When people enter substance abuse treatment, they may discover that their problems involve more than drugs, alcohol or other addictions. Mental health problems may also be present. In fact, many people turn to drugs and alcohol to self-medicate for mental health issues like depression and anxiety. Addiction can also cause anxiety and depression, leading to further problems and addictions.
Having both a substance abuse disorder and a mental health issue is called dual diagnosis, and the treatment for both is called co-occurring disorder treatment.
According to the Substance Abuse and Mental Health Services Administration, approximately 7.9 million adults had co-occurring disorders in 2014, the last year for which these figures are available. There are about 23.5 million people in the United States in need of substance abuse treatment, which means that slightly more than one out of every three people needs integrated treatment. You’re not alone if your therapist or counselor says you could benefit from co-occurring disorders treatment.
There are so many myths swirling around about both substance abuse disorder and mental illness that it’s no wonder some people get nervous when they hear they have both. But never fear — if you’re in treatment for a substance abuse disorder, or you’re talking to a therapist about your problems, chances are good your illness is being approached in a therapeutic way that will help you heal.
The first step to understanding co-occurring treatment is to understand the differences and similarities between substance abuse disorder and various mental illnesses, and how the two are also alike. From there, you can explore the ways to recognize disorders in yourself or a loved one, issues pertaining to early detection and prevention, and the various options for treatment.
The first step to understanding co-occurring treatment is to understand the differences and similarities between substance abuse disorder and various mental illnesses, and how the two are also alike. From there, you can explore the ways to recognize disorders in yourself or a loved one, issues pertaining to early detection and prevention, and the various options for treatment.
Having a dual diagnosis means taking care of two illnesses at once, but both can be treated. It’s sort of like getting diagnosed with both high blood pressure and diabetes at the same time. Sure, it stinks that you’ve got both, but both can be treated, and if you follow your doctor’s advice and take the right medications according to her instructions, you can feel better again. The same goes for a dual diagnosis.
Symptoms of Co-Occurring Disorder
If having a co-occurring disorder means you have two illnesses at the same time, what are their symptoms, and how can you distinguish between them?
It’s very hard to easily distinguish between two disorders such as substance abuse and mental illness. Many commonly abused drugs can cause symptoms of mental illness, after all. Alcohol abuse can make people feel depressed. Cocaine can make people act manic.
In order to tell which came first, and how to treat the exact illness that’s underlying someone’s issues, they need to be sober for a period of time and under the observation of an experienced and caring individual team who can distinguish between normal behavior, addiction behavior, withdrawal behavior, and mental illness.
If that sounds like a tall order, it is. But it’s not an impossible order. It may take time and patience to unravel a patient’s symptoms, but the same can be said of any illness. Many people are sent from their primary care physician to a series of specialists for an accurate diagnosis. The same may be true of a co-occurring disorder.
How Is Co-Occurring Disorder Diagnosed?
The key to correctly diagnosing co-occurring disorder is for the doctor or therapists to be aware of all symptoms and substances abused. It’s only when a professional knows the full story that he or she can make an accurate diagnosis.
There are two likely situations in which a co-occurring disorder is diagnosed:
- Substance Abuse Treatment: When a recovering addict becomes sober, symptoms of mental health issues often begin to come to the surface. Without alcohol or drugs to mask them, the original mental health issues that may have triggered a substance abuse problem can occur. That’s why in-patient rehab is an important step in recovery.
During in-patient treatment, the team at the rehab center can monitor your health and behavior, and help you distinguish between the lingering effects of substance abuse and underlying symptoms, such as depression, anxiety, bipolar disease and schizophrenia. When the substances are removed, it clears away a portion of the symptoms, leaving room for the mental health issues to arise
- Counseling or Therapy: Therapists often ask patients if they are using substances, and if so, how much and when. They’re not being nosy. They’re actually looking for signs of co-occurring disorder. If someone comes to their office for counseling for depression and they find the client is also drinking and using drugs, the client may benefit from rehab before returning to therapy. In this case, the client knows that she has a mental health issue, but may not understand that substance abuse disorder, coupled with mental health issues, can be a problem.
Anyone suffering from a co-occurring disorder should get prompt treatment for both illnesses. Most doctors recommend getting the client’s substance abuse under control first through detox, rehab, and recovery. Some medications used to treat mental health issues can react badly with commonly abused drugs and alcohol. It’s better to be clean for a period of time before taking certain medications.
Antidepressants can make you sleepy, which can be exacerbated by alcohol, for example. Tranquilizers and benzodiazepine medications commonly prescribed to treat anxiety and panic disorder can also be highly addictive, and if you already have a substance abuse disorder, your doctor may suggest other treatments like biofeedback and alternative therapies. Your doctor will know which ones are safe to prescribe.
