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Like the common cold, there is no known cure for addiction. Also like the common cold, the condition has existed for as long as written records have been kept. There are hieroglyphics depicting alcohol addiction from ancient Egypt that go back as far as 3,000 B.C., and evidence indicates that other ancient civilizations were consuming hallucinogens, coca, and wine for far longer. Unfortunately, addiction is nothing new and is unlikely to disappear any time soon; the good news is that substance use disorder, as well as the common cold, can be treated, and emerging treatments are becoming more effective all the time. In fact, advancements in dual-diagnosis treatment for co-occurring disorders are blazing new trails in both addiction and mental health care.
Substance use disorder treatment has been in development for centuries. At one point, doctors tried everything from poison-induced comas to the application of leeches as possible remedies. Thankfully, within the last century, the more traditional practices of group therapy and counseling were introduced with more success. However, the single greatest discovery in the study of addiction treatment has been the integrated approach for co-occurring mental health and substance use disorders. Although it was long suspected, doctors and scientists were not able to prove a direct link between mental illness and substance abuse until the 1980s. Even then, integrated treatment for co-occurring disorders was not yet offered or even developed until decades later. Since then, incredible advancements have been made in the treatment of mental health disorders and addiction at the same time, and it's not hard to see why the approach is so effective.
Almost half of everyone who suffers from drug or alcohol use disorder also shows symptoms of other mental disorders. That's about eight million people in the United States alone. Study after study reveals that people with mental or mood disorders are more likely to develop substance use disorders, but even today, only about 14% of people with comorbid addiction and mental illness ever receive integrated treatment for both problems.
Have you ever suspected that your battle with addiction may be influenced by an underlying mental condition? Or perhaps you see symptoms of co-occurring disorders in someone close to you? Read on; in this article we'll explore the connection between co-occurring disorders and addiction, as well as the available treatments for this common problem.
Dual diagnosis is the practice of comprehensively examining a patient in order to reveal multiple diagnoses of both mental health disorders and substance use disorder. According to the National Survey on Drug Use and Health (NSDUH), as many as 45% of all those who suffer from addiction also suffer mental illness, and some other research suggests that this percentage may be closer to 60%.
No matter the exact number, it is clear that many people have dual diagnoses and that the various conditions are closely linked. Years of research indicate a clear connection between addiction and mental illness, but no direct causality has yet been proved. Does addiction cause mental illness or do mental conditions cause addiction? Although there is no concrete answer to this question, science suggests that both theories could be correct.
For example, it has been concluded that adults who suffer from ADHD may be more likely to suffer from addiction. Some say that this stems from the stimulant medications that are prescribed for ADHD, while other studies suggest that it's not stimulants but alcohol that creates problems for people with attention deficit disorders. This could mean that the mental condition of ADHD may make people more vulnerable to develop alcohol or drug use disorders.
Of course, there is also evidence to suggest that heavy substance abuse can bring about mental health problems as well. Here are some examples:
While direct causality has not been proven between mental illness and addiction, it is evident that the two are closely intertwined and connected. For this reason, it is not ideal or effective to treat either condition on its own without taking into account the influence of other co-occurring conditions.
Unfortunately, yes, comorbid mental illness and addiction is more common than anyone would have suspected 30 years ago. It is estimated that as many as 18% of Americans now suffer from mental illness and of those, almost half also have problems with addiction, according to the National Institute on Drug Abuse (NIDA).
Based on reports from treatment centers and health facilities, almost eight million Americans have co-occurring disorders, but this statistic only includes those who reported their symptoms and were diagnosed. It is likely that many more unreported cases exist.
The most alarming factor in this scenario is the continuing lack of resources and programs that provide integrated treatment for co-occurring disorders. Among the millions of people who suffer from comorbid substance use and mental disorders, only 14% ever receive proper treatment for both.
Self-medication refers to the tendency of people who have mood disorders or mental illness to medicate their own symptoms by abusing alcohol or drugs. If you've ever met someone who has social anxiety issues and likes to drink to 'loosen up', then you've witnessed self-medication first hand.
