Navigation: The Link Between Addiction and Co-Occurring Disorders, Impact on Treatment, Holistic Approach to Treatment: Dual Diagnosis
Addiction is a medical condition that does not discriminate based on age, gender, race, or socioeconomic status. It is a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain.
Also called substance use disorder (SUD), addiction is a complex condition that affects both the body and the mind, leading to a compulsive need for the substance, whether it’s drugs or alcohol. This means an addicted person will keep taking the substance even when they are already suffering from its effects. [1]
Addiction typically involves physical dependence, where the body adapts to the drug and requires increasingly higher doses to achieve the desired effect. It also involves psychological dependence, wherein the person experiences intense cravings whenever they are not using the substance.
Over time, addiction can disrupt a person’s ability to function in daily life. It can impact their relationships, their work, and their quality of life.
But the worst part is that while addiction on its own can be challenging enough to overcome, it often doesn’t occur in isolation. Many addicted people also struggle with mental health disorders or other conditions. This further complicates their treatment and recovery process.
Here we will discuss some of the most common disorders to co-occur with substance use disorder.
The Link Between Addiction and Co-Occurring Disorders
Some people develop addiction because they started experimenting with recreational drugs. For others, addiction develops due to their misuse or abuse of a prescription medication given by their doctor. [1]
Regardless of how it starts, addiction can oftentimes co-occur with other disorders. Understanding the relationship between addiction and other disorders is crucial for effective intervention and support.
When we talk about co-occurring disorders in the context of addiction, we are referring to the simultaneous presence of both a substance use disorder and one or more conditions. Most of the time, these conditions are forms of mental health disorders such as anxiety, depression, bipolar disorder, post-traumatic stress disorder (PTSD), or schizophrenia, among others. [2]
Co-occurring disorders are often intertwined and can exacerbate each other’s symptoms, making diagnosis and treatment more complex. This is because the relationship between addiction and co-occurring disorders is often bidirectional and interconnected.
Those with mental health disorders may turn to substances as a form of self-medication to alleviate their symptoms, leading to the development of addiction. This is why people with mental illness have a higher chance of experiencing a substance use disorder than those who are not affected. [2]
SAMHSA’s 2022 National Survey on Drug Use and Health reports that around 2.5 million US adults have a co-occurring disorder. [2]
On the flip side, substance abuse can worsen pre-existing mental health conditions or trigger the onset of new ones.
This interconnectedness highlights the importance of comprehensive assessment and integrated treatment approaches. Both the addiction and the co-occurring disorders need to be addressed at the same time.
Without addressing both aspects of the problem, the likelihood of relapse and poor treatment outcomes increases significantly. Here are some of the conditions that usually co-occur with addiction:
Mental Health Disorders
Drug addiction often co-occurs with mental health disorders because of the complex interplay of biological, psychological, and environmental factors. Simply put, there are many common risk factors shared between these two conditions that increase the likelihood of developing both. [3]
As we said earlier, those with pre-existing mental health conditions may turn to drugs as a means of self-medication, while those with drug problems may develop mental illnesses during their substance abuse.
There is a genetic factor to both addiction and mental health disorders. But at the same time, environmental stressors such as trauma, abuse, and chronic stress can contribute to both conditions. [3]
The cycle of addiction and mental illness can become self-reinforcing, making it challenging for addicted individuals to break free from this harmful pattern. They need comprehensive treatment that addresses both concerns at the same time.
It is worth noting that mental health disorders and addiction don’t necessarily cause one another. It’s just that a person who has one is exposed to a greater risk of developing the other. And when they do co-occur, they have the tendency to worsen one another.
Common mental health problems to co-occur with addiction include:
Depression: Depression often co-occurs with substance use disorders. Individuals may use drugs as a way to self-medicate their symptoms of depression, but substance abuse can worsen depression symptoms over time.
Anxiety Disorders: Anxiety disorders, such as generalized anxiety disorder, panic disorder, and social anxiety disorder, commonly co-occur with drug addiction. Like depression, people with anxiety may use substances to cope with their anxious feelings, which can lead to addiction.
Post-Traumatic Stress Disorder (PTSD): PTSD often co-occurs with substance use disorders, particularly among those who have experienced trauma. We will discuss more about that later on. Drugs and alcohol may be used to numb painful memories or to cope with ongoing symptoms of PTSD.
Bipolar Disorder: Bipolar disorder involves periods of manic episodes followed by depressive episodes. Substance abuse is common among people with bipolar disorder, and drug use can complicate the management of the disorder.
Attention-Deficit/Hyperactivity Disorder (ADHD): ADHD is often associated with an increased risk of substance abuse, as individuals may use drugs or alcohol to self-medicate symptoms such as impulsivity and inattention.
Schizophrenia: While less common, schizophrenia can co-occur with substance use disorders. Those with schizophrenia may use drugs as a way to cope with hallucinations or delusions, but substance abuse can exacerbate symptoms of the disorder.
