What are Co-Occurring Disorders?

America is currently grappling with a new devil; opioids. Despite the monumental war America has waged on drugs, it seems the problem only worsens. Everyday overdose death rates continue to flare up in parts of the US and drugs are continuously finding their way into our borders. Worse yet, with new substances like fentanyl—a synthetic opioid 50 times stronger than heroin—this epidemic is harvesting a death toll in the thousands. Fentanyl is now responsible for half of the overdose deaths in the US. In fact, the opioid epidemic has become America’s grim reaper; today, the #1 cause of death for Americans under the age of 35 is overdose.

While our efforts are expended on securing our borders, instilling extreme punishments for drug dealers and traffickers, and establishing infrastructure for addicts in need, perhaps the solution begins with a dialogue that’s directed inward. Not to say only within our borders but within the human psyche.

For years we have upped the availability of medicine geared towards combating addiction, created programs supporting addicts in recovery, and issued billions on funding to combat the problem, but many would agree that instead of pulling the root of the issue, we’re only weeding out the surface, allowing for the evil to grow time and time again.

While experts say the opioid crisis in the US begins first with how we categorize pain, then with the standards of our healthcare system, treating mental illness is still a topic of extreme controversy. Yet, mental illness and addiction are often mutually exclusive.

America, it’s time to talk about co-occurring disorders.

What Are Co-occurring Disorders?

Co-occurring disorders is now the term used by healthcare professionals to describe what was once a dual disorder or a dual diagnosis. Despite what term is used, all three mean the same thing; an individual affected by both a mental illness and a substance abuse disorder. This shouldn’t be a shock to you, as tropes surrounding this phenomenon have lived on for decades.

The Vietnam vet returns from the war riddled with PTSD, then turns to heroin. The teen with severe depression looks to prescription pills to cope. The homeless man with schizophrenia chases the dragon at the corner. Tragically, mental illness often begets drug use, which makes those afflicted more prone to developing a substance-use disorder.

COD (co-occurring disorders) do not follow a strict set of classifications. Any number of them can occur. The commonalities often exist when one drug pairs well with ‘curbing’ the symptoms onset by a certain mental illness. For example, severe depression and uppers (cocaine, meth, Adderall, etc.), anxiety disorder and alcohol or benzos (Xanax, valium, etc.), schizophrenia and alcoholism, and so forth. As you can see there’s a push and pull relationship between substances and specific mental illness. Those with depression look to uppers to make them happy. Those with anxiety look to benzodiazepines and alcohol to give them tranquility. Those with schizophrenia drink to ease the confusion. Yet, any combination of co-occurring disorders can exist.

A Deadly Mix

It’s approximated by the Substance Abuse and Mental Health Services Administration (SAMHSA) that nearly 8 million adults suffer from COD. Worst yet, those that are diagnosed with COD are usually only treated for one condition leading up to their dual diagnosis. But their two afflictions are mutually exclusive and by treating one the other continues to have a negative impact on the individual at hand.

Furthermore, those with COD are vulnerable to a host of issues someone with only one condition isn’t. And what’s that idiom, fire feeds fire? Unfortunately, those with COD have this saying in their lifeblood. As they try to heal, they’re at risk of relapse. If this occurs, it leads to psychiatric distress, which can only amplify the original mental illness. As the original illness worsens, they’re then subject once more to the risk of relapse. This vicious cycle, if untreated, can send an addict reeling into despair.

Thus, when we say this is a conversation that needs to be had, it is a very well one that could save lives and change the fate of the mentally ill. Understanding COD is also understanding that when treating an individual victim to it, if treated in the same fashion as substance-abuse disorders, the treatment itself lacks its efficacy and the patient will have a cumbersome recovery with a dramatically larger propensity for failure or relapse.

Are There Distinct Symptoms?

Mental illness began as a disease that was arduous to diagnosis. Many individuals expressed symptoms that differed from one another and in different severities, making them hard to distinguish. It took the healthcare industry years to accurately diagnose certain mental illnesses and draw commonalities between them and unfortunately, due to the nature of COD, the same issue coats the diagnosis process.

Certain substance abuse patterns and mental health deficiencies will work to mask the other. Someone that’s severely depressed after their fix is removed can be regarded as someone in the clutches of withdrawals, as emotions run wild during this period. Someone having extreme substance abuse withdrawals can be perceived as suffering from symptoms of a certain mental illness.

Thus, finding a system that can separate and identify the two in isolation is paramount for successful recovery of those with COD. But doing so is a task of extreme difficulty. Sadly, it’s the exact reason why many with COD are never diagnosed correctly and ultimately don’t respond well to the common treatments.

How Do They Diagnose Co-occurring Disorders?

Co-occurring disorders can be screened for via multiple processes, one of the most prominent being developed by SAMHSA. There’s a variety of different screenings and tools used to isolate substance abuse disorder and mental illness. Often, it’s more of a trial and error, as an individual will have their background and history dissected and their progress in dual diagnosis treatment centers analyzed. Measuring history and progress within standard treatment can be a telltale sign of COD and is commonly one of the more accurate ways to diagnose.

However, the process of diagnosis is dependent on the medical professional, as usually each person will integrate and adhere to their own system.