Mental Illness May Contribute to Addiction Disorders
Knowing which came first, the chicken or the egg, doesn’t help you much when it comes to co-occurring disorders. Both must be treated in order for the client to get well. However, knowing that one may actually lead to the other can help families be more vigilant when it comes to the health of others, especially children and teens who may be exhibiting problems related to mental illness, substance abuse or both.
Many experts believe that mental health problems lead to substance abuse far more often than substance abuse leads to mental health issues. Their reasoning is based in observation and research.
- Self-medication during early onset: The National Institute on Drug Abuse states that sub-clinical expression of mental illnesses may lead to substance abuse as self-medication. Someone who starts to hallucinate during the onset of schizophrenia may start smoking marijuana to ease their symptoms, for example. Someone suffering from social anxiety or generalized anxiety may turn to alcohol to feel better.
In both cases, what starts off as a need to self-medicate eventually turns into both an addiction and a mental disorder. The need to control the mental disorder causes the person to take more substances, which stop working at some point to control the mental disorder. The person is left with two problems instead of one.
- Overlapping genetic and biological factors: There’s also a belief that underlying genetic factors, brain disorders, deficits in neurochemicals and other biological factors may contribute to co-occurring disorders. This theory holds that unbalanced brain chemicals, for example, may cause users to seek substance to abuse to rebalance their internal chemistry. A rush of dopamine from a drug high in this case would replace the chemicals needed to release dopamine naturally.
In some cases, prolonged substance abuse can fundamentally change the brain’s chemistry to one that’s more conducive to mental disorders. If methamphetamines, or LSD or, to some extent, marijuana, is abused for very long periods of time, it can alter the brain permanently. That’s not to say you can’t recover from abusing these substances, but your brain may need more time to reconfigure around some damaged parts.
If it helps to know where your disease started from, then these facts are good to know. For others, the question isn’t, “How did it start?” but instead, “How do I make it stop?” That’s where co-occurring disorder treatment comes into the picture.
Co-Occurring Disorder Treatment
You’re in treatment or therapy, and the professional who is working with you gently hints that you may have a co-occurring disorder. It’s time to think about getting the specialized treatment that you may need.
Where your treatment begins has everything to do with where your health is now:
- If you are sober, but experiencing symptoms of mental illness, your counselor, therapist or sponsor may suggest making an appointment with a psychiatrist. A psychiatrist is a physician who is licensed to diagnose and treat mental illnesses. A counselor or therapist may also be a good choice, but they cannot officially diagnose your medical condition and they cannot prescribe medication if it’s needed.
- If you are in treatment for a mental disorder and your therapist thinks you have a substance abuse problem, you have several choices. First, you can start attending 12-step meetings of your choice (probably A.A. or N.A.). You may also wish to explore in-patient and out-patient recovery options.
Options for Mental Health Treatment
Many people hold a picture in their minds, probably gleaned from old Hollywood movies, of mental health treatment in a psychiatric hospital. They may be afraid of seeing a psychiatrist or may think that taking medication to treat anxiety, depression or bipolar disorder will make them feel like a “zombie,” or not quite themselves.
In reality, most mental health treatment occurs in a doctor’s office or therapist’s office. Therapy such as cognitive-behavioral therapy, which focuses on changing underlying thought patterns that can exacerbate addiction and mental illness, may be used. Clients and therapists simply talk and listen, with exercises and “homework,” such as reading or journaling, given to the client.
Psychiatrists can offer the same services, but many therapists work in conjunction with a psychiatrist to refer clients to them when they feel they need a medical diagnosis for a problem. If you have a therapist you like working with, or have started working with a therapist as part of your recovery program, you may wish to continue working with your therapist while seeking an opinion and treatment options from a psychiatrist.
During treatment with a local therapist or psychiatrist, unless you seem to pose a danger to yourself or others, you’ll continue to live at home and go to school or work like you normally do. You’ll have appointments for therapy and meetings with your doctor just like any other doctor’s appointments. You can fit it into your daily schedule.
In-Patient Recovery and Dual Diagnosis Treatment
In-patient recovery centers such as JourneyPure Emerald Coast can also offer treatment for dual diagnosis. In-patient means you stay at the recovery center for a set time period of time, such as 30, 60 or 90 days, which are the typical recovery periods covered by insurance. You live at the recovery facility during treatment and only return home at the end of your stay.
During your recovery at an in-patient center, you’ll receive care and treatment for both mental health issues and substance abuse problems. You’ll also leave with a specific care plan to help you continue your recovery once you leave.
