When a person is living with both a substance abuse disorder and a co-occurring mental health disorder, the best possible path for recovery begins with comprehensive treatment for both disorders. A co-occurring disorders treatment program should have all the resources the individual needs to build a foundation of recovery for both disorders. Here’s what you need to know.
Mental Health FAQs
- Depression (e.g., moderate to severe depression, dysthymia)
- Anxiety disorders (e.g., post-traumatic stress disorder, phobias, panic disorder, obsessive-compulsive disorder, etc.)
- Personality disorders (e.g., antisocial personality disorder, borderline personality disorder, etc.)
- Eating disorders (e.g., anorexia nervosa, bulimia nervosa, binge eating, etc.)
- Bipolar disorder
- Attention deficit hyperactivity disorder (ADHD, ADD)
- Autism spectrum disorders (ASD)
- Psychotic disorders (e.g., schizophrenia)
What are the root causes for mental health disorders?
There is no one cause of any mental health disorder. In most cases, a combination of issues contribute to the development of a mental health disorder, including:
- Family history: If you have a parent or sibling diagnosed with a mental health disorder, the chances that you will develop the same or similar mental health issues increase as compared to the general public. Similarly, if a grandparent was diagnosed with a certain mental illness, you may be more likely to develop that disorder as well, though the rate of risk is lower than if it were a closer relative.
- Trauma: The experience of a traumatic event, like sexual abuse, physical assault, wartime experience, or a natural disaster, may contribute to the development of a mental health disorder as well.
- Biology: Lack of oxygen at birth, prenatal exposure to toxins or chemicals, a serious accident, or brain injury – all of these and more can contribute to the development of a mental health disorder.
- Experiences: In some cases, the use of illicit substances or the development of a chronic and/or terminal illness like cancer may cause intrusive mental health symptoms.
- Mood swings
- Panic attacks
- Suicidal thoughts and/or behaviors
- Erratic behavior
In most cases, if mental health symptoms persist after drug use stops, which disorder came first does not heavily impact treatment. Both disorders will require treatment as the person learns how to manage the effects of both issues in order to avoid relapse in recovery.
- Inability to maintain commitments at home, work, or school (e.g., often late for work, missing school, forgetting to follow through on obligations or assignments, poor performance, and neglect of responsibilities including childcare or budgetary concerns)
- Use of drugs or alcohol in situations where it may be physically dangerous to both the user and bystanders (e.g., driving a car while under the influence)
- Legal issues caused by choices made under the influence or purchasing and/or using illegal drugs
- Continuing use of drugs and alcohol despite ongoing negative consequences (e.g., fights over drug use with a partner or boss, physical altercations or poor choices under the influence, etc.)
Addiction, however, is often diagnosed when the following issues are present:
- A tolerance for the drug of choice defined by a need to take more and more of the drug (or combine it with use of other substances) in order to achieve a high
- Physical withdrawal symptoms that occur when the person is without the drug of choice
- Inability to limit use of drugs or alcohol during a use session or over a period of days
- Inability to stop drinking or using drugs or limit use despite a genuine desire to do so
- Unwavering focus on getting more of the drug of choice and/or staying high or drunk that often requires poor choices and chronic damaging behaviors
- Giving up hobbies, friendships, interests, or commitments in order to better pursue drug and alcohol use
- Ongoing use and abuse of drugs and alcohol despite the increasingly negative physical and/or psychological issues that result
- The person’s mental health diagnosis
- The health and social needs of the person (e.g., family relationships, health status, etc.)
- The goals of the person for recovery and beyond (e.g., independent living, a return to a former career, etc.)
- The potential situational threats to the person’s ability to remain sober (e.g., underlying behavioral disorders, learning disabilities, physical disabilities, chronic disorders, etc.)
Essentially, each person’s treatment plan should be highly personalized and include a range of treatment options that speak to both the mental health disorder diagnosis and the substance abuse problem.
- Schizophrenia: Typical antipsychotic medications are usually used to treat schizophrenia (e.g., thorazine, Haldol, perphenazine, and fluphenazine).