There is also research to support the theory of self-medication, such as an article by the Drug and Alcohol Dependence Journal that shows the prevalence of alcohol and nicotine use among people who have PTSD. Later on, we'll delve further into particular co-occurring disorders like these, but first it's important to point out the risks of self-medicating.
Self-medication is common, even outside of substance abuse situations. Someone who self-diagnoses their own infection and takes antibiotics without a prescription is also guilty of self-medication. Even seemingly innocent mistakes like this can have lasting health consequences.
When illicit substances are added to the mix, the results become even more disastrous. For one thing, many people who suffer from mental illness take some kind of psychiatric prescriptions. If they then choose to self-medicate with drugs or alcohol, drug interactions and side effects become likely and dangerous. These are some potential dangers of self-medicating behaviors:
If mental health and addiction are closely interconnected, than the same should be said of polysubstance abuse and mental illness. In one impactful survey by the Mental Health and Substance Use Journal, it was concluded that the following statistics were true of a random sampling of addiction center patients:
Observations like these indicate that polysubstance abuse and co-occurring disorders occur at about the same rates among patients with substance use disorders; the two conditions often overlap. Dropout rates indicate that both groups have a hard time completing substance use treatment programs, making it even more difficult for dual diagnosis patients to receive the help they need and achieve recovery.
The prevalence of co-occurring polysubstance addictions and mental disorders is yet another barrier to traditional treatment methods for either condition. Findings such as those posted above further illustrate the need for integrated dual diagnosis treatment and continued research into how these conditions interact.
While there are many types of mood disorders and mental illness, some of them share similar symptoms. Here are some of the common signs:
It would be unrealistic to try to list all the possible mental illnesses, but there are a few that are more prevalent in the general population. A combination of the symptoms listed above could point to one of the following common mental health conditions:
ADHD and stimulants are natural co-conspirators, so to speak. Since prescription stimulants are the go-to treatment for attention deficit disorders, it is easy to see how the daily consumption of stimulants could lead to abuse. Especially among adolescents and college-aged individuals, there is a potential for addiction when it comes to medications like Adderall and Ritalin.
Young people between the ages of 14 and 25 have a 60% chance of abusing prescribed stimulants and, among those who do abuse them, there is a 30% chance that users will graduate to the abuse of other illicit stimulants like cocaine.
One of the most difficult challenges for addiction specialists when presented with co-occurring ADHD and stimulant abuse is to find a way to effectively treat the mental condition without the use of addictive stimulant medications.
This common co-occurring disorder often goes undiagnosed because the symptoms of the two conditions are so similar. Symptoms of opioid abuse and PTSD tend to look the same to the untrained eye, so patients may go for years without a proper dual diagnosis.
The same receptors in the brain that cause the unwanted memories and flashbacks that are associated with PTSD also seem to affect a patient's susceptibility to the euphoric effects of opioids. Researchers theorize that this is the reason behind the prevalence of this particular co-occurrence of disorders.
Fortunately, once a dual diagnosis has been made for comorbid PTSD and opioid addiction, the conditions are not usually difficult to treat simultaneously. Opioid replacement therapy (ORT) and targeted counseling approaches have been shown to work well for both conditions, even when they occur at the same time.
These two disorders often coincide since patients with OCD attempt to calm down and self-medicate obsessive tendencies by smoking weed. In fact, one survey found that the more severe the OCD symptoms were in a patient, the more they smoked marijuana. Eventually, they are unable to cope with the symptoms of OCD without assistance from marijuana, which leads to addiction and dependence.
These coinciding disorders can be difficult and elusive to treat. All previous substance abuse and compulsive behaviors will have to be taken into account before treatment can begin.
Cocaine is frequently a go-to drug for people who suffer from anxiety disorder, since the rush of energy and invincibility that is associated with a cocaine high can temporarily quell the anxious, fearful, and stressful feelings brought on by the condition.
Unfortunately, cocaine will actually have the opposite effect over time. Almost as soon as the cocaine high begins to wear off, the user may feel inundated with feelings of stress and anxiety, further aggravating the original anxiety disorder. So pronounced is this consequence that some researchers blame long-time cocaine abuse for the onset of certain anxiety disorders.
This is another case in which the treatment can become the addiction. Since benzodiazepine medications are the perfunctory treatment option for panic disorder, it is not unusual for patients to develop addictions to benzos unintentionally.