Obsessive-Compulsive Disorder (OCD): OCD involves intrusive thoughts and repetitive behaviors. Substance abuse may occur as individuals attempt to alleviate the distress caused by OCD symptoms.
Effective treatment typically involves addressing both the substance use disorder and any co-occurring mental health disorders simultaneously through integrated treatment approaches.
Personality Disorders
Personality disorders are a type of mental health disorder that are characterized by inflexible and enduring patterns of behavior, cognition, and inner experience that deviate from the expectations of a person’s culture.
These patterns typically manifest across various personal and social situations, causing significant distress or impairment in functioning. There are several types of personality disorders, each with its own specific characteristics and symptoms. These personality disorders may often co-occur with drug addiction for the same reason as other mental illnesses.
There is a complex interplay of biological, psychological, and environmental factors contributing to the co-occurrence of substance use disorders and personality disorders.
People with borderline personality disorder or antisocial personality disorder often experience intense emotional dysregulation, impulsivity, and difficulty in forming stable relationships.
These characteristics may lead them to seek out substances as a means of coping with their distress. They may drink excessively or use drugs to regulate their emotions, for example.
Additionally, people with personality disorders may have a heightened risk for sensation-seeking behavior. Some may have a lack of regard for consequences. These characteristics make them more susceptible to drug misuse or abuse.
Borderline personality disorder and antisocial personality disorder are particularly associated with addiction. Interestingly, even though the types of personality disorders seen in patients with SUDs are similar, those with drug use disorder are more likely to develop a personality disorder than those with alcohol use disorder (AUD). [4]
Trauma and PTSD
Traumatic experiences, such as physical or emotional abuse, accidents, or combat exposure, can lead to the development of post-traumatic stress disorder or PTSD. Many people who suffer from PTSD turn to substances as a way to cope with the distressing symptoms of trauma, leading to addiction.
Trauma, whether it’s experienced in childhood or later in life, can lead to profound emotional distress and an overwhelming sense of powerlessness. [5]
In an attempt to cope with these intense feelings, some individuals may use drugs or alcohol to seek relief from their symptoms. People with PTSD may engage in substance use as a way to numb painful memories or to escape from their distress.
The neurobiological changes that occur in response to trauma can also increase susceptibility to addiction by altering brain circuits involved in reward, motivation, and stress regulation.
Most studies exploring the connection between SUDs and PTSD focused on veteran populations and patients in substance treatment programs. In highly traumatized populations, high rates of lifetime dependence on various substances were found. The level of substance use was linked to the levels of childhood physical, emotional, and sexual abuse. [5]
These studies show the strong connection between childhood trauma and SUDs. To address this problem, it is important to enhance awareness of PTSD and its connection with substance abuse.
Chronic Pain
Chronic pain refers to persistent or recurrent pain that lasts beyond the normal healing time for an injury or illness. Unlike acute pain, it typically lasts for more than 3 to 6 months. Also unlike acute pain, it may not have an easily identifiable cause or may be related to an underlying medical condition.
Chronic pain can manifest in various forms, such as headaches, back pain, arthritis, neuropathic pain, fibromyalgia, and other conditions. And just like the other conditions listed here, it can co-occur with substance use disorders, significantly decreasing a person’s quality of life.
This is because of the need for pain management and medications. Prescription medications such as opioids can quickly lead to addiction if misused. This is why people with fibromyalgia or rheumatoid arthritis are at increased risk of developing an addiction.
An estimated 10 percent of patients with chronic pain misuse their prescription opioids. [6]
Aside from being exposed to pain medications that are potentially addictive, there are other factors that contribute to the co-occurrence of chronic pain and substance use disorders. Chronic pain may impact a person’s mental health, leading to conditions such as depression and anxiety, which further increase the risk of substance abuse.
In some cases, substance abuse can exacerbate pain sensitivity, creating a vicious cycle where individuals use drugs to manage both their physical pain and psychological distress.
Due to the high rates of opioid misuse and addiction among patients with chronic pain, it is important to address the problem through comprehensive addiction treatment.
Impact on Treatment
Unfortunately, co-occurring disorders tend to bring unique challenges to the already complex process of addiction treatment. Co-occurring disorders, also known as dual diagnosis or comorbidity, need to be addressed simultaneously in order to produce lasting effects.
There are several other ways co-occurring disorders can impact addiction treatment. It’s important to discuss them so that patients understand what to expect.
Complexity of Diagnosis: Identifying and diagnosing co-occurring disorders can be challenging due to overlapping symptoms. Often, symptoms of one disorder can mask or exacerbate symptoms of the other, leading to misdiagnosis or delayed diagnosis. There is also the fact that those with co-occurring disorders tend to have more persistent and severe symptoms. [7]
Treatment Resistance: Patients who are struggling with co-occurring disorders may be more resistant to traditional addiction treatment approaches. Mental health symptoms can interfere with their ability to engage in treatment, adhere to recommendations, and maintain abstinence from addictive substances.
