Addiction Treatment for Co-Occurring Disorders
Co-occurring disorders is the term given when people are diagnosed with multiple medical or mental health conditions. Co-occurring mental health and substance use disorders (the clinical term for addiction, also known as SUDs) are sometimes referred to as dual diagnoses. If you have co-occurring disorders, you may benefit from specialized dual diagnosis treatment because each condition can worsen the other, and symptoms of both disorders need treatment in order for you to get better.1 Different co-occurring disorders treatment options are available to help you begin the healing and recovery process.
While some may think that co-occurring disorders are rare, statistics from the 2020 National Survey on Drug Use and Health (NSDUH) show that co-occurring mental health disorders are incredibly common alongside SUD diagnoses.
- 9 million adults had any mental illness (AMI) in the previous year.1 14.2 million of these people had a serious mental illness (SMI).1 Out of the 14.2 million with an SMI, 5.7 million (40%) also had an SUD.1 SMI means a person has a psychiatric disorder that seriously impairs their ability to function in everyday life.2
- Out of the 52.9 million with AMI, 17 million (32%) also had an SUD.1 Nearly half (49.5%) of these individuals received no treatment.1 Nearly 1/3 of those with SMI (33.6%) received no treatment.1
- Almost all (94.3%) of the 17 million adults with a past year co-occurring mental illness and SUD did not receive treatment services for both1 An estimated 9.3% of the 5.7 million adults with a past year serious mental illness and SUD did not receive treatment services for both conditions.
What Is a Co-occurring Disorder?
Co-occurring disorders is the term given to describe a diagnosis of substance use disorder and one or multiple mental health disorders.4, 1 People with multiple mental health disorders are up to nine times more likely to have multiple SUDs.1 In some cases, it is not always easy to tell what is a co-occurring disorder, because SUDs can mimic symptoms of mental health conditions.1 This is why specialized screening and treatment are important.
Co-occurring substance use and mental disorders commonly occur together because each can affect the development of and the course of one another, and it’s not always clear which disorder came first.1 Sometimes, a mental health condition can cause or impact the development of addiction, but the reverse is also true.1 Although it’s not always the case, people with mental health conditions may sometimes use substances to self-medicate or ease symptoms of a mental health disorder, a strategy that typically worsens symptoms in the long run.1, 3 People with certain types of addictions can also develop mental illness as a result of their substance use (such as cocaine-induced psychosis or opioid-induced depression).1
Certain overlapping risk factors can affect the development of co-occurring disorders with substance abuse. This can include stress, trauma, and certain genetic influences.3 Substance use can cause changes in the brain and behavior that can increase a person’s chance of developing co-occurring mental disorders, but brain changes that occur in people with mental illness can also increase the rewarding effects of substance use, which can potentially make repetitive substance use more likely.2
Common Co-Occurring Mental Health Disorders
What are co-occurring disorders that can affect people with addiction? While a person with a dual diagnosis can have any psychiatric condition in addition to an SUD, common mental health disorders that co-occur with SUDs include:4
Excessive fear and worry along with behavioral changes are the primary features of anxiety disorders.1 The most common anxiety disorders that occur with addiction are generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder (SAD). Co-occurring anxiety and SUDs are common; having a 12-month or longer drug use disorder is associated with 1.2-1.3 increased odds of having an anxiety disorder, 1.0-1.3 increased odds of having panic disorder, 1.2-1.3 increased odds of having GAD, and 1.1-1.3 increased odds of having SAD, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).1
This can include different types of depressive disorders, such as major depressive disorder (MDD) or persistent depressive disorder (PDD, also referred to as dysthymia). Some of the general symptoms of depression include a depressed mood for most of the day, lack of interest in activities you once enjoyed, sleep or appetite changes, and suicidal ideation or actions.1 According to SAMHSA, depression and SUDs very commonly co-occur; having a drug-related SUD for 12-months or more is correlated with a 1.3-1.5 increased chance of having PDD, and 1.2-1.3 increased risk of MDD.1
Post-traumatic stress disorder (PTSD)
This can occur after exposure to a traumatic event and is characterized by intense, intrusive re-experiences of the event; chronic avoidance of people, places, or things that remind you of the event; negative feelings; and increased arousal and reactivity (such as hypervigilance).1 According to SAMHSA, PTSD and SUDs are highly correlated; in people with SUDs, lifetime prevalence of PTSD is thought to range between 26-52%, whereas in people with PTSD, lifetime rates of SUD are estimated to be between 36-52%.1
Bipolar I disorder
