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All about Co-Occurring Disorders

Stress concept

The most effective manner to treat co-occurring disorders is to use a comprehensive “dual-treatment” approach, where both conditions are approached as the primary disorder. In other words, a personalized plan is drafted to offer relief from the symptoms of both maladies. Treating one illness while ignoring the other gives the recovering addict an incomplete skill set and can leave them woefully unprepared to face the challenges of a clean and sober life. Let’s take a look at some of the ways that addiction and some common mental disorders might co-occur and have a multiplied impact upon the life of the afflicted addict or alcoholic.

Addiction and Depression

According to the National Center for Biotechnology Information, nearly two-thirds of alcohol-dependent people meet the standard for a medical diagnosis of depression. There are several reasons why this is true.

  • Both disorders share similar genetic and environmental factors that, when combined, can heighten the risk of developing both
  • Depression and addiction each have a causal effect — having either disorder increases the likelihood of having the other.

Let’s examine that relationship in closer detail – Addiction inevitably causes negative consequences in the afflicted individual’s life, such as financial problems, relationship difficulties, work issues, or legal troubles, all of which can lead to damaged self-esteem, resulting in depression. Addiction can cause volatile mood swings, emotional instability, and poor decision-making, which can leave the individual extremely vulnerable to depression. Likewise, a depressed might attempt to obtain relief by self-medicating with alcohol, illegal drugs, or other mood-altering substances and behaviors. The aforementioned study found that alcohol abuse was a contributing factor in developing depression more often than depression causing alcohol abuse. Multiple-drug use can hinder recovery and increase rthe isk of relapse. Marijuana, in particular, can stand in the way of alcohol dependence treatment, due to impaired motivation.

Addiction and Bipolar Disorder

“The observed tendency for cannabis use to precede or coincide with, rather than follow, mania symptoms, and the more specific association between cannabis use and new onset manic symptoms, suggests potential causal influences from cannabis use to the development of mania. It is a significant link.” ~ Dr. Steven Marwaha, Ph.D., MRCPysch, Associate Clinical Professor of Psychiatry at the University of Warwick, United Kingdom According to the Substance Abuse and Mental Health Administration, marijuana is the most-used illicit drug in the United States, and the National Institute on Drug abuse has reported that “80 percent of current illicit drug users are marijuana or hashish users.” This means that any conversation concerning drug use has to begin with marijuana and its effects. Supporters of marijuana decriminalization are quick to promote its supposed benefits, but new research highlights the fact that the drug can in reality worsen the symptoms of a number of mental illnesses, including bipolar disorder. It has been extensively documented that individuals with bipolar disorder also have a high usage rate for recreational drugs, including cannabis. A recent study published in the Journal of Affective Disorders, authored by Dr. Marwaha, concluded that manic episodes were preceded by cannabis use. Even more significantly, cannabis use significantly magnifies those manic manifestations. Even more, research is ongoing in Spain. Researchers at the International Mood Disorders Research Center came to the determination that bipolar patients experiencing mixed or manic episodes who stop using cannabis fare far better than those patients who continue using. Within the context of an acute treatment regimen, those patients who refrained from cannabis use (or who had no history of use) during a maintenance program had a noteworthy improvement in function and a decreased chance of recurrence. The research team was headed by Dr. Ana Gonzalez-Pinto, M.D., PhD, from the Division of Psychiatry Research, Santiago Apostol Hospital in Vitoria. The study followed nearly 2000 patients over a treatment period of more than two years. While speaking to Medscape Medical News, Dr. Gonzalez-Pinto said that those patients who continued using marijuana during the research period tried suicide more often than those who stopped or had no previous history. Spanish researchers said, “Our findings indicate that the negative effects of cannabis use on the course of bipolar disorder disappear when patients stop using it.” Dr. Marwaha said, “The main clinical implication may be that we need to help patients quit cannabis, as their outcomes may then be the same as if they never used.” Dr. Marwaha also stated that even though treating substance abuse in patients who also have a severe co-occurring mental illness is “notoriously difficult“, there is a definite need for different techniques to guide patients to”quit cannabis and thus improve their outcomes“.

Addiction and Anxiety

As maintained by the Anxiety and Depression Association of America, disorders on the anxiety spectrum are the most common mental illnesses in the country. Approximately 18 percent of the American population – 40 million adults – is affected by some type of anxiety disorder, but only about one-third of them ever actually seek help. Some forms of the illness include –

  • Acute Stress Disorder – usually a newly-developed anxiety resulting from a recent traumatic event
  • Panic Disorder – often resulting in debilitating attacks
  • Agoraphobia – a severe fear of crowded places or enclosed spaces
  • Obsessive-Compulsive Disorder – engaging in compulsive, repetitive behavior to reduce feelings of uneasiness or fear
  • Social Phobia – extreme fear of or anxiety about public humiliation or embarrassment
  • Post-Traumatic Stress Disorder – past exposure to an traumatic event, especially one that involved possible or actual injury or death
  • Generalized Anxiety Disorder – constant and overwhelming anxiety or worry without focusing on any one specific event. This disorder affects almost 7 million American adults. Women are twice as likely to suffer from GAD as men.

Substance abuse and anxiety disorders co-occur much more often than can be attributable to mere chance and both are among the most frequently-diagnosed psychiatric problems in the US. Anxiety disorders have a lifetime rate of diagnosis of 28.8%, while the lifetime rate for substance abuse is at 14.6%. Although the two disorders are closely intertwined, there are some differing pathways to comorbidity:

  • Substance abuse leads to an anxiety disorder only .2% of the time.
  • Anxiety disorders precede substance abuse disorders in more than 75% of cases.

This indicates that individuals with anxiety seem to be self-medicating in order to relieve the worst symptoms of their illness. Further complicating this is the fact that some anti-anxiety medications are themselves frequently abused. Furthermore, substance abuse is worsened and complicated when induced by an anxiety disorder:

  • an increase in the severity of lifetime alcohol abuse
  • a worsening of the symptoms of alcohol withdrawal
  • increased relapse rates after treatment

On the flip side, a substance abuse problem negatively impacts the efficacy of treatment for anxiety disorders:

  • a decrease in the recovery rate from GAD
  • an increase in the risk of recurrence of GAD
  • a greater risk of suicide in patients with Panic Disorder

All of these statistics and studies linking various co-occurring mental disorders with alcoholism and drug abuse only serve to highlight the drastic need for new and novel treatments. Because multiple psychiatric concerns need to be addressed, multiple approaches and maybe even differing disciplines need to be employed. This would require the expertise of professionals who are experienced and trained in treating individuals with co-occurring disorders. Some possible strategies might include psychotherapy, the appropriate medication, and the usual treatment strategies for combating substance abuse –counseling/therapy, 12-step peer support groups, stress management, education, and relapse prevention. However, because the problem of co-occurring disorders creates a psychiatric need that is so nearly all-incompetent, nontraditional treatment methods may also be particularly effective. Exercise, yoga, massage, and even acupuncture all made each hold a degree of promise for afflicted alcoholics and addicts. More importantly, perhaps there needs to be a paradigm shift among professionals in the mental health and addiction fields. Perhaps when the diagnosis of one disorder is confirmed, a co-occurring disorder should be automatically assumed until it can be ruled out. This would mean that fewer sufferers “fall through the cracks” and fail to receive the right kind of assistance – help that actually addresses all of their needs.