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How Co-Occurring Disorders Work

How Co-Occurring Disorders Work

A mental health condition such as depression, anxiety or bipolar disorder does not automatically create a substance use disorder, and vice versa. But for some people, the two are linked.

When someone experiences both at the same time, it’s known as a co-occurring disorder. Some people in the field also call this a dual diagnosis.

They’re more common than you might think: nearly eight million people in the United States live with both a mental health condition and substance use disorder. The National Alliance on Mental Illness (NAMI) reports that about half of people who have a mental health condition also have a substance use disorder.

What does a co-occurring disorder look like?

Co-occurring disorders vary from person to person in terms of severity, duration and how they impact the person’s day-to-day life.

For example, one person may have equally severe bipolar disorder and substance use disorder, while another person may have the same disorders, but one is more severe than the other.

Because they’re managing two conditions at the same time, people with co-occurring disorders tend to experience more severe and chronic medical, social, and emotional issues than those who suffer from a mental health condition or a substance use disorder alone. Oftentimes, they require longer treatment, experience more crises and relapse, and progress more gradually than people with just one disorder.

What are the risk factors for co-occurring disorders?

On their own, mental health disorders and substance use disorders can develop for a variety of reasons. When a person experiences both at the same time, some of the causes may overlap. For instance, a genetic vulnerability may make someone susceptible to both addiction and a mental health disorder.

In other cases, the exact causes may be unrelated—or unknown. Some of the most frequent culprits include:

  • Stress
  • Prescription drug use
  • A history of trauma or abuse
  • Insufficient or underdeveloped coping skills

What are the symptoms of a co-occurring disorder?

A co-occurring disorder is two separate but simultaneous disorders. Because no two people with co-occurring disorders are alike, symptoms vary from person to person.

There’s no one set of symptoms for any mental health condition, but for many people, it can look like:

  • Extreme mood changes
  • Feelings of hopelessness, guilt, or worry
  • Irritability
  • Avoiding friends and family
  • Loss of interest in daily activities
  • Confused thinking and impaired judgment
  • Sleep changes, insomnia, or loss of energy

Common symptoms of a substance use disorder include:

  • Sudden changes in behavior
  • Avoiding friends and family
  • Withdrawal symptoms

How are co-occurring disorders treated?

Integrated treatment is the term used to describe how co-occurring disorders are managed.

This strategy pairs mental health techniques with recovery methods for substance use disorder. With integrated treatment, practitioners address both disorders simultaneously, which often leads to better outcomes than tackling them separately.

Treatment planning is not the same for everyone because there’s so much variation from person to person, but there are common approaches.

Detoxification is the first step. Inpatient detoxification is generally more effective than outpatient, according to the NAMI, for “initial sobriety and safety.” From there, inpatient rehabilitation provides around-the-clock medical and mental health care while treating the substance use disorder and its underlying causes.

Eagleville offers a specialized, secure unit for stabilization and early treatment. Eagleville Hospital’s co-occurring disorder program is led by an experienced psychiatrist who sees each patient daily.

Psychotherapy typically plays a large part, too. Cognitive behavioral therapy, in particular, helps clients cope with and change harmful thinking that may heighten the risk of substance use. Medications can also be used to both treat mental illness and ease withdrawal symptoms during the detoxification process.

Throughout treatment, social workers and case managers help each client create an achievable and personalized treatment plan that considers:

  • Substance use history
  • Medical issues
  • Mental health conditions
  • Criminal justice involvement
  • Financial challenges

Social workers and case managers also help clients develop an aftercare plan that outlines how they will continue to manage the co-occurring disorder after discharge. That plan may include continuing treatment at Eagleville or a referral to a halfway house or a 12-step program.