This is characterized by mood swings that involve manic episodes (meaning extreme energy, euphoria, and activity) and depressive episodes.1 According to SAMHSA, bipolar I disorder occurs commonly with SUDs; 65% of those with bipolar disorder have a lifetime SUD.1 Having a 12-month or lifetime SUD is associated with a 1.4-1.5 increased risk of developing bipolar I disorder.1 In addition, having bipolar I disorder can cause a 2-5.8 times increased risk of SUDs.1
How to Treat Co-Occurring Disorders
Before the treatment process typically begins, individuals are evaluated using various types of screening and assessment tools. This is followed by the formulation of a treatment plan to help determine the right placement for your needs. The preferred model of treatment is an integrated approach where all disorders are treated concurrently. Substance use disorder treatment for persons with co-occurring disorders can involve other models of treatment, such as sequential or serial treatment, which means treating one disorder at a time, or simultaneous or parallel treatment, which treats both disorders but at different facilities.1 p.186 These types of treatment are considered to be less effective than a model that integrates treatment because they could actually worsen symptoms, and they do not provide comprehensive and collaborative care.1
As everyone has different needs, treatment for co-occurring disorders should be tailored to the individual and should ideally take place at one facility. Integrated treatment, the preferred method of addressing dual diagnosis, focuses on treating the person as a whole. Integrated treatment typically combines treatments for mental illness and addiction co-occurring disorders at the same treatment facility.1 Integrated treatment has been shown to be superior to other forms of treatment, in that it helps decrease substance use, improves mental illness symptoms, and helps people stay in treatment; furthermore, people often report increased satisfaction with this form of treatment.1
Co-occurring Disorders Treatment Process
The process of treating co-occurring mental health disorders typically begins with a comprehensive assessment to determine your exact needs. The treatment setting that is best for you can depend on the severity of your disorders as well as other individual factors.1 Medical detox may be the first step, which is designed to help you stop using substances and safely manage withdrawal symptoms. You may then proceed to inpatient rehab or an outpatient rehab clinic, depending on your needs. Your treatment facility should also prepare an aftercare plan for ongoing support; aftercare might include participation in mutual support groups (such as Alcoholics Anonymous) or some type of sober living facility, which may help you maintain sobriety as you transition to your daily life. 1
Integrated treatment settings may use medicines as part of treatment, in addition to different types of psychotherapies.4 The types of therapies used will depend on an individual’s needs and may include cognitive-behavioral therapy (CBT), motivational interviewing, exposure therapy, or dialectical behavior therapy (DBT), contingency management, and others designed to help change unhelpful or negative thought and behavior patterns.3 You may also receive a combination of psychotherapies. Long-term multidisciplinary treatment approaches such as Assertive Community Treatment (ACT) or Integrated Case Management (ICM) are also sometimes used; these treatment approaches provide intensive outreach and ongoing, long-term support.1
Does Insurance Cover Treatment for Co-Occurring Disorders?
If you have health insurance, your plan may be able to cover some or all of the cost of treatment for co-occurring disorders and addiction. The Affordable Care Act (ACA) requires insurance plans to provide equivalent coverage for substance abuse and mental health conditions, including co-occurring mental health disorders, as they do for medical conditions.5 However, coverage may vary depending on your type of insurance plan, your medical needs and treatment goals, the location of the facility, and the length of treatment. It’s important to determine the extent of your insurance coverage before committing to treatment. To see if you’re covered for co-occurring disorders treatment, contact your insurance provider or check your coverage online.
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How to Find Treatment for Co-Occurring Disorders
You can find a co-occurring disorders treatment center in a number of ways. A good place to start can be your primary care physician, who can perform a comprehensive evaluation and help determine the appropriate level of care. Keep in mind that you should find a specialized treatment track for your specific co-occurring disorder, as every disorder can require a different treatment approach. There are dozens of online treatment directories that can connect you with detox and rehab centers that treat co-occurring disorders.
American Addiction Centers (AAC) is a leading provider of dual diagnosis treatment and has co-occurring disorders treatment centers across the nation. We operate a 24/7 confidential substance abuse hotline that can connect you with an expert who can answer any questions you have about the treatment process and even help direct you to potential facilities. If you’re interested in starting the recovery process and taking back control of your health and wellbeing, please give us a call at . Alternatively, if you would like to get started online, start the process by checking your insurance coverage instantly or texting our team.