- Depression: Antidepressants are used to treat moderate to severe depression. The most popularly prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs) (e.g., fluoxetine, citalopram, sertraline, paroxetine, and escitalopram).
- Bipolar disorder: Any combination of antipsychotics, antidepressants, and/or mood stabilizers may be appropriate in the treatment of bipolar disorder. Anticonvulsant medications that help to stabilize mood like divalproex sodium (Depakote), lamotrigine (Lamictal), oxcarbazepine (Trileptal), and carbamazepine (Tegretol) are often used in the treatment of bipolar disorder. Additionally, atypical antipsychotic medications like olanzapine, aripiprazole, risperidone, ziprasidone, and others are often prescribed alongside other meds. In some cases, antidepressants like fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft) are also prescribed.
- Anxiety disorders: Depending upon what is causing the issues with anxiety and the specific symptoms experienced, beta blockers, antidepressants, and antipsychotics may be appropriate. Specifically, tricyclic antidepressants like imipramine are often prescribed for those diagnosed with general anxiety disorder or panic disorder while clomipramine is often prescribed to treat obsessive-compulsive disorder. Additionally, benzodiazepines are specific to the disorder as well. For example, lorazepam is often prescribed for panic disorder while clonazepam is commonly prescribed for general anxiety disorder or social phobia. Propranolol, a beta blocker, is only prescribed for those who experience significant physical anxiety symptoms.
- Attention deficit hyperactivity disorder (ADHD): Stimulants are the medication of choice for most diagnosed with attention deficit hyperactivity disorder, especially methylphenidate, amphetamine, and dextroamphetamine.
It should be noted, however, that even though medications are an important part of treatment for many, they are only part of a comprehensive treatment program that will be able to give the patient the best opportunity to succeed in recovery for the long-term. Behavioral therapy, holistic treatments, and more ensure that people have an arsenal of positive coping skills to turn to in recovery.
- Attend family therapy/couples counseling with their addicted loved one
- Attend family support groups that will connect them with peer support
- Address personal mental health issues and/or substance abuse or addiction problems therapeutically on their own
- Learn more about addiction and the diagnosed mental health disorder and what is expected – and beneficial – during treatment
- Help the addicted person stick to recovery principles once home (e.g., help him to manage his treatment and therapy schedule or attend some 12-step meetings, doctors’ appointments, or therapy sessions with him as appropriate)
- Avoid trying to “fix” the addicted person’s problems or do things for him with the goal of making things easier for that person
- Avoid nagging or constant interrogation to determine whether or not the person is lying, drinking, or using drugs
While family members can be excellent support systems for people in recovery, it is possible for them to enable a return to drug and alcohol use or to inadvertently be a part of the reason that the person falls away from adherence to his mental health treatment plan. Speaking with a professional about the best ways to support someone in recovery – as well as the behaviors to avoid – will help to make sure that the family member is always a positive part of the recovering person’s life.
- Health insurance coverage
- Personal savings
- Savings allocated for other purposes (e.g., college, retirement, etc.)
- Personal loans or gifts from family members
Treatment Statistics and Research on Co-Occurring Disorders
Co-occurring disorders are exceedingly common. Those who are living with a drug or alcohol use disorder are about twice as likely to also exhibit symptoms of a mental health disorder as compared to the general population. Similarly, those who are living with a mental health disorder are twice as likely to develop a substance abuse problem as well. About 8.9 million Americans are believed to be living with both a drug or alcohol problem and a mental health disorder, yet only about 7.4 percent receive the treatment they need to heal.
In 2013, about 17.3 million Americans over the age of 12 lived with an alcohol use disorder including alcoholism in the past year, and 6.9 million Americans 12 and older abused illicit drugs and/or were addicted to them in the year prior to being surveyed.
Mental health disorders are one of the most common causes of disability in the United States and bear the largest disease burden of any disease. An estimated 14 million Americans (or 1 in 17 people) are living with a serious mental illness or mental health issues in any given year.
An estimated 25 percent of all years of life that are lost due to early death and disability are caused by disability in the US and Canada. About 30,000 Americans take their own lives each year, making suicide the 11th leading cause of death in the United States.
