According to empirical studies, the treatment and management of co-occurrence disorders or dual diagnosis are serious problems. Comorbidity or COD needs more advanced knowledge and techniques for screening, diagnosing, assessing, treating, and managing. According to a national survey on drug abuse and mental health in 2016, around 8 million people suffered mental and substance abuse disorders and 2 million had co-occurring disorders. Co-occurring disorder refers to a condition where a patient has a mental illness and a comorbid substance abuse disorder. Mood, anxiety disorders, and trauma often overlap with alcohol and drug abuse. Most patients suffering from dual diagnosis start using substances to help deal with mood disorders, anxiety, or trauma. As patients insist on using substances to deal with their mental illness, they end up with addiction, making treatment for their first illness even more complicated. Like other medical conditions that cause other health, mental health patients develop and escalate symptoms when alcohol or drug abuse is involved.
The most common symptoms that mood and anxiety patients use drugs to deal with include severe intrusive thoughts, low motivation and hope, and fear of public interactions. However, the use of drugs can also deteriorate mental health, causing anxiety and mood disorders. Good mental health is difficult to achieve while dealing with a substance disorder; hence the growth of urgency for treating both disorders. Due to the similarity of symptoms in substance abuse and mental health, the identification of disorders can be challenging. Therefore, mental health experts are encouraged to be thorough in assessment and diagnosis to avoid wrong diagnosis and wrong treatment approaches. (SAMHSA, 2020).
The similar and unique symptoms of both disorders affect the normal function of a person. Co-occurring disorders also influence each other. When a mood disorder anxiety or trauma treatment is neglected, it makes the substance abuse disorder worse, and when the substance abuse is untreated or increases, it increases the symptoms of the mental health or trauma symptoms (SAMHSA, 2020). Substance abuse and mental disorders like anxiety and depression do not necessarily because they are closely related. Past traumas mostly cause anxiety and depression. Alcohol, for instance, increases anxiety symptoms. As mentioned, individuals use drugs and alcohol to self-medicate and treat undiagnosed conditions to deal with emotions and change their moods for those with mood disorders.
Unfortunately, substance abuse causes side effects in the wrong run and affects the conditions they helped manage.
Comparing people with substance use and mental health disorders, those with co-occurring conditions have a high hospitalization because of the complex treatment of the condition.
Mental health illness is attributed to the complex interplay of genetics and the environment; hence, substance abuse directly causes the disorders. However, substance abuse increases the risk of developing underlying mental issues. For instance, the use of an opioid is reported to increase the chances of disorders, causing significant mood problems and anxiety. Overdose and addiction relating to opioids has become a crisis in public health and has been targeted by several campaigns and treatment campaigns. The concern has been attributed to the millions of American adult patients with co-occurring disorders with opioid addiction (Jones & McCance-Katz, 2019).
Also, the interaction of abused substances and doctor-prescribed medications may trigger or cause new symptoms. Alcohol and abused drugs interfere with medical drugs like mood stabilizers and anxiety medications, reducing their effectiveness and overall delaying recovery. Denial is both disorders that are common to patients. It is difficult for a patient to admit their dependency on substances to deal with typical day to day events. Whether in increasing symptoms of mental health or increasing the chances of underlying mental health issues, substance abuse influences an individual’s health.
Co-occurring disorders complicate screening diagnosis and treatment and, if not adequately handled, can compromise recovery. The number of reported mental disorders are increasing as substance disorders cases simultaneously rise. The increase in both disorders can be termed as evidence that patients with poly-substance use are vulnerable to co-occurring disorders (SAMHSA, 2020). Symptoms of mental and substance disorder intensify each other, making it hard to separate them. The best approach, therefore, to treat co-occurring disorders is to treat both simultaneously. Counselors treating co-occurring disorders always want to establish the disorder that developed first, which is not easy or clear in most times. Despite the illness that appeared first or led to the other’s development, recovery depends on getting both treated and managed. In some cases, a mental disorder or trauma can lead to alcohol or drugs to cope and, finally, addiction. It could also be that a person develops a disorder, for instance, a drug-induced psychotic disorder.