Once an addiction begins to form to a daily benzo prescription, abuse will generally develop, followed by drug dependence. This can also lead to polysubstance abuse and overdose, so it is important to recognize the signs of addiction as soon as possible.
If an addiction to benzos has formed, a patient with a co-occurring disorder will need to detox completely and seek out alternative treatment measures for panic disorder symptoms.
Antisocial personality disorder (ASPD) used to be called sociopathy and because of a tendency of people with ASPD to deny their mental illness, it is extremely difficult to treat. This condition shows a strong correlation with addiction; in fact, it is estimated that 90% of those who suffer from ASPD also struggle with substance use disorders. Alcohol appears to be the substance of choice for comorbid ASPD and addiction, but other substances are often abused as well.
Although it is not evident exactly why ASPD and alcohol so commonly interact, it may be an attempt for patients to assimilate into social situations or feel more comfortable around other people. On average, ASPD patients will start drinking at a young age and consistently refuse addiction treatment unless legally obligated to enter an alcohol rehab facility.
Although co-occurring ASPD and alcohol use disorder may seem irremediable or beyond hope, integrated treatment programs can help patients to cope with both conditions. Cognitive behavioral therapy in particular shows great promise for treating these individuals.
Although it is not clear exactly why, evidence indicates that people with schizophrenia tend to smoke weed. Researchers at the Henquet of Maastricht University Medical Center in the Netherlands suggest that this co-occurrence may be due to a predisposition for schizophrenics to enjoy marijuana as well as its psychoactive effects. In fact, they may actually feel an amplified and more intense high from marijuana.
Although weed-smoking may be popular among schizophrenics, it is not recommended. Marijuana not only creates a more intense high for these patients, it may also be exacerbating the condition. Weed can make the symptoms of schizophrenia worse and may even bring on psychosis when taken in large quantities. Especially for anyone with a family history of psychosis or previous psychotic episodes, consuming marijuana can be disastrous.
Self-medication is alarmingly common among patients who suffer from bipolar disorder. This is probably due to the fact that 'uppers' like cocaine can help someone in a depressive phase to feel more invigorated while 'downers' like alcohol can temporarily bring someone down from a manic phase. Co-occurring bipolar and substance use disorder is one of the most widespread dual diagnoses.
Although this type of substance abuse may help to temporarily even out bipolar episodes, it only makes the condition worse in the long run. Substance abuse tends to exacerbate the symptoms of bipolar disorder over time, resulting in up and down episodes that are longer and more intense.
Of all the dual diagnoses described in this article, by far the most common is depressive disorder and substance use disorder. This is usually another form of self-medication, since the happy euphoria produced by drug use can briefly relieve feelings of hopelessness and melancholy. Although the most common substances abused by depressed individuals are alcohol and heroin, there exists a correlation between depression and most other types of substance abuse, as well. After all, all drugs can provide a short euphoria.
If left untreated, co-occurring depression and substance use disorder will continue to feed off each other and worsen over time. This can be one of the most difficult dual diagnoses to recover from, and the detox phase tends to exacerbate the symptoms of depression, making the process even more miserable for the recovering addict. Antidepressants may be used during this type of recovery, but antidepressant medications should not be mixed with alcohol or drugs.
The greatest challenge to dual diagnosis is the complex and entangled nature of comorbidity itself. The symptoms of mental illness and severe drug abuse are often so similar that it can seem impossible to identify which side effects are caused by mental conditions and which are caused by substance use.
Especially in cases of long-term drug use, the brain becomes so inundated with toxic substances that it ceases functioning at a normal level. Sleep deprivation, erratic eating habits, and withdrawal symptoms can all cause such changes in the psyche and behaviors of an individual that clinicians cannot identify where substance abuse ends and mental health disorders begin. In this situation, the patient usually needs to complete detox before any precise dual diagnosis can be made. Once the withdrawal symptoms have passed and the brain is clear of the effects of toxic substances, medical personnel can then perform mental health examinations with more accuracy.
By far the most effective method of care for dual diagnoses is integrated treatment, an intricate approach that aims to address both mental health disorders and substance use disorders at the same time.