About 9.6 million Americans over the age of 18 (about 4.1 percent of all adults) were living with a serious mental illness in 2012. Additionally, an estimated 20 percent of kids under the age of 18 in the United States either have had or currently are living with a “seriously debilitating mental disorder.”
More than 18 percent of American adults are living with an anxiety disorder and almost 23 percent of these cases are identified as severe. Additionally, women are 60 percent more likely to be diagnosed with an anxiety disorder than men.
Attention deficit hyperactivity disorder (ADHD) is best known as a childhood disorder characterized by difficulty managing behavior, staying focused, or paying attention to directions, but it is a problem that often continues into adulthood. It is estimated that more than 4 percent of adults over the age of 18 in the US struggle with the disorder, with more than 41 percent of the cases classified as serious. Additionally, 9 percent of kids between the ages of 13 and 18 are diagnosed with ADHD, a diagnosis that is more than twice as common among males as females.
Autism spectrum disorders (ASD) are defined by deficits in social communication and interaction in various forums as well as repetitive behaviors and restricted interests that begin in the first few years of life. It encompasses a spectrum of experience from mild to severe and is a disorder that occurs in one of every 68 children. It is almost five times as likely to occur in males as compared to females.
Eating disorders like anorexia nervosa (serious self-deprivation of calories), binge eating (eating large amounts of food followed by periods of extreme dieting and/or purging), and bulimia nervosa (purging of food) are some of the most deadly mental health disorders because they not only deprive the body of necessary calories for energy but also of nutrients necessary to survive. Eating disorders do not just plague women or adults. An estimated 2.7 percent of children in the US struggle with an eating disorder, and more and more men are diagnosed with these types of disorders every day.
Mood disorders (e.g., bipolar disorder, dysthymic disorder, and/or major depressive disorder) plague about 9.5 percent of the US population over the age of 18, and about 45 percent of these cases are classified as severe. Women are about 50 percent more likely to be diagnosed with a mood disorder as compared to men. About 14 percent of children between the ages of 13 and 18 are diagnosed with a mood disorder, and about 4.7 percent of these cases are deemed “serious.”
Personality disorders (e.g., borderline personality disorder, avoidant personality disorder, antisocial personality disorder, and others) are defined by an ongoing pattern of behavior and perspective that is markedly different than that which is expected by the society in which he lives and that allows him to function healthfully within that society. More than 9 percent of the population is living with a personality disorder yet only 39 percent of that number are getting the treatment they need to manage it effectively.
Though 13.4 percent of adults in the United States received some level of treatment for a mental health issue, only 58.7 percent of those who needed treatment for a serious mental illness got the help they needed.
- Cognitive behavioral therapy (CBT): Cognitive behavioral therapy combines cognitive therapy and behavioral therapy to identify the behaviors and perspectives that a person holds that may be contributing to or creating the difficulties she experiences. This type of therapy is very commonly used to treat a range of mental health disorders in order to help people identify the beliefs and viewpoints that are harming them since these are often a significant part of the mental health disorder. Once identified, these harmful perspectives and behaviors can be replaced by more positive ones that aid the individual in creating a more positive quality of life for herself.
CBT can be adapted to treat depression, anxiety disorders, bipolar disorders, eating disorders, schizophrenia, substance abuse and addiction, and trauma.
- Dialectical behavior therapy (DBT): One form of cognitive behavioral therapy is dialectical behavior therapy. DBT was designed to address suicidal behavior in patients, and it is often used to treat borderline personality disorder as it is often characterized by suicidal thoughts and behaviors.
- Interpersonal therapy: The focus of interpersonal therapy is on improving communication patterns with others with the goal of learning how to get needs met healthfully while respecting the needs of others. It is commonly used to treat depression or dysthymia.
- Family-focused therapy: The value in this type of therapy is heavily placed on improving family relationships and healing old wounds that may be continually problematic for all involved. Family members take part in therapy sessions with the patient. This form of therapy is often utilized to treat bipolar disorder and for patients who are living at home while seeking drug abuse and addiction treatment.
