A phrase commonly used by addiction providers is “co-occurring disorder”. Just what that means can be a complex answer. Taken in its simplest terms, it’s a phrase used to describe an individual who suffers from multiple disorders at one time. From there, the simplicity of this statement stops entirely. There are multitudes of different types of disorders that any one person can struggle with.
Co-occurring refers to two disorders that are happening simultaneously. In the addiction treatment space, this term will generally refer to someone who is experiencing a substance abuse disorder, as well as another physical or mental health diagnosis, such Post-Traumatic Stress Disorder or Chronic Pain Disorders. Because more than one symptomatic issue is presenting at the same time, this can make creating a treatment plan more complex. Fortunately, quality physicians and therapists in the addiction treatment industry are well versed in treating these cases, and the prognosis is good for those individuals who are diagnosed with co-occurring disorders. According to dualdiagnosis.org:
“It is estimated that about 17.5 million Americans over the age of 18 (or 8 percent of the adult population) had a serious mental health disorder in the past year. Of these, about 4 million people also struggled with a co-occurring drug or alcohol dependency.”
How Are Co-Occurring Disorders Treated?
There are a number of treatment modalities that have shown to be effective in treating co-occurring disorders. These methods are a combination of treatment methods used to treat substance abuse disorders in conjunction with therapeutic methods to treat underlying conditions, including:
- Detoxification: In many instances of substances abuse, it is recommended that the individual undergoes a medical detoxification process. During this process, the individual will be able to undergo a safe withdrawal from addictive substances, while under the care and supervision of medical staff. Most commonly, detox is recommended for withdrawal from alcohol, benzodiazepines, and Opiate or Opioids due the potentially dangerous withdrawal symptoms that can occur while detoxing from those substances.
This step is often necessary to begin the process of treating the addiction but can also benefit those suffering from additional diagnoses. Some benefits of medical detox can include identifying and potentially improving rebound pain– or increased pain over time from treating chronic pain with Opiates. The detox process can also help to get the individual back to a behavioral baseline so that providers can better diagnose any mental health problems and begin an effective treatment plan for medications that may be necessary, such as antidepressants or mood stabilizers.
- Rehabilitation: The word rehabilitation is often associated drug-use, and while that is one form of rehab, there are also facilities that focus entirely on mental health, as well as facilities that specialize in the treatment of both substance abuse and mental health care. There are several levels of Rehabilitation that could be recommended by treatment staff, depending on the level of care that would most benefit the individual seeking help. These include Inpatient, Intensive Outpatient, and Outpatient treatment. Each level of care includes varying levels of support, and in many cases can be used in succession to provide long term support.
In Inpatient treatment, the individual will live at the facility for a period of time, and will have access to medical care, therapeutic services, 24/7 accountability and drug testing, and often additional services such as case management, prepared meals, and access to exercise facilities. Intensive Outpatient is a step down from Inpatient Treatment, wherein the individual will no longer live at the facility or have access to medical care but will still attend individual and group therapy for the majority of the day and will be drug tested for accountability purposes. Finally, Outpatient is the lowest level of rehabilitation, in which the individual will only receive therapeutic services for a few hours a week, usually will still receive drug testing, and is encouraged to look for work, re-enroll in school, or in other ways rejoin their community.
- Continued Care Services: Continued care is a general term that refers to a variety of methods that are used post-rehabilitation to ensure the continued sobriety and mental health of the individual. This could include continued sessions with an outside therapist, entering a sober living environment, following up with a primary care doctor, incorporating exercise in a daily routine, practicing good nutrition, attending 12-Step groups, or any other activities that help the individual achieve success after treatment.
Which Therapeutic Interventions Can Treat Co-Occurring Disorders?
There are many different treatment methods that have been found to be affective in treating co-occurring disorders. Integrated therapy is a therapeutic method that combinesa variety of different tools, which are personalized to the individual. This is the most commonly recommended therapeutic modality for treating co-occurring disorders. This method can include, but is not limited to:
- Cognitive Behavioral Therapy: This is a form of therapy that focuses on finding faulty patterns of thinking or learned behaviors and seeks to identify and establish coping skills that can help the individual overcome these patterns.
- Behavioral Activation Therapy: This type of therapy focuses on decreasing behaviors prevalent in those who experience depression and anxiety, such as isolation and avoidance patterns. The goal of this method is to gradually break down those behavior patterns by doing activities that negate the desire to avoid. This can be as simple as doing a daily hygiene routine, or getting exercise, or even working toward long term goals like completing a degree program.
- Interpersonal Therapy: This approach focuses on helping the individual determine how they are being negatively affected by relationships in their lives, or how their relationship skills are causing negative consequences for them. This ideology comes from the thought that poor personal relationships can cause depression.
- Eye Movement Desensitization and Reprocessing (EMDR): This is a form of therapy that combines talk with rapid eye movement in a way that mimics REM sleep and is thought to help an individual process traumatic events. This method of processing trauma can be intense and often involves putting in place a good support network, as well as identifying a “safe place” that the individual can utilize if they are feeling overwhelmed.
Prognosis for Co-Occurring Disorders Treatment
The prognosis for individuals who suffer for co-occurring disorders can actually be very good. If the individual is able to remain sober from substances which can worsen the underlying physical or mental condition, and follows through with therapy, or medications that are recommended. Under these circumstances, it is very possible to manage both the addiction and secondary disorder and allow the individual to lead and healthy and successful life.
Evidence suggests that prognosis is not dependent on factors such as age, sex, substance of abuse, or type of underlying condition.
Conversely, it was found that factors which did affect the possible prognosis of co-occurring individuals was the severity of the underlying condition. For example, those who are considered to be Severely Mentally Ill (SMI) had a less favorable prognosis than those who’s mental illness was considered less advanced.
Getting Help Only a medical professional can diagnose an individual with co-occurring disorders, and a treatment plan should be made in conjunction with mental health professionals. Regardless of individual treatment plan, what substance the individual is abusing, or what secondary condition they are suffering with, the first step to improving their health and quality of life is to speak with a doctor, mental health professional, or other trusted parties who can steer you in the right direction. While it may seem overwhelming, there is hope for recovery for every person, and it starts with taking that first step of seeking help.