Doctor with her patientsYou’ve probably heard expressions like “drowning your sorrows with alcohol” or “numbing your pain with drugs.” But these popular sayings reflect a reality that causes suffering in thousands of Americans; many of the people who struggle with substance abuse also meet the diagnostic criteria for one or more psychiatric disorders. The coexistence of mental illness and addiction, also known as co-occurring disorders or a dual diagnosis, requires a specialized approach to therapy that can evaluate and treat both problems. Unless they receive treatment that targets their mental illness as well as their addiction, these individuals are likely to drop out of treatment or relapse.

Dual diagnosis recovery programs offer hope to people with co-occurring disorders. These programs integrate mental health services with addiction therapy to promote healing on both levels.

Dual diagnosis treatment should be customized to meet the needs of the individual, giving you the very best chance at success. If you or someone you love is battling the double demons of mental illness and addiction, you can find the help you need through a rehab facility that specializes in co-occurring disorders.

How Many People Have Co-Occurring Disorders?

  • It wasn’t until the 1980s that the mental health and addiction treatment communities became aware of the full extent of the problem of co-occurring disorders. Until that time, substance use disorders like alcoholism and opiate abuse were considered to be separate problems from mental health disorders like depression or anxiety. An individual with a drinking problem or a drug addiction was expected to “sober up” at a rehab facility before getting help for a mental health concern. By the same token, patients at mental health facilities were not treated for co-existing substance abuse issues.

    Today, psychiatric professionals and substance abuse treatment specialists know more about the nature and prevalence of co-occurring disorders. According to the National Alliance on Mental Illness, the problem is extremely common:

    • Approximately 33 percent of individuals with any psychiatric disorder also suffer from substance abuse.
    • Nearly 50 percent of people with a severe psychiatric disorder, such as bipolar disorder or schizophrenia, are also struggling with addiction.
    • Over 33 percent of alcoholics meet the criteria for a mental illness.
    • Over half of individuals who are addicted to drugs also have a psychiatric disorder.

    In the 1980s and 1990s, mental health professionals began to collaborate in earnest with addiction experts to create programs that addressed the needs of mentally ill patients with substance use disorders. For the first time, integrated treatment became available that reflected the needs, challenges, and goals of Americans with a dual diagnosis.

Which Comes First: Mental Illness or Addiction?

There is no definite answer to the question of whether mental illness causes addiction, or vice versa. In many patients, the two diagnoses are so deeply intertwined that it’s hard to tell the difference between the symptoms of a psychiatric problem and the signs of substance abuse. Mental illness and addiction can be intertwined in one or more ways:

  • Substance abuse can trigger psychiatric symptoms or make these symptoms worse.
  • Drugs and alcohol may be used as a form of self-medication to manage psychiatric symptoms.
  • Genetic factors (a family history of addiction) may predispose a person to psychiatric illness and substance abuse.
  • Chemical imbalances in the brain may make the individual more vulnerable to both addiction and mental illness.
  • Factors in the individual’s environment — such as an abusive home or a traumatic experience — may contribute to both mental illness and addiction.

To make the diagnostic process even more complicated, many of the effects of chemical intoxication, chronic substance abuse, and drug withdrawal mimic the signs of a mental health disorder. For instance, alcohol abuse can cause lethargy, feelings of hopelessness, self-isolation, and weight gain – all common symptoms of depression. Schizophrenia can cause hallucinations, paranoia, and disorganized thinking, which resemble the effects of drug use.

The Substance Abuse and Mental Health Services Administration cautions that the cognitive impairment caused by drug intoxication can interfere with an accurate diagnosis of mental illness. Drug and alcohol detox cleanses the chemicals from the system, making it easier for clinicians to detect the signs of mental illness.

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Which Psychiatric Disorders Occur with Addiction?

Any form of mental illness may increase the risk of addictive behavior; however, there are certain psychiatric disorders that occur more often in patients seeking help for substance abuse. The Division of Pharmacologic Therapies of the U.S. Department of Health and Human Services states that some of the most common co-occurring psychiatric disorders include:

Common drugs of abuse among people with a dual diagnosis include alcohol, marijuana, cocaine, meth, and heroin. Prescription drug abuse is widespread among individuals with mental illness, who may turn to painkillers, anti-anxiety medications, or sedatives in an attempt to control their destructive thoughts and fears. But while drugs and alcohol may provide temporary relief from depression, anxiety, or delusional thinking, these chemicals eventually make psychiatric symptoms worse.

What are the Risks of Mental Illness and Addiction?

Time and again, research has shown that people with mental illness and substance abuse disorders are more likely to drop out of rehab or to relapse after they complete a program. A 10-year study published in Psychiatric Services showed that people with co-occurring disorders are at risk of relapsing back to active drug or alcohol use for many years after completing a rehab program. Two-thirds of the study participants relapsed at some point during the 10-year period, and one-third relapsed within the first 12 months.