Co-occurring disorders can also be bidirectional, meaning the presence of a third condition causing one or both the disorders like chronic pain. Similarly, external environmental factors like stress can affect one disorder; hence it is less likely to establish a causal relationship. Regardless of the causal relationship of co-occurring disorders, the influence between both conditions proves that both disorders require equal seriousness in treatment. In some cases, substance abuse can mimic mental disorders making screening a crucial part of the treatment.
Co-occurring disorders do not always occur with equal severity. In most cases, one disorder is more severe, affecting the other more. Understanding this as a clinician is essential in creating a person-centered treatment plan. Even similar co-occurring disorders require different approaches for the diagnosis, treatment, referrals, and management. Various models have been established to help clinicians make decisions based on each case’s impact and severity. For instance, the four-quadrant model categorizes patients into four categories depending on the severity of the disorders. Although some patients may use substances to cope, clinicians are advised not to assume it as the cause of their mental and substance disorders (Sarvet et al., 2018.) Treatment for mental health disorders can include medication, group, or private counseling, mostly behavioral and cognitive, and healthy family and peer support. Substance abuse disorder treated ay entail detox, withdrawal management, behavioral therapy, and support groups like AA to help support sobriety. According to the Department of Health and human resources in America (SAMHSA) through long-term research studies has proved that co-occurring disorders are better approached through a comprehensive, long term, stage wise model.
Clinicians should be advised that substance abuse disorder, especially detox and withdrawal management, should not be left for patients without care. Most substance abuse patients are even hospitalized to reduce and help control drug withdrawal risks and effects. Effects of withdrawal include tremor, anxiety, sweating, nausea, agitation. If left without care, the patient can take the drugs to reduce the impact. An addiction counselor cannot help a patient with co-occurring disorders, nor can a mental health counselor. Both experts need to work in parallel to ensure both disorders are treated, and one does not weigh on the other. One of the problem patients with comorbidity patients is being sent from one counselor to another before proper diagnosis. Some patients spend years moving from one counselor to another, treating one disorder while not the other making the treatment less effective.
Hence clinicians need to focus on integrated and holistic treatment for diagnosis and treatment for disorders to cater to the full range of client’s symptoms equally (McHugh, 2015). For a client to recover, they have to overcome denial and accept treatment. Therefore clinicians need to adopt a stage-wise model tailored to a patient’s stage of acceptance for treatment. In addition to substance abuse treatment and mental disorders, co-occurring disorder patients require more support to help stabilize their social skills and life either at home or work.
Positive research findings on continued care for addicted persons have emphasized that clinicians’ continuous care benefits patients with co-occurring disorders. Therefore, in co-occurring disorder, no one disorder should be treated the other as both influences each other. Assessment to determine both disorders’ comorbidity and severity are efficient in developing a personal, tailored, interfaced approach to treat a specific individual (TIP 42; SAMHSA, 2020.)
References.
Jones, C. M., & McCance-Katz, E. F. (2019). Co-occurring substance use and mental disorders among adults with opioid use disorder. Drug and alcohol dependence, 197.
McHugh, R. K. (2015). Treatment of co-occurring anxiety disorders and substance use disorders. Harvard review of psychiatry, 23(2).
Tip 42; Substance Use Treatment for Persons with Co-occurring Disorders. A treatment improvement protocol (TIP) 42 at https://store.samhsagov/product/tip-420-substance-use-treatement-persons-co-ocurring-disorders/PEP20-02-01-004.
Sarvet, A. L., Hasin, D. S., Meyers, J. L., Saha, T. D., Ruan, W. J., Stohl, M., & Grant, B. F. (2018). Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA Psychiatry, 75(4).