This approach requires highly individualized programs that take into account each patient's unique symptoms. No two dual diagnoses are alike, so there is no one way to approach co-occurring disorders. A specialized team of psychiatrists, nurses, counselors, and doctors work together to study each patient's particular case, formulating a specialized plan for each and every patient. This is the only way to effectively undertake integrated treatment, since the symptoms and presentation of every dual diagnosis are different.
Until very recently, very few addiction treatment centers were equipped to offer integrated treatment for dual diagnosis. Because of its scarcity, the Substance Abuse and Mental Health Services Administration (SAMHSA) sponsored COSIG grants to fund, train, and equip hundreds of drug rehab facilities across the nation to develop integrated dual diagnosis care. Now the option is available in almost every state.
Hundreds of studies and surveys have been done to measure how successful different treatments are for co occurring disorders. The results show that traditional drug rehab and treatment methods are less effective when alcohol or drug use disorder is combined with mental illness. Comorbid patients have higher rehab dropout rates and lower recovery rates than people who suffer from addiction alone.
This is partly because the side effects of mental health disorders can make recovery more demanding and also because some withdrawal symptoms tend to be more severe for mentally ill patients. Traditional detox and rehab therapy will naturally fail when applied to these scenarios.
Another complication is the fact that the vast majority of comorbidity cases have never been properly diagnosed. People who struggle with substance abuse (along with their family and friends) tend to blame their problems on addiction, when mental health problems are actually the primary contributing factor. If a patient does not even know that they are suffering from mental illness, they may not know to seek out a dual diagnosis facility. For this reason, every patient seeking help for substance abuse should also be screened for mental conditions in order to apply the proper treatment plan.
In order for real progress to be made with dual diagnosis patients, both co-occurring conditions should be treated concurrently in an integrated manner. Below we'll go over some of the methods used in dual diagnosis rehab centers.
Also known as medical intervention, medically assisted treatment involves the use of prescription medications to soothe some symptoms of drug withdrawal and substance abuse while also treating certain mental health issues. Because psychiatric medicine can also be incorporated into MAT, it is an ideal option for dual diagnoses.
Since the psychological symptoms of drug withdrawal can be much more severe for patients with co-occurring addiction and mental health conditions, managing those withdrawal symptoms is vital to a successful recovery program. Antidepressants and anxiety medications can reduce the psychological side effects of drug or alcohol withdrawal while helping with the symptoms of mental illness at the same time. When recommended by a psychiatrist, they can also be combined with other traditional medical intervention treatments like opioid replacement therapy.
By finding the right balance of medications to treat the individual symptoms and co-occurring disorders of each patient, an experienced team of addiction clinicians can make the detox and rehabilitation process much more comfortable for comorbid patients.
Completing the process of addiction detox and rehab is not easy for anyone. No one enjoys looking inside their psyche and inner turmoil to identify their own demons, but this is always necessary to a healthy recovery. For those who have a dual diagnosis, the process is even more difficult. More than a few patients walk away before they have a chance to complete the program.
Motivational enhancement therapy is a therapeutic process that helps each individual identify the hidden wants and needs that lie beneath their own will to succeed. By looking inside and finding the goals that they are working toward, each person discovers their own true reasons to power through the tough moments in order to achieve a healthy recovery.
A simple way to describe contingency management is the adult version of a sticker chart. This rewards-based system of treatment is based on every human's natural longing for praise, approval, and winning.
In a contingency-management program, each patient will be rewarded for completing different stages of the recovery process. Desirable prizes, like cash, vouchers, and sought-after services, are rewarded as patients make progress in their recovery. This serves two purposes - to provide added motivation into a difficult process, and also to condition patients to associate sobriety and progress with joy and satisfaction.
Since comorbid patients tend to have much lower completion rates in drug rehab programs, contingency management has been shown to increase success rates by as much as 50%.
Both substance use disorders and mental health disorders can result in unhealthy, self-destructive thinking patterns and attitudes. Cognitive behavior therapy (CBT) seeks to identify those thoughts, attitudes, and beliefs that are contributing to unstable mental conditions and substance abuse. Once those destructive thought patterns have been identified, they can be analyzed and restructured into a healthier mindset.
