Co-occurring Disorders - An Overview

Introduction

The co-existence of mental health disorders and drug abuse disorders is collectively known as co-occurring disorders. Such a situation increases the severity of both disorders. Usually, these conditions exist independently of each other in a person. Still, their symptoms must be amplified when both are present together, as they are more severe when they co-occur. Co-occurring disorders not only make the symptoms worse, but they also complicate the diagnosis and treatment of a condition.

What Are the Causes of Co-occurring Disorders?

The causes of co-occurring disorders are:

• Environmental Factors - Co-occurring disorders can occur due to various environmental factors such as childhood trauma or abuse, stress, and physical or mental abuse that lead to mental health and substance abuse disorders.

• Genetic Factors - They may increase the vulnerability to developing mental illness and substance abuse disorder. Also, in some cases, substance abuse can trigger mental health illnesses by activating associated genes that would not have been active otherwise.

• Developmental Factors - Mental health issues and substance abuse often surface in a person's life during adolescence and adulthood. Therefore, during the brain development phase, the use of substances can affect brain health and thus affect mental health or vice versa.

What Are the Symptoms of Co-occurring Disorders?

The symptoms of co-occurring disorders develop in the same person and are similar to substance abuse and mental health disorders.

These include:

• Risky behavior.

• A person loses control over substance abuse.

• Changes in behavior are sudden.

• A person feels the need to use substances for normal functioning.

• Health and hygiene get compromised.

• Management of daily tasks becomes difficult for a person.

• Substance abuse under unsafe conditions.

• A person also develops a high tolerance to withdrawal symptoms or a substance.

• They isolate or withdraw themselves from friends and family.

What Are the Various Mental Disorders That Co-Occur With Substance Abuse?

Mental health disorders co-occurring with drug abuse are as follows:

• Eating Disorder - It is an abnormal eating behavior, such as binge eating, anorexia nervosa, and bulimia nervosa, that affects a person's mental and physical health. Such eating disorders put a person at risk of developing substance abuse habits and thus cause co-occurrence.

• Anxiety Disorder - It is a mental health disorder that causes worry, fear, and restlessness and affects daily life activities. This is the most common co-occurring disorder with substance abuse. Anxiety disorders can be of many types, such as generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and social anxiety disorder. A person co-diagnosed with anxiety and substance use disorders also develops severe symptoms, but substance-induced anxiety issues are less common than mood disorders.

• Personality Disorder - It is a group of mental health disorders that causes unusual functioning, behaving, and thinking patterns. Various personality disorders that often co-exist with substance abuse include antisocial personality disorder, borderline personality disorder, and narcissistic personality disorder. This co-occurring disorder is more common in drug abusers than in alcohol abusers.

• Mood Disorder - It is also a group of serious mental disorders used to describe various bipolar and depression disorders. The condition is usually co-diagnosed with substance abuse. However, it is unclear which one gets diagnosed initially, but both affect each other and worsen the symptoms. Therefore, the doctor should try to treat the substance abuse disorder first and then treat the mood disorder. Treating both conditions simultaneously can also improve the patient's condition.

• Psychotic Disorder - This mental health disorder causes abnormal perceptions and thinking and presents symptoms of hallucinations and delusions. This disorder is challenging to diagnose if it co-exists with substance abuse disorder because the psychotic disorder can also be a symptom of substance abuse in some cases.

What Are the Risk Factors for Co-occurring Disorders?

The risk factors for mental health disorders include:

• Unresolved trauma.

• Homelessness and poverty.

• Childhood trauma and abuse.

• Peer rejection.

• Poor academic performance and achievements.

• Lack of support and parental involvement.

• Unresolved depression, anxiety, and emotional distress.

• Family history of mental health issues or other biological or genetic factors, such as chemical imbalances in the brain.

The risk factors for substance abuse disorders include:

• Chaotic family environment.

• Family history of drug abuse.

• Lack of effective parenting.

• Poor academic performance and achievements.

• Temperament issues.

• Perception of drug-abused behavior in a society.

• Affiliation with other people involved in drug abuse.

• Lack of support and parent involvement.

How Are Co-occurring Disorders Diagnosed?

A person with co-occurring disorders usually presents symptoms of mental health disorders only, even if they have mental issues without substance abuse. The person can have symptoms of both conditions and mental health illnesses do not need to get worse in a person involved in substance abuse.

How Are Co-occurring Disorders Treated?

Co-occurring disorders need to be treated by addressing both co-existing conditions. The treatment can be initiated by controlling substance abuse, detoxifying, and treating mental health disorder symptoms with therapy. An integrated treatment plan can be initiated that includes dialectical and cognitive behavioral therapy that improves a patient's coping skills and reduces maladaptive behavior. The treatment intervention should include psychosocial, pharmacological, social, and educational approaches to treat such co-existing psychiatric disorders in a person. Counseling models and evidence-based approaches can also be incorporated into treatment plans for substance use disorders and trauma patients. In addition, integrated group therapy can also be used in adults who suffer from substance abuse and bipolar disorders.

The integrated treatment plan can help in the following ways:

• Discontinuation of drug abuse.

• Improved quality of life.

• Improvement in functioning and psychiatric symptoms.

• Recovery from both co-existing disorders and better outcomes and treatment success.

• Reduced interactions and medications.

• Decreased hospitalization.

Why Do Mental Health and Substance Abuse Disorders Co-occur?

Mental health and substance abuse disorders co-occur due to the following reasons.

• Overlapping the risk factors of both disorders, such as genetic and environmental factors.

• Substance abuse can trigger mental health disorders by causing long-lasting effects on brain functioning and structure.

• People suffering from mental health disorders and other related emotional distress and depression may get involved in drug abuse, alcoholism, and self-medication.

Conclusion

Co-occurring disorders, such as mental health issues and drug abuse, are often very challenging to diagnose as the symptoms overlap and entangle. Therefore, these symptoms usually interact with each other and thus influence the course and outcome of both disorders. However, early detection of the disorders and an integrated treatment plan can help improve the condition's prognosis and a person's quality of life.