Understanding Co-Occurring Disorders

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According to the Substance Abuse and Mental Health Services Administration (SAMHSA), "People with substance use disorders are at particular risk for developing one or more primary conditions or chronic diseases." The same can be said for individuals with mental health disorders adopting substance-abusing behaviors. When substance use disorder (SUD) and mental health disorders occur simultaneously, they are referred to as co-occurring disorders.

Prevalence of Co-Occurring Disorders

Data by the National Institute on Drug Abuse (NIDA) found that in 2017, nearly 7.7 million adults experienced a co-occurring mental health disorder and SUD. Of the 20.3 million adults with SUDs, nearly 40% also had a mental illness. Further, of the 42.1 million adults with mental illness, nearly 20% had SUDs. 

Despite their prevalence, co-occurring disorders can be incredibly challenging to overcome. This is because co-occurring disorders are comorbid, meaning “that the interactions between these two disorders can worsen the course of both.” Although treatment can be complicated, recovery from co-occurring disorders is possible through the use of integrated and individualized treatment. 

Substance Use Disorder and Addiction

To understand co-occurring disorders, it is important to understand SUD and mental health disorders separately. Addiction is the most severe type of SUD, defined by the NIDA as "a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences." 

Chronic substance use and SUD causes lasting impairments in an individual's brain and associated behavior, interfering with brain circuits responsible for self-control, stress management, emotional regulation, and more. Professional intervention is often required to address and reverse these brain changes. 

Addiction interferes with an individual's ability to function normally in their daily life, often leading to dysfunction in interpersonal relationships, academic life, career life, and overall sense of self. Unfortunately, it can take years of substance abuse for an individual to consciously recognize the consequences in their life. However, this is not necessarily the fault of the individual using drugs; it is the fault of their ever-changing brain circuits as a result of chronic alcohol and drug use. 

Mental Health Disorders

The National Institue of Mental Health (NIMH) uses two broad categories to accurately define mental illnesses:

  • Any mental illness (AMI) is “defined as a mental, behavioral, or emotional disorder.”
  • Serious mental illness (SMI) is “defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities.”

In either case of mental illness, each disorder can vary in impact. While some may struggle with mild or moderate symptoms of their mental health disorder, others may experience crippling symptoms. AMI encompasses all types of mental illness, whereas SMI is a more severe subset of AMI. 

There are many different types of mental health disorders. Some of the most common types include:

  • Anxiety disorders: generalized anxiety disorder (GAD) and social anxiety disorder
  • Mood disorders: major depressive disorder (MDD) and bipolar disorder
  • Personality disorders: borderline personality disorder (BPD), dependent personality disorder, and more
  • Neurodevelopmental disorders: attention-deficit/hyperactivity disorder (ADHD) 
  • Psychotic disorders: schizophrenia and schizoaffective disorder
  • Trauma-related disorders: post-traumatic stress disorder (PSTD)
  • Eating disorders: anorexia nervosa and bulimia nervosa

The Potential Causes of Co-Occurring Disorders

Although SUD and mental health disorders tend to occur together, it does not necessarily mean that one caused the other. Research by the NIMH sheds light on three possibilities to explain why co-occurring disorders often exist together:

#1. Shared Risk Factors

Many risk factors that contribute to the development of SUD also contribute to the development of mental health disorders. For example, an individual with a family history of substance abuse experiences a greater risk of using alcohol and other drugs as well as a greater risk of developing a mental health disorder. Additionally, unresolved childhood trauma and additional stress can also influence substance use, abuse, and mental illness. 

#2. Self-Medicating Practices

Individuals who struggle with mental health disorders are more likely to use alcohol and other drugs to self-medicate their symptoms. However, this can quickly develop into chemical dependency and addiction. Not only does self-medicating worsen symptoms over time, but it also leaves the underlying causes of symptoms untreated. 

#3. Resulting Brain Changes

The last possibility is that SUD can trigger lasting brain changes, making an individual more vulnerable to developing a mental health disorder. Alcohol and other drugs cause lasting impairments to the brain and behavior. Even if an individual is not at risk of developing a mental health disorder, brain changes caused by substance abuse can be a risk in itself. 

Treatment for Co-Occurring Disorders

Effective treatment for co-occurring disorders requires addressing both disorders simultaneously. Most facilities utilize individualized and integrated approaches. Individualized treatment tailors treatment to fit the unique needs and recovery goals of a client. Integrated treatment integrates several different treatment approaches to address both the symptoms and effects of SUD as well as the symptoms and effects of the mental health disorder.

The SAMHSA explains, “Integrating both screening and treatment for mental and substance use disorders leads to a better quality of care and health outcomes for those living with co-occurring disorders by treating the whole person.” Some of these positive outcomes include:

  • "Reduced or discontinued substance use
  • Improvement in psychiatric symptoms and functioning
  • Increased chance for successful treatment and recovery for both disorders
  • Improved quality of life
  • Decreased hospitalization
  • Reduced medication interactions
  • Increased housing stability
  • Fewer arrests"

Co-occurring disorders are the existence of substance use disorders (SUDs) and mental health disorders together. These conditions can present various complications for treatment and recovery, as co-occurring disorders are co-morbid. Still, recovery is possible through the use of individualized and integrated treatment. At Pathways Recovery Center, we understand how important it is to treat the underlying causes of addiction to ensure long-lasting recovery. We are passionate about helping our clients address and overcome these underlying causes, especially co-occurring mental health disorders. We offer a wide variety of treatment services and programs to individualize our client care. For support, guidance, or more information, give us a call today at (888) 771-0966

Clinically reviewed by 

Moses Nasser
Dr. Moses Nasser, a double board-certified physician in Family Medicine and Addiction Medicine, with expertise in holistic healing, addiction medicine, and psychiatric care, holds an X-waiver to prescribe buprenorphine and has extensive experience in mindfulness-based customer service and medication-assisted treatment.

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