How Common Are Co-Occurring Disorders?

Individuals with co-occurring mental health and substance use disorders are presenting in increasing numbers in a variety of treatment settings. Why is that? The increase can be traced by several reasons; first, there is an increase awareness of co-occurring disorders in addiction treatment. To some extent new information and a national movement toward the integrated treatment of co-occurring disorders and addiction has increased the recognition and diagnosis of these disorders.

Second, there are changing patterns of drug abuse. The generation born between 1946 and 1961 represents one-third of the nation’s population. This segment of the population faced several changes from the previous generations. Treatment of mental health disorders moved from institutions to the community where alcohol and drugs like Opioids are readily available. Exposure to the drug culture during this time meant experimenting with the different types of drugs was more acceptable, resulting in a higher rate of substance abuse among this age group.

Third, the social acceptance and experimentation with illegal drugs increased dramatically in the United States.

History of Mental Health Treatment

The history and philosophy of treatment in the psychiatric setting was traditionally based on several philosophies. A case management format took responsibility for identifying the needs and providing services to meet the needs of the client. The goal was to provide care in the community setting, which reduced the need for hospitalization. People were not encouraged to request higher levels of care. Success was in part measured by a reduction in state hospital admissions. Psychiatric problems were viewed as the primary problems that caused the secondary problems of alcohol and drug abuse or dependence. It was believed that once a person attained stability of their mental illness, they would not experience problems with drinking or using drugs.

Do people abuse substances for the temporary relief of depression or other mental health symptoms? Of course, they do. Do some of you identify with the belief that treating a mental health disorder, like major depression will eliminate any problems with alcohol and drug abuse? If you do, you are not alone in this belief. It is always important to treat a psychiatric disorder and address the symptoms. Even though a mental health disorder may create excuses to use substances, a psychiatric illness does not cause substance dependence.

History of Substance Disorder Treatment

The history and philosophy of treatment in the addiction treatment setting was traditionally based on the following philosophies: addiction counselors cared about the person in treatment but did not take care of the person’s needs. If a person did not do well, the pain of these consequences was often considered the prerequisite needed to bring people to the point of asking for help. The client was encouraged to ask for as much help as necessary, including hospitalization when indicated. Alcoholism and addiction were considered the primary problem causing the secondary psychiatric problems. Does alcohol and drug abuse cause problems in emotional stability, thinking, personality, and behaviors? Of course, it does. Alcoholism and addiction, however, do not cause mental health disorders.

Separate Systems Created Barriers to Treatment of Co-Occurring Disorders

The differences between mental health and addiction treatment philosophies created unfortunate barriers to treatment. Gaps in service were caused by several factors. When a dually diagnosed person entered into a mental health facility, the treatment they received often depended on several factors. The psychiatric system, in what were otherwise superb psychiatric treatment programs, were often found to have a little or no means for addressing substance use.

When addiction was viewed as a secondary to the mental illness, substance disorders often went untreated. Remember, it was previously thought that treating a psychiatric disorder was enough in managing substance abuse. Addictive disorders often went unrecognized or were minimized in the establishment of a patient’s status as a psychiatric patient. When addictive behavior got obviously out of control, the person was often referred to an addiction treatment facility.

When a  person with a co-occurring disorder entered a chemical dependency program, the treatment they often received depended on several factors. The signs and symptoms of a thought disorder, mood disorder, or personality disorder may have been confused with the typical symptoms of early recovery from addiction. Well-meaning counselors may have seen someone’s struggles as those of a person in need of more A.A. meetings, a sponsor, more dedication to working the program of recovery, or simply more time in sobriety. The traditional view was a person needed to fully experience their emotional pain as a necessary step in promoting the willingness to make changes. This delayed the need for additional psychiatric assessment or perhaps medication to treat mental health disorder and support continued sobriety.

Another philosophical treatment difference was the reluctance in the addiction field to medicate people for psychiatric disorders who were in treatment for substance dependence. Furthermore, when a co-occurring psychiatric disorder was not recognized and treated, a person struggled with maintaining abstinence, which resulted in discharge from the chemical dependency facility. Being discharged often led to the continued abuse of alcohol and drugs to self-medicate untreated psychiatric symptoms and a worsening of both disorders.

Author: Cindy Hardy – Last Edited: October 29, 2019