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Thursday, July 6, 2017

Co-Occurring Substance Use and Mental Health

co occurring substance use mental healthAn extremely high prevalence of comorbidity exists between substance use disorders and mental illnesses. What “comorbid” or “co-occurring” means is that the symptoms of two or more disorders occur simultaneously (or congruently) in the same person. The interaction between the illnesses can drastically exacerbate the symptoms a person experiences, as well as make the conditions challenging and more complex to treat. Co-occurring disorders can be quite difficult to diagnose due to the compound nature of the symptoms, as for each disorder there is a biological, psychological, and social component of the symptoms that often overlap. It is fairly common that individuals will receive treatment for one disorder while the other is left untreated. When left undiagnosed or untreated, co-occurring disorders can lead to more severe symptoms than solely mental illness or substance use, such as: medical illnesses, homelessness, incarceration, suicide, and death.

With substance use and mental health, the question that plagues providers is often similar to the chicken and the egg question- which came first? One aspect of this conundrum is certain people with mental health disorders are far more likely to experience substance use disorders than those without mental health disorders, and vice versa.

It is quite challenging to determine causality of substance use and mental health disorders for several reasons that include, but are not limited to, the following considerations:

1) Mental illnesses can prompt a person to self-medicate symptoms with substance use. Consider a depressed person who drinks alcohol to alleviate symptoms of depression. Alcohol is a known depressant, so while drinking may temporarily cause the person to feel better, the symptoms of depression remain untreated and will likely worsen, requiring greater amounts of alcohol or more frequent episodes of drinking to provide the person with some relief, this pattern being one of the criteria for the onset of alcoholic drinking.

2) Drug and alcohol use can cause individuals to experience symptoms of mental illness. Consider a person who has been using methamphetamines for days without sleep, who begins to experience active hallucinations and symptoms of psychosis.

3) Both substance use disorders and mental illnesses can be caused by exposure to stress and/or trauma, genetic vulnerabilities or predispositions, and underlying brain deficits.

4) Mood disorders in particular increase a person’s vulnerability to substance use and addiction, as well as the inverse.

How are co-occurring disorders treated? These disorders are undoubtedly served best by an integrated treatment, where practitioners address both the mental health and substance use disorders simultaneously, as well as any primary care issues that may have developed as a result of the untreated disorders and the side effects thereof. According to SAMHSA, “Combining strategies from psychiatry and addiction treatment can lower relapse rate among rehab graduates, reduce the number of suicide attempts, and foster long-term abstinence.” In addition, comprehensive, integrated treatment not only reduces cost for the individual or family, but has far better outcomes than when treating the disorders separately.

When utilizing integrated mental health and substance use interventions, the same team of clinicians will work together in one setting, will all take responsibility for the client’s treatment, and will create a very comprehensive, coherent treatment package where symptoms from all disorders are treated. In this method, the treatment approach and philosophies remain consistent, as well as the set of recommendations. This also lessens the chance for individuals to medication-seek from providers who aren’t in contact with one another. For example, consider a person who suffers from symptoms of anxiety (as related to both Generalized Anxiety Disorder and alcohol use disorder). That person could easily go to a mental health provider, report the feelings of anxiety and not the alcohol use disorder, and be prescribed a benzodiazepine. This may lessen feelings of anxiety, but it would do nothing for the person’s sobriety, and would likely exacerbate the situation as now the person has a prescription for benzodiazepines and is drinking alcohol on top of them, a very dangerous combination that can be lethal. It is for this reason pharmacotherapy is much more effective when the treatment plan addresses mental health as well as substance use.

The following are additional reasons integrated treatment for co-occurring disorders is most effective:

1) Treatment of substance use and mental health issues simultaneously may help clients address unique triggers, such as depression, panic, or mood swings.

2) Group therapy in this setting provides a more specific and stronger support system for those who experience substance use and mental health disorders.

3) Integrated treatment also aims to overcome side effects of mental health disorder, such as barriers to socialization, impaired motivation, and reduced attention.

4) Challenges with medication are reduced, as there is a drastic reduction in prescribing medication that may be counterintuitive to symptoms of substance use, but not to mental health and vice versa.

In closing, co-occurring disorders are nothing less than very complex disorders that hence, require a complex form of treatment to be most effective. Substance use and mental health combined, when left untreated, are incredibly deadly. It truly requires a team of individuals collaborating recommendations and treating ALL symptoms to help those with these disorders to enjoy a life of recovery.


Heather Smyly

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