CBT is used to help each individual analyze the behaviors and views that are resulting in addictive patterns, self-hatred, and emotional damage. Because it addresses so many aspects of the psyche, CBT can be used to treat both drug abuse disorders and mood disorders at the same time.
Holistic solutions are simple, yet effective. Relaxing, centering exercises like yoga, meditation, and acupuncture have all been proven incredibly useful for drug or alcohol addicted patients as well as those who battle with mental illness.
By focusing on whole-self healing of the mind, body, and soul, patients find new ways to feel centered and comfortable in a newly sober body. Holistic therapy addresses the body and mind as one unit and also provides new mental and physical outlets for patients to refocus their energies. By learning these types of holistic outlets, patients will be more prepared to build a healthy, balanced lifestyle in recovery.
It can take quite a few misfortunes and setbacks before the average person admits that they have a problem with drug or alcohol abuse. In most cases, if you have to ask, then you probably already have a problem or will develop one if you continue with your current habits. If you're not sure about your own substance use or that of someone close to you, here are some warning signs to look for:
In other words, once your substance use has begun to cause issues with your health, your professional responsibilities, or your social life, you definitely have a problem. Another cause for alarm might be if you have tried to reduce or quit your drug use, but were unable to. If any of these factors ring true, it's time to find help. Whether you are struggling with possible co-occurring disorders or addiction all by itself, trying to quit without any support or guidance can be grueling, even dangerous. Seek out the assistance you need and begin your recovery before your habits cause permanent damage.
Substance abuse - whether it be alcohol, illicit drugs, or prescription meds - is both dangerous and life-altering. Even if you don't feel that your habits have crossed over into addiction, they could create lasting or life-threatening problems in the future. And once you begin to notice the appearance of withdrawal symptoms when you quit using, a dependence has already formed.
Substance dependence will be difficult to overcome. If you've already tried to quit using only to find it unachievable, you have an idea of how demanding the process is. With every failed attempt, relapse and overdose become more likely. Drug withdrawal is a debilitating and painful process that may even prove hazardous to your health. In order to detox in the safest, most comfortable way possible, it is advised to seek out a professional detox program at a licensed drug or alcohol treatment facility.
Even after the detox phase is complete, there is more work to be done in order to establish long-term sobriety. A lot of soul-searching and rehabilitation is necessary to confront the causes of addiction, learn how to cope with triggers and cravings, and establish a sustainable sober lifestyle. If you're truly ready to get sober, give your recovery the best chance possible and seek out a quality drug rehab center.
Whether you're reading this article for yourself or to help someone else, it's likely that you suspect someone of suffering from co-occurring addiction and mental disorders. Without a proper diagnosis, comorbid substance abuse and mental illness can be hard to identify; there are a few indicators to look for, however:
This is usually the first question a patient asks when searching for the right dual diagnosis rehab center, but there's no quick, simple answer.
Especially when it comes to dual diagnoses, every patient has a unique diagnosis and a different set of symptoms to cope with. By its very nature, integrated treatment is highly individualized; each patient will be offered a distinctive treatment plan, different therapies, and specialized medications.
Even the length of treatment and types of aftercare programs will need to be catered to each patient's different needs, so it is impossible to estimate an exact cost of treatment at the outset. Most health insurance policies are required to cover some types of addiction treatment as well; insurance will also affect your final out-of-pocket cost. The best way to get an idea of the price of integrated treatment is to call an addiction hotline to setup an initial consultation with a rehab facility near you.
The time is now. If you suspect that you or someone you care about is suffering from comorbid addiction and mental illness, don't waste any time. This dangerous combination of disorders will often feed off each other and compound quickly, sometimes disastrously. Especially if you've tried more traditional methods only to relapse or drop out of treatment, integrated dual diagnosis care may be the answer you've been searching for.
Don't let co-occurring disorders plague you for another day. There are hundreds of well-equipped dual diagnosis facilities across the country, and a well-trained team of professionals is waiting to help you. Recent research shows that integrated treatment for co-occurring disorders is both effective and successful, and new advanced methodologies are being developed every day. Make the call now that will change the rest of your life.
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