Increased Risk of Relapse: Co-occurring disorders are associated with a higher risk of relapse compared to those with a single disorder. This heightened vulnerability to relapse may be because of poor adherence to medication or difficulties in coping with stressors.
Integrated Treatment Needs: Effective treatment of co-occurring disorders requires an integrated approach that addresses both the substance use disorder and the mental health disorder at the same time. During integrated treatment, substance abuse treatment providers coordinate with one another to develop individualized treatment plans that target both disorders concurrently.
Complex Medication Management: Patients with co-occurring disorders may also require pharmacological interventions to manage symptoms of both disorders. However, prescribing medications for dual diagnoses requires careful consideration. After all, certain medications can be addictive. Treatment providers need to think about potential interactions, side effects, and the risk of substance misuse.
Addressing Underlying Trauma: Because trauma is such a common co-occurring disorder among those with addiction, it needs to be addressed properly. Trauma can exacerbate both substance use and mental health symptoms, highlighting the importance of trauma-informed care in addiction treatment.
Supportive Services: In addition to addressing substance use and mental health symptoms, individuals with co-occurring disorders may benefit from supportive services such as housing assistance, vocational rehabilitation, and peer support groups. These services can help address social determinants of health and improve treatment outcomes.
Stigma and Discrimination: Addiction has a social factor to it. In fact, many people with co-occurring disorders refuse to seek treatment because they are afraid of what other people may have to say. They may face stigma and discrimination both within the healthcare system and in society at large. Stigma can act as a barrier to seeking treatment and may exacerbate feelings of shame and self-blame. [7]
To address this stigma, educating people regarding the dangers and effects of co-occurring disorders is necessary.
Holistic Approach to Treatment: Dual Diagnosis
Co-occurring disorders present unique challenges in addiction treatment, requiring an integrated and holistic approach that addresses both substance use and mental health symptoms.
By providing comprehensive care that recognizes the interconnectedness of these disorders, treatment providers can improve outcomes and enhance the well-being of individuals with co-occurring disorders.
This is where dual diagnosis treatment comes in.
Dual diagnosis treatment refers to a specialized approach to treating patients with co-occurring disorders. It is ideal for people who have both a substance use disorder and a mental health disorder. [8]
The treatment typically involves a comprehensive and integrated approach that generally begins with a comprehensive assessment of the patient’s condition. This is conducted by mental health professionals to evaluate the extent and nature of both conditions.
This assessment helps in developing an individualized treatment plan. A personalized approach is always preferred when it comes to addiction treatment because everyone is different. The effects of substance abuse will vary from one patient to another. The same can be said for their co-occurring conditions, the intensity of their symptoms, and the underlying causes of their dual diagnosis.
Based on the assessment, a personalized treatment plan is developed that integrates various therapeutic modalities to address both disorders concurrently. This plan may include medication management, psychotherapy, support groups, family therapy, and holistic approaches such as yoga or mindfulness practices.
In some cases, medical detox may be necessary. This is for patients who are physically dependent on drugs or alcohol. This process involves gradually lowering the person’s intake while their withdrawal symptoms and cravings are managed by medical professionals.
Medications may be administered during this process to help keep cravings and symptoms under control.
To ensure the patient’s safety during this difficult stage of recovery, it is typically conducted under medical supervision in a detoxification facility.
Therapy sessions are another fundamental component of dual diagnosis treatment. Cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), motivational interviewing, and other evidence-based therapeutic approaches are commonly used to address both the substance abuse and mental health issues. [8]
And because addiction has a social aspect to it, peer support and group therapy are also important. Group therapy sessions and peer support groups give patients the opportunity to connect with others who are facing similar challenges. These group settings offer support, encouragement, and the opportunity to learn from others’ experiences.
Dual diagnosis treatment often includes education sessions aimed at helping patients understand their disorders, triggers for substance use, coping strategies, and relapse prevention techniques. Skill-building exercises may also be incorporated to enhance problem-solving and coping skills.
As recovering individuals progress through dual diagnosis treatment, a comprehensive aftercare plan is developed. This is done to support their transition back into the community.
This may include continued therapy, participation in support groups, outpatient programs, vocational training, or housing assistance.
Dual diagnosis treatment is designed to provide holistic and integrated care that addresses the complex interplay between substance abuse and mental health disorders, with the ultimate goal of promoting long-term recovery and improved quality of life.
If you or someone you love is struggling with co-occurring disorders, look for a rehab center near you today and learn more about the various treatment options that are available. The road to recovery begins today.
Sources:
[1]: https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112
[3]: https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health
[4]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241194/
[5]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051362/
[7]: https://www.mentalhelp.net/dual-diagnosis/10-things-you-need-to-know/
[8]: https://medlineplus.gov/dualdiagnosis.html
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