Co-Occurring Disorders

Co-occurring disorders are commonly diagnosed through medical screening and in-depth assessments. These screenings aim to address a person's behavior through different approaches related to their symptoms. 

The diagnosis evaluation typically considers a person's physical and mental history in chronological order, including their history with substance use disorders.

Co-Occurring Disorder Treatment Options

Different treatment options for co-occurring disorders vary by severity and complexity. The most popular forms of dual diagnosis treatment include inpatient, outpatient, and integrated treatment. 

What is Integrated Treatment?

An integrated treatment program is a medical practice that focuses on treating two or more conditions. It uses multiple medications and treatments to control the symptoms of co-occurring disorders. An integrated treatment approach includes a combination of pharmacotherapy and psychotherapy. 

The US Department of Health and Human Services of the Substance Abuse and Mental Health Services Administration (SAMHSA) suggests that integrated treatment for co-occurring disorders is the most effective and oriented approach. [6]

Inpatient Treatment

Inpatient treatment is another practical and holistic approach to treating mental illness and substance abuse. These treatment programs require the affected person to stay in a hospital or therapy facility until their symptoms are controlled and stabilized. These programs are particularly important for people without stable home environments.

Partial Hospitalization Programs (PHPs)

A partial hospitalization program (PHP) is a formal treatment program for co-occurring disorders that allow people to return home at night. However, these programs occupy most of the day with structured activities. They aim to encourage people to participate in healthy activities as well as educate and inform.

Outpatient Treatment

Outpatient treatment is a less intensive program that lasts for several hours on most weekdays. Treatment is educational and therapeutic. The process involves relapse prevention planning and isn’t as restrictive as inpatient treatment.

Some detox and social support programs are also part of this treatment to help people recover from co-occurring disorders. 

Does Insurance Cover Co-Occurring Disorder Treatment?

Qualified health insurance policies may cover some costs of treatment. The level of financial coverage depends on the treatment location and the specifics of coverage for each policy.

Many rehab centers for co-occurring disorders collaborate with insurance companies to help people meet their financial needs.

According to the Affordable Care Act (ACA), mental health services are critical health benefits that an insurance company must cover. The limits of coverage vary, as do the deductible amounts and co-pays. Therefore, a majority of health insurance companies offer partial financial coverage for: 

  • Inpatient treatment centers and services 
  • Rehab treatment centers for substance misuse and addiction (provided by addiction specialists)
  • Behavioral therapies (e.g., counseling, mental health communities, and psychotherapy) 
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Updated on June 22, 2022
6 sources cited
  1. Substance Abuse and Mental Health Service. “Key Substance Use and Mental Health Indicators in the United States.” Substance Abuse and Mental Health Service, Jul. 2019
  2. NIDA. "Part 1: The Connection Between Substance Use Disorders and Mental Illness." National Institute on Drug Abuse, 13 Apr. 2021
  3. Mental Health. “Mental Health and Substance Use Co-Occurring Disorders.” Mentalhealth.gov Online Publication, 10 Mar. 2022
  4. National Institute of Mental Health, NIH. “Substance Use and Co-Occurring Mental Disorders.” NIH online publication, Mar. 2021
  5. National Institute of Drug Abuse. “Why is there comorbidity between substance use disorders and mental illnesses?” NIH Online Publication, Apr. 2020.
  6. Kelly, Thomas M, and Dennis C Daley. “Integrated treatment of substance use and psychiatric disorders.” Social work in public health vol. 28,3-4 : 388-406. doi:10.1080/19371918.2013.774673

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