- Antipsychotic medications: There are both “typical” and “atypical” antipsychotic medications used to treat mental health disorders like schizophrenia and bipolar disorder. They serve to address symptoms like hallucinations, breaks with reality, and psychotic symptoms.
- Antidepressants: Used to treat depression, anxiety disorders, and bipolar disorder, antidepressant medications work to help balance any imbalance of naturally occurring chemicals in the brain that affect mood and emotion.
- Mood stabilizers: Mood stabilizers are one of a few different types of medications commonly prescribed to treat bipolar disorder. Anticonvulsant medications are often used to stabilize mood and can be effective in managing the ups and downs experienced by some individuals.
- Anti-anxiety medications: Benzodiazepines are sometimes prescribed to people struggling with extreme anxiety symptoms. They work by slowing the central nervous system’s responses to stress and can work more quickly than waiting for a buildup of other medications, like antidepressants, in the system. Unfortunately, these drugs can be highly addictive and may contribute to the development of a co-occurring substance abuse disorder over time.
- Beta blockers: Beta blockers may be prescribed to those who experience extreme physical symptoms during a panic attack or before facing a situation that triggers a phobia.
- Stimulants: Attention deficit and hyperactivity disorder (ADHD) is often treated with stimulant medications. They can help to improve focus in children who are living with the disorder, but if body chemistry changes, they can become addictive and contribute to a co-occurring drug abuse or addiction disorder.
Specific Mental Illnesses
There are a number of different types of mental health disorders that can be problematic and co-occurring with substance abuse issues. These include:
- Prevalence: More than 20 million Americans are living with some form of depression.
- Common symptoms: Signs of depression include extreme weight loss or gain, sadness, lack of energy, sleeping too much or too little, lack of interest in old hobbies, feeling worthless, and considering suicide.
- General causes: Depression may be caused by acute issues or specific events, or it may exist as part of a different diagnosis. For example, postpartum depression may occur within the year after a woman gives birth, or seasonal affective disorder may become an issue for some people during the winter, but for those living with bipolar disorder, depression is only part of the disorder.
- Treatment medications: Depression is usually treated with tricyclic antidepressants like Prozac or Zoloft.
- Successful therapies: Medication alone is not enough to overcome depression. In most cases, cognitive behavioral therapy is recommended as well as other holistic treatments designed to lower stress, advance physical health, and improve mood.
- Long-term outcome: With regular engagement with treatment, many living with depression learn how to manage their symptoms effectively.
- Prevalence: An estimated 40 million Americans struggle with an anxiety disorder.
- Common symptoms: The signs and symptoms of an anxiety disorder may vary depending on the specific disorder but may include flashbacks to traumatic events, rapid heart rate and breathing when faced with a feared situation or thing, nightmares, obsessive thoughts or behaviors, and overwhelming feelings of fear or panic.
- General causes: Anxiety may be a genetic issue that begins to become apparent during the teen years or even childhood, or it may be triggered (or worsened) by acute events. For example, someone who lives through a traumatic sexual or physical assault, natural disaster, or life-threatening situation may develop post-traumatic stress disorder.
- Treatment medications: Benzodiazepines like Xanax or Klonopin, beta blockers like Inderol, or antidepressants like Lexapro, Celexa, or Zoloft – or any combination of these – may be helpful in treating anxiety.
- Successful therapies: Exposure therapy, a form of cognitive behavioral therapy (CBT), may be helpful especially for those who must face their fears in order to learn how to manage the anxiety those fears trigger. Other forms of cognitive behavioral therapy as well as holistic treatments like yoga and meditation may help individuals to manage anxiety as it arises.
- Long-term outcome: With ongoing treatment, anxiety symptoms should lessen with time. In some cases, patients may eventually be free of the need for medications if they are initially necessary, especially if their anxiety was driven or worsened by drug use.
- Prevalence: An estimated 9 percent of American adults over the age of 18 have a personality disorder.
- Common symptoms: Symptoms vary from disorder to disorder but in general, those living with a personality disorder often have explosive relationships with others, find it difficult to get their needs met healthfully without dysfunctional behaviors (e.g., lying, manipulating others, etc.), have emotionally inappropriate responses to normal stimuli, and find it difficult to control impulsive behavior.
