Co-Occurring Disorders: What They Are and How They're Treated
If someone has co-occurring disorders, it means that they have two or more conditions at the same time. You might also hear the term “dual-diagnosis,” which means the same thing. When you have a combination of diagnoses, it can be easy to have thoughts like “Why both at once?” or “Why do I have so many things?” It’s very common to have comorbidities. Knowing that you do is an important part of understanding your whole-person needs.
Acknowledging co-occurring disorders can be one of the key parts to finding out what works for a person in treatment. We’re going to go more in-depth than what you’d expect from most other sources. Our hope is that you’ll see yourself in this and, in turn, will be able to get the care you need and deserve.
What Are Co-Occurring Disorders?
Co-occurring disorders happen when someone has a substance use disorder and another mental health condition at the same time. Those who have both a substance use disorder and another mental health condition often find that the two diagnoses “feed” each other. People with substance use disorders are more likely to have an array of other concerns, like ADHD, PTSD, anxiety, bipolar disorder, depression, and personality disorders.
People with these conditions may use substances to escape, numb out, self-soothe, or, at first, “function better” or “feel normal” – to get through the day or to push through challenges they’ve not yet learned to navigate otherwise. It could also be a matter of impulsivity, curbing hyperactivity in a condition like ADHD, not knowing what to do with intense emotional pain, to stay awake, or to go to sleep.
Substance abuse tends to play a role in a person’s life. Uncovering the role it plays for you matters because it means you can learn to meet the need in another, healthier way. That is one of the things we work on in co-occurring disorder treatment.
Signs and Symptoms
Every condition is different, but there are common signs and symptoms of addiction and co-occurring disorders people can look out for.
- Substance patterns such as those where you use a substance to serve a specific purpose (e.g., to show up to social events or work, to make racing thoughts or depressive feelings go away, to soothe fears or stress)
- Behavior changes – seeming much more or less talkative than usual, increased impulsivity, dangerous or risky behavior, not caring about consequences, being more private or secretive than usual, not spending time on hobbies or with loved ones, spending more time in social circles where people use drugs and alcohol often
- Trouble quitting – even if you want to or say that you will stop or reduce the amount of a substance you use, you don’t
- Changes in energy levels and sleep (e.g., intense surges of energy followed by crashes, sleeping more or less than usual)
- Mood shifts – irritability, euphoria, agitation, depression
People don’t need to have every possible sign or symptom to have a problem. Mental health conditions and substance use disorders present in different ways, and the factors that play into them most vary from person to person. What we look for is what your symptoms are and how they affect your life. Affected areas of life can range from your job to self-care, relationships, family life, overall mental and physical health, and more.
Why Co-Occurring Disorders Happen
Co-occurring disorders aren’t simply a matter of coincidence. In people with co-occurring disorders, our clinicians often notice a couple of major players.
- Shared risk factors: Trauma and genetics affect your risk for both substance use disorders and other mental health conditions.
- Self-medication: In some cases, people use substances to self-medicate an existing mental health condition. For example, if a person already has social anxiety disorder, they may drink to cope with it when they don’t know how else to curb it, which could then lead to alcohol use disorder.
It’s also notable to consider how substances affect the brain. Drugs and alcohol cause brain changes and can worsen or create new mental health symptoms. With prolonged sobriety, brain changes caused by substance use can reverse.
How Co-Occurring Disorders Are Diagnosed
Co-occurring disorders are diagnosed via a comprehensive assessment. This involves meeting with a provider who will conduct a verbal interview and review your personal history. You can generally expect to complete some paperwork (online or in person) before the appointment begins. During the evaluation, a doctorate-level provider, such as a psychiatrist, will ask questions like, “What are your symptoms?” “When did they start?” “Do you have any family history of mental health conditions or substance abuse?”
A key part of the diagnostic process is to rule out other possible causes of symptoms. For example, mental health symptoms that go away entirely when a person stops using a stimulant drug or drinking won’t be diagnosed as a co-occurring disorder. Since co-occurring disorders are so common, seeing a trained professional who knows how to distinguish them from symptoms caused by substances and physical health conditions (e.g., thyroid issues) is critical.
How Co-Occurring Disorders Are Treated
Dual diagnosis treatment (also called integrated treatment) is our standard of care. Many people in substance use disorder treatment have one or more additional mental health concerns. No matter what level of care you’re in, we’re here to acknowledge the full scope of what’s going on in your life and how that affects your treatment needs. Many people start with a higher level of care (e.g., detox and residential treatment, followed by PHP). In other cases, though, a person may start with a lower level of care, such as IOP.
During the intake process at Sanford Behavioral Health, we can recommend a starting level of care and help you find the right treatment path. Program options include:
- Detox. Since emotional and physical withdrawal symptoms can be challenging, it is important to get professional detox support. This can be especially true for people with co-occurring disorders. Detox helps you stop using substances safely and reach physical stability.
- Residential. Residential inpatient treatment involves highly structured, daily therapy for addiction and co-occurring disorders. Clients live on-site at Sanford Behavioral Health for the duration of the program. We also have an extended residential program available.
- PHP. Our partial hospitalization program (PHP) in Michigan provides heavily structured dual-diagnosis treatment in an outpatient environment. People sleep and live at home but come in for therapy daily for most of the day, which leaves little room for other activities. This can be an alternative to, or a step down from, our residential program, depending on your needs.
- IOP. The intensive outpatient program (IOP) at Sanford involves three hours of therapy per day, three days per week. Morning and evening schedules are available to accommodate people who are working or going to school while getting help for addiction and co-occurring disorders. Some people start IOP at our center after finishing a higher level of care. Those with less severe symptoms may start with IOP, which can help them avoid the need for hospitalization and higher levels of care later.
- Aftercare. Aftercare provides continued support for addiction and co-occurring disorders after treatment programs end. We provide extensive aftercare services that help people keep making progress.
Most people with co-occurring disorders benefit most from a combination of medication and therapy. We always recommend an individualized approach because people respond best to different therapies and medication treatments.
Getting Help for Co-Occurring Disorders
What is an example of a co-occurring disorder? It can be any mental health condition that presents alongside substance abuse: anxiety, depression, OCD, an eating disorder, or something else. Which mental health disorder is most commonly co-occurring with a substance use disorder? We see a co-occurrence of anxiety and depression a lot. However, personality disorders, PTSD, and ADHD are up there, too.
While having one or more co-occurring disorders can be challenging, it’s very common. Effective integrated treatment can help. Sanford Behavioral Health provides a single-campus, no-transfer continuum of care for co-occurring mental health and substance abuse. Personalized and collaborative care is our standard. We have a diverse team of providers who help people heal from all mental health conditions, addiction, and eating disorders.
We are located in Grand Rapids, MI. No matter what you’re going through, you’re not alone here. Call our admissions line at 616.202.3326 for yourself or a loved one today. All calls to Sanford Behavioral Health are free and confidential.