Co-Occurring Disorders and Homelessness

It shouldn’t be a surprise to you that the homeless are often a victim to COD. Due to the severity of these cases, the homeless population usually needs assistance well beyond that of someone suffering specifically from mental illness or substance abuse disorder. The harrowing fact is this: to treat homeless with COD, integrated care is vital to recovery, and a dismal number of the population has access to it.

Being that COD—the nightmarish disease it is—can work to create somewhat of an implosion in the human psyche, because the homeless don’t have access to integrated care they often degrade to a point that chronic homelessness becomes their reality. We’re currently trying to address this issue and establish infrastructure that will not only screen for COD in homeless populations but provide treatment for it as well.

However, this is an ongoing process and time can be a sharp blade. Without help, as you very well know, someone that could’ve been treated will lose their social skills, behavioral health, economic security, and become a slave to their own disease, thus a slave to homelessness and disconnection.

Co-Occurring Disorders and Veterans

You’re probably familiar with the tragic stories of veterans that return home from war, only to crumble beneath the wrath of PTSD. PTSD then begets drug use, commonly as a coping mechanism, and substance abuse disorders can develop in the blink of an eye. According to the Veteran’s Affairs Department (VA), about 33% of veterans fall into the category of COD.

However, veterans have more organizations supporting COD than the homeless and have access to a host of different resources that can not only help with diagnosis but treatment too.

As listed on SAMHSA’s own website, there are a few primary resources for veterans with COD.

National Center for PTSD (PTSD)

PTSD created an educational course for practitioners that covers managing PTSD in relation to COD. This is regarded as excellent material that helps equip professionals with the right weapons to combat the disease.

The Veteran’s Affairs Department

The VA also created their own set of guidelines which intelligently dissect methods of screening, assessment, and treatment of the horrible combination (PTSD and substance abuse disorders).

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

This organization provides a list of recommendations from the Institute of Medicine on integrating efficient care for veterans with co-occurring disorders.

What Exactly is Integrated Treatment?

As aforementioned, in the case of COD one fire feeds the other. The substance abuse disorder fuels the mental illness and vice versa. Thus, integrated care is a type of treatment that, instead of isolating one or the other, treats both at the same time, in the same location, by the same healthcare professionals.

This means that once an individual is admitted to treatment, healthcare professionals from the treatment team will study the issues at hand and treat them individually. Often, this can be a prolific process, more of a learn-as-we-go method of operating that doesn’t usually couple the normal types of treatment. This is due in part because COD can be quite diverse, with the recovery process having a tendency for volatility not witnessed in isolated cases.

A common structure for these treatments go as following:

The Thought Process

A clinician or treatment team will offer a judgment-free space for the afflicted to think about the role drugs or alcohol has played in their lives. They can then formulate the problem to its core—as you could deduce, this often means that rather than seeing a vice as a coping mechanism, it’s regarded as something negative and not conducive to healing.

Education

The team will then educate the patient, explaining how COD affects the brain and the way in which drugs can amplify a preexistent problem. This will then grant the patient the knowledge to understand their experience on an objective plane, helping them further discern between ‘right’ and ‘wrong’ when it comes to the choices they make.

Community and Resources

This falls in line with most in-patient style rehabs, but the treatment team will encourage the patient to socialize with like-minded peers who are dealing with similar problems and provide community-driven resources to help them heal. It’s the ‘you’re not alone’ theme materialized by joining a community of others who have struggled with COD.

The Future

As the patient progresses, they will then be encouraged to outline their future goals and what they hope to accomplish with not only sobriety but mental stability. This will mean not only abstinence from certain substances but the ways to mitigate the symptoms of their mental illness and cure it altogether.

COD-specific Therapy

This category is an umbrella for all the resources given to someone specifically with COD. This could be a certain type of therapist, strategy, medicine-plan, and so forth. Essentially, it’s everything the treatment team does they know is specific to those suffering with COD—all of which tackles both problems at once. The above can be thought of as branches from this tree.

Outpatient Programs

It’s important to note there that, more often than not, COD is treated via outpatient programs. Reason being: those afflicted usually need a host of other resources that the typical rehab patient does not. This means assisted living, ongoing management, medication management, and so forth. COD is a viscous disease that can render someone incapable of dealing with society.

Sometimes they need to be socialized again and exposed—with guidance—to the outside world once more.

Conclusion

When it comes to the war on drugs and the problem America currently faces, all manners of dialogue need to be had regarding our epidemic. No one will argue that we keep throwing money at the problem with little to show for. By addressing problems like COD and analyzing them intuitively, we’re one step closer to treating and curing the problem… rather than slapping a band-aid on it.

With that being said, if you suspect that someone is suffering from COD, it’s paramount that you reach out to a healthcare professional or an organization that can help. Those with the disease have a higher propensity for falling off the wagon, and, unfortunately, never getting back on it. Education is awareness, awareness is a weapon, and cultivating this tool begins first and foremost with these conversations.

The more we address COD, the further our efforts will escalate on the war against drugs, aiding our veterans, and saving our homeless.

Sources:

“Co-Occurring Disorders.” Psychology Today. 14 Mar. 2019. https://www.psychologytoday.com/us/conditions/co-occurring-disorders

“Co-Occurring Disorders.” Mental Health America. 14 Mar. 2019. http://www.mentalhealthamerica.net/conditions/co-occurring-disorders

“Co-Occurring Disorders Treatment Guide.” American Addiction Centers. 14 Mar. 2019. https://americanaddictioncenters.org/co-occurring-disorders