- General causes: Genetics and childhood experiences may play a part in the development of a personality disorder, but there is no known cause.
- Treatment medications: Anti-anxiety medications, mood stabilizers, antidepressants, and/or antipsychotics may be appropriate.
- Successful therapies: In some cases, inpatient hospitalization may be necessary to stabilize the individual. In less severe situations, intensive outpatient treatment that incorporates medication as well as behavioral therapies is recommended.
- Long-term outcome: Every person is different. Some find that symptoms begin to improve during middle age; others find that dedication to a medication regimen and behavioral therapy is the only way to find balance.
- Prevalence: As many as 24 million Americans are living with an eating disorders. Eating disorders are 2.5 times more likely to occur in women, but they occur in men, as well.
- Common symptoms: Depending upon the specific eating disorder experienced by the person, the symptoms will be different. Anorexia nervosa is characterized by starving oneself, while binge eating is defined by regular and excessive overeating. Bulimia nervosa is defined by binge eating following by purging.
- General causes: Psychological, genetic, social, biological, and behavioral factors may all play a part in the development of an eating disorder.
- Treatment medications: Antidepressants and/or anti-anxiety medications may be helpful depending upon the experience of the individual. This is in addition to the medical care required to address physical problems created by extended disordered eating.
- Successful therapies: Cognitive behavioral therapy, nutritional counseling, and personal training often play key roles in recovery from an eating disorder.
- Long-term outcome: Round-the-clock care is often necessary in the first few months of treatment in order to help the person stabilize medically and establish healthy eating habits.
- Prevalence: An estimated 2.6 percent of American adults over the age of 18 are living with bipolar disorder.
- Common symptoms: Extreme mood swings, suicidal thoughts and/or behaviors, and erratic behavior that leads to difficulty in relationships at home and work signify bipolar disorder.
- General causes: Genetics may play a role in the development of bipolar disorder, but abnormal brain function and structure may additionally play a part.
- Treatment medications: Antipsychotic medications, antidepressants, and mood stabilizers may be used in the treatment of bipolar disorder.
- Successful therapies: Medication is a primary part of bipolar disorder but so too are regular cognitive behavioral therapy, family therapy, and other therapeutic interventions.
- Long-term outcome: Bipolar disorder is usually a lifelong disorder that requires ongoing engagement with treatment in order for continued management of symptoms and mood.
- Prevalence: It is estimated that about one in 68 children is somewhere on the autism spectrum.
- Common symptoms: Repetitive behaviors and interests, difficulties interacting appropriately and effectively with others, and impaired functioning across multiple fronts often characterize autism.
- General causes: There is no known cause of autism, but research suggests genetics and environmental factors may play a role.
- Treatment medications: A range of medications may be appropriate in the treatment of autism, including antipsychotics, antidepressants, stimulant drugs, and/or mood stabilizers.
- Successful therapies: Applied behavioral analysis (ABA) therapy is a widely accepted method of treatment to assist individuals in learning new behaviors and minimizing intrusive behaviors.
- Long-term outcome: Autism is a lifelong disorder. Early and intensive intervention is recommended for the best possible outcome. Medications and therapeutic assistance may be necessary for life.
- Prevalence: An estimated 3 percent of the population may be living with a psychotic disorder or experience psychotic behaviors.
- Common symptoms: Delusions and hallucinations are hallmarks of psychotic disorders.
- General causes: Stroke, brain tumors, certain drugs and alcohol, and some brain infections may cause psychotic behaviors or contribute to the development of a psychotic disorder. Additionally, psychotic behaviors may be experienced by people diagnosed with bipolar disorder. Genetics and environment may play a part.
- Treatment medications: Antipsychotic medications are often part of treatment. Antidepressants and/or anti-anxiety medications may also be effective, depending upon the specific person’s experience.
- Successful therapies: Inpatient hospitalization may be required for the most severe cases and in instances where the patient may hurt himself, but many will be able to manage symptoms with medication, brain stimulation therapies, and therapeutic support.
- Long-term outcome: With ongoing support and treatment, patients may be able to live independently and safely.