Why does mental illness set the stage for a return to drug or alcohol abuse, even after the individual has gone through rehab? Here are a few of the factors that put these individuals at risk of addiction:

    • Social prejudice against psychiatric illness
    • Lack of a strong support system
    • Higher unemployment rates
    • Low self-esteem
    • Poor motivation to recover
    • Fear and self-isolation

The rates of poverty, unemployment, incarceration, communicable disease, and suicide are higher among individuals with co-occurring disorders. Encouraging these individuals to enter rehab — and supporting them in their efforts to transform their lives — isn’t just a matter of helping them get clean and sober. It’s literally a matter of life and death.

What are the Signs of a Co-Occurring Disorder?

Identifying the signs of mental illness and substance abuse can be extremely challenging, even for professionals trained in diagnosing co-occurring disorders. If you or a loved one is actively drinking or using drugs, identifying symptoms of mental illness becomes even more difficult. Here are a few red flags that may indicate that you’re suffering from a psychiatric disorder as well as a substance abuse problem:

  • You can’t seem to get over feelings of sadness, guilt, worthlessness, or worry, even when you make an effort to get sober.
  • You have a close relative, like a parent, grandparent, or sibling, who had signs or symptoms of mental illness.
  • You have trouble starting or maintaining relationships with others because you often feel depressed, angry, irritable, or afraid of other people.
  • You have trouble keeping a job because you feel stressed, anxious, angry, or afraid at work.
  • You often use drugs or alcohol to elevate your mood, to calm yourself down, or to feel more emotionally stable.
  • You often think of harming yourself or of committing suicide, even when you’re not under the influence.

Although drugs and alcohol can be highly destructive, they can also be powerful coping tools for people living with mental illness. Along with detox and recovery services, dual diagnosis rehab programs offer help with emotional regulation, stress reduction, crisis intervention, medication management, and other critical mental health services. With the help of substance abuse counselors, psychotherapists, and peer support groups, it is possible to overcome co-occurring disorders and create a meaningful, rewarding life.

How are Co-Occurring Disorders Treated?

For individuals with mental illness, conventional rehab programs rarely lead to long-term recovery. Traditional treatment plans don’t accommodate the needs of people with psychiatric disorders, or give them the resources they need to overcome their personal obstacles. Successful dual diagnosis treatment is based on several important factors:

  • A qualified, cross-trained staff. In order to provide effective care, the professionals who work in dual diagnosis treatment must be equally knowledgeable in the fields of mental health and addiction therapy. Staff members should work together as a unified team to give their patients the very best chance at success.
  • Customized treatment plans. Psychiatric symptoms can vary greatly from one individual to another. Some patients may have difficulty focusing during meetings, while others may have trouble motiving themselves to attend counseling sessions. For others, compulsive thoughts or feelings of fear may get in the way of treatment. Individualized treatment plans are flexible enough to accommodate the special needs of each patient.
  • Adequate length of treatment. Because of the work involved in dual diagnosis recovery — and the challenges that these patients face in treatment — the length of stay in a recovery program is critical. Some patients may see improvement within a matter of months, but for many people living with a dual diagnosis, recovery can take 12 months or longer. Giving the patient adequate time to explore the roots of addiction, learn how to cope with mental illness, and acquire life skills can make all the difference in the world in his or her chances of success.
  • Centralized services. At one time, mental health care and addiction therapy were rarely, if ever, offered in a single location. Today, integrated programs offer both psychiatric services and substance abuse treatment at a single location, where patients can receive help for multiple concerns under one roof.
  • A patient-centered, motivational approach. In dual diagnosis treatment, therapy focuses on motivating and encouraging the patient to create the life he or she wants. Instead of criticizing, judging, or confronting their patients, therapists collaborate with patients to help them build inner strength and acquire new coping skills.

Treating mental illness and addiction isn’t easy. A high level of education, experience, and dedication are required from the professionals who staff a dual diagnosis recovery program. For dually diagnosed patients, the treatment team provides a crucial support network that can help them achieve their goals, both in the immediate future and in the years to come.

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What Happens After Rehab?

For individuals with co-occurring disorders, the period after rehabilitation is just as important as rehab itself. These patients need the support and care of compassionate professionals throughout their lives, not just while they’re going through detox or early recovery. A successful rehab program for co-occurring disorders includes a strong aftercare component, with services such as:

Life holds a lot of challenges and obstacles for people trying to recover from mental illness and addiction. In the months and years after rehab, you should feel that you’re always welcome to come back, no matter what turns your life may take. A comprehensive treatment program for co-occurring disorders includes ongoing support services that can help you make the transition from rehab to the “real” world.

At The Recovery Village, we take a holistic, patient-centered approach to rehab. Our multidisciplinary team consists of highly qualified, credentialed professionals who are cross-trained in substance abuse treatment and mental health care. From the detox phase of recovery through rehab and aftercare, we’re here to help you achieve healing at the physical, mental, and spiritual levels. Call our toll-free number for more information about our customized treatment plans today.

Mental Health and Addiction Therapies
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