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Treating Substance Abuse & Co-Occurring Mental Illness

Table of Contents

Mental disorders such as depression, anxiety, bipolar disorder, dementia, and schizophrenia are relatively common. Yet what many people don’t know is that these mental health conditions often co-occur with substance use disorders—also known as a dual diagnosis. In order to effectively treat both conditions during rehab, an integrated treatment approach should be taken, which may involve an interdisciplinary team of counselors, case managers, psychiatrists, and therapists. However, the complexity of both disorders can pose some challenges in effectively treating each disorder.

Understanding Dual Diagnoses

Adolescent struggling with addictionThough concurrently having both a mental disorder and a substance use disorder is not unusual, the causality behind the onset of each condition isn’t always clear. For example, in some cases, the mental health disorder may be present before a person becomes addicted to substances, and in others, the addiction may trigger the onset of a mental health disorder or further exacerbate its presentation.

As a matter of a quick review, a substance use disorder is a complex disease that is characterized by the ongoing, compulsive use of drugs or alcohol despite harmful personal, social, or medical consequences. People who struggle with addiction are thought to experience several neurochemical changes within their brains that make it more difficult for them to stop using the drug, even though they know it causes problems in their life.

And mental health disorders are usually “characterized by a combination of abnormal thoughts, perceptions, emotions, behavior, and relationships with others.”2

Grappling with both simultaneously takes a toll not only on the person primarily experiencing the issues, but their family and community as well. According to the World Health Organization (WHO), dual diagnoses are the leading cause of disability worldwide, with roughly 23% of all years lost due to disability caused by them.1

Mental health conditions that most commonly co-occur with substance use disorders are:2,3

Challenges During Treatment

Teen alone lamenting outsidePeople who struggle with co-occurring disorders have higher relapse rates, which is, in part, due to the fact that mental health and substance abuse treatment systems are not always integrated. This makes it difficult for a person to navigate being treated for and recovering from both conditions. In recent years, more dual diagnosis services have been created to help bridge this gap and better serve people with both disorders. A successful recovery means that a person learns to manage both of their illnesses so that they can pursue a meaningful life.4

Comprehensive treatment for both co-occurring disorders must take into consideration the following challenges:4

[content-overview]Challenge: People who have dual diagnoses present at varying stages of their mental disorder or addiction.[/content-overview]

[content-overview]Challenge: People with dual diagnoses may experience problems connecting with services or may resist entering treatment and remaining there.[/content-overview]

[content-overview]Challenge: People who struggle with mental health and substance abuse disorders may lack motivation to move through treatment and maintain their recovery progress.[/content-overview]

[content-overview]Challenge: To achieve long-term sobriety, treatment providers need to address the underlying issues that fuel addiction and exacerbate mental health issues.[/content-overview]

[content-overview]Challenge: Treatment providers don’t always comprehensively address both addiction and mental health issues over the long-term.[/content-overview]

Despite the increased awareness that people with dual diagnoses benefit from integrated treatment, research studies show that only 18% of addiction treatment and 9% of mental health programs meet criteria for offering capable dual diagnosis services.6 Establishing guidelines for effectively treating co-occurring disorders is important for serving this population. 

Sources

  1. World Health Organization. (n.d.). 10 Facts on Mental Health.
  2. World Health Organization. (2017). Mental Disorders.
  3. Anxiety and Depression Association of America. (2017). Facts & Statistics.
  4. Drake, R.E., Essock, S.M., Shaner, A., Carey, K.B., Minkoff, K., Kola, L., & Rickards, L. (2001). Implementing Dual Diagnosis Services for Clients with Severe Mental Illness. Psychiatric Services52(4), 469­–476.
  5. Haller, M., Norman, S.B., Cummins, K., Trim, R.S., Xu, X., Cui, R., & Tate, S. R. (2016). Integrated Cognitive Behavioral Therapy Versus Cognitive Processing Therapy for Adults with Depression, Substance Use Disorder, and Trauma. Journal of Substance Abuse Treatment62, 38–48.
  6. McGovern, M.P., Lambert-Harris, C., Gotham, H.J., Claus, R.E., & Xie, H. (2014). Dual Diagnosis Capability in Mental Health and Addiction Treatment Services: An Assessment of Programs Across Multiple State Systems. Administration and Policy in Mental Health41(2), 205–214.