Healing the Whole Self: Co-Occurring Disorders Treatment

Co-occurring disorders are typically conditions where substance abuse is directly linked to mental illness, regardless of which came first. SAMHSA has reported in its 2021 National Survey on Drug Use and Health that approximately 9.2 million American adults have a co-occurring disorder. Addiction to any substance, including alcohol, prescription drugs, and stimulants, can co-occur with any form of diagnosable mental health condition, including:

• Psychotic illness
• Schizophrenia
• Bipolar disorder
• Conduct disorders
• Borderline personality disorder
• Major depressive disorder
• Post-traumatic stress disorder (PTSD)
• Attention deficit hyperactivity disorder (ADHD)
• Obsessive-compulsive disorder (OCD)
• Eating disorders
• Depression
• Anxiety

In some cases, mental illness leads to substance abuse, and in others, substance abuse happens first. For example, someone with depression may use drugs to self-medicate or someone who is addicted to methamphetamine may experience recurrent “meth psychosis” or other permanent changes to the brain due to drug use. Often the cause-and-effect relationship is less clear. Once co-occurring disorders exist, mental illness and addiction have a bidirectional relationship where either can continue to affect the other.

Integrated treatment ensures both the substance abuse disorder and mental health issues are treated at the same time. A more complete recovery is possible with an integrated approach because patients with co-occurring disorders are less likely to complete substance abuse treatment than those without mental health conditions. They are also more likely to have weaker coping skills and fall prey to wrong thinking, which can make a successful recovery more difficult.

Because there are many possible combinations of substance abuse dependency and mental health conditions, it’s important that treatments address the unique needs of each individual. One type of treatment will not be suitable for all people, so it must be personalized. Holistic programs treat the whole person and include a variety of modalities.

A comprehensive assessment is an important first step in developing a personalized treatment plan for someone with co-occurring disorders. The assessment should include the identification of vulnerabilities to addiction, such as past trauma and self-medication for anxiety or depression.

It should also include an evaluation of the person’s mental and emotional state so co-occurring disorders, and their severity, can be identified. This information forms the basis of an individualized treatment plan that addresses not just the addiction, but also any other mental health disorder.

The effectiveness of evidence-based approaches is confirmed by research. Four of the most common approaches are:

• Medication-assisted treatment
• Cognitive-behavioral therapy
• Dialectical-behavior therapy
• Support groups and peer support

Medication-Assisted Treatment (MAT)

For many patients, medications can help alleviate detoxification symptoms and make the withdrawal process more tolerable. In addition, other medications may help achieve long-term recovery, depending on the substance. For example, methadone is an option for those addicted to opiates because it helps with cravings and prevents users from feeling the benefits of opiates. Naltrexone and Vivitrol, its long-acting injectable form, also block the euphoric rewards of opiates and can help in the recovery of opiate dependency.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy is an effective treatment for both substance abuse and many mental health conditions. It can be especially helpful for people with co-occurring disorders because it treats both issues at the same time. It works primarily by helping individuals develop positive thought patterns and learn healthy coping skills.

Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy helps people regulate their emotions, so they can properly navigate painful experiences without turning to self-harm or substance abuse, so it can be an effective treatment for co-occurring disorders. This therapy often integrates mindfulness and interpersonal effectiveness techniques.

Support Groups and Peer Support

Support groups and peer support are invaluable in recovery. Connecting with others who share similar experiences and learning how they cope with mental health issues and deal with cravings can help a person with co-occurring disorders follow in their footsteps. Many find 12-step programs especially helpful, although there are other alternatives.

Addiction typically affects relationships because it often involves isolation, neglecting responsibilities, secrecy, and lying. With co-occurring disorders, the strain on relationships that addiction causes can be even more severe.

An important part of successful recovery involves healing those relationships and reestablishing bonds. In many cases, loved ones need to be educated about addiction to offer acceptance and support without being judgmental. However, it can take a long time to rebuild trust once it’s been lost. Having a supportive network can increase a patient’s chances of a successful recovery even with co-occurring disorders, so it’s important to have the support of loved ones and family members in recovery.

For loved ones and those suffering from co-occurring disorders, there are treatment centers with addiction and mental health professionals who can treat both addiction and mental health issues in an integrated setting. It’s common to have questions or to not be sure where to start. Here are some resources to learn more about co-occurring disorders treatment and where to find help:

• National Institute on Drug Abuse
• Substance Abuse and Mental Health Services Administration
• Alcoholics Anonymous
• Narcotics Anonymous