Medications Used to Treat Mental Illness Today
Most of the modern medicines used to treat mental illness today are a far cry from the older medicines that made people feel dissociated, tired or “zombie-like.” SSRIs, or selective serotonin reuptake inhibitors, are an effective medication used to treat anxiety, panic attacks, and depression. Some may also be used to treat obsessive-compulsive disorder.
These medicines act upon the feedback loop between the neurons and various chemicals, such as dopamine, norepinephrine, and serotonin. Your doctor begins treatment by selecting the best medicine she thinks is right for your condition and prescribing the smallest dose. After a few weeks or months, the dose is gradually increased until a level is found that’s right for you.
It’s not an exact science, and there’s no blood test or another objective test to figure out exactly which medicine will work the best for you and at what dose. It may be trial and error for a while. That can be frustrating, but it’s an important part of the process.
It’s also important to tell your doctor about any side effects from medicines used to treat mental disorders. Most have mild, manageable side effects. Some SSRIs may cause weight gain, while others may cause you to feel a little sleepier than normal. For most recovering substance abusers, insomnia is an old friend. We could do with a little more sleep!
Other mental health disorders, such as bipolar disorder and schizophrenia, are treated with other medications. One reason it’s so important to have a psychiatrist diagnose and prescribe the right medicine is that some medications used to treat clinical depression can make bipolar disorder worse. Just seeing clients in the depressive phase of bipolar disorder can be mistaken for clinical depression, unless a doctor is skilled at diagnosing patients with mental disorders. It may take time to sort through all of the various symptoms, so finding a doctor you can trust is vital.
You can find a psychiatrist or therapist through word-of-mouth or referrals, the same way you’d find an orthopedist or dermatologist. Your primary care or family physician is a good place to start. He can help you find someone local or may have a psychiatrist he knows that he refers patients to on a regular basis. If he doesn’t have someone you can call, people in your recovery program or 12-step group may know someone.
Remember: One out of three people in recovery may have a dual diagnosis, which means they have a psychiatrist or therapist they work with, too.
Other Treatments for Dual Diagnosis
There are other treatment options for people with a dual diagnosis. Sobriety and medication to manage mental health symptoms are two of the most common treatment methods, but others work, too.
Depression and anxiety disorders can often be managed through talk therapy, either individually or in groups. Additional steps may include improving your diet, getting plenty of exercise, learning to meditate and more.
Biofeedback has been useful for many clients with anxiety. During biofeedback, you learn how to “train your brain” and, by extension, your body’s responses by changing how you think and feel.
EMDR, or Eye Movement Desensitization and Reprocessing, helps people release past trauma without using medication. During this therapy, specific steps are followed to safely release past traumatic incidences and memories that may be making you feel anxious or depressed. It’s another example of a drug-free therapy that works for many people.
There are many other holistic treatments for people with dual diagnosis. The important thing to remember is that treating both mental illness and substance abuse isn’t a simple process. There’s no one-size-fits-all treatment. It may take time to find what works best for you, but your doctor, therapist, and counselor are all there for your health and well-being. They want you to recover completely and will work with you until you do.
Dual Diagnosis Treatment at JourneyPure Emerald Coast
JourneyPure Emerald Coast offers treatment for mood disorders, anxiety, depression and bipolar disorders that occur alongside substance abuse. Our residential treatment center offers dual diagnosis treatment.
At our Florida residence, you’ll find a group of experienced and caring professionals who can help you get well. Each day includes personal time as well as time for therapy, group therapy, 12-step recovery meetings and other treatments that we work out just for you.
Residential treatment for dual diagnosis offers many benefits. It gives you time to focus on your recovery without the distractions of school, work or other family commitments. Healing takes time and energy, and having a safe place to recover, free from distractions and judgment, makes it a little easier.
Being away from your family or friends who knew you during your substance use days also has its benefits. Once you’re away from anyone who may have had a harmful influence on you, it gives you perspective to think about the relationship and judge for yourself whether or not it’s worth keeping.
Residential treatment also keeps temptation away. When you’re new in recovery, it can be hard to fight cravings to return to the substances that you abused. Being around other recovering addicts, as well as being immersed in a recovery program, works right from the start and can make it easier to maintain your recovery once you go home. You’re already on your way, and it’s easier to just keep going along the new path than to return to the old.
JourneyPure Emerald Coast has an admissions person on call 24/7, so no matter what day or time you call us, we’re here. Most major insurance plans are accepted, and if you’re worried about payments, just talk to us. We’ll help you figure it out.
More importantly, get help. Don’t wait. We know what it’s like to struggle through depression, anxiety and substance abuse — not to mention other mental illnesses. It’s not good, but you can recover. Give us a call at (615) 907-5928 to talk to someone today, or contact us today.
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