Substance abuse and addiction can mask a mental illness and vice versa. Many clients admit to an addiction treatment program only to find out that they are also struggling with a mental health disorder such as depression or anxiety. This depression or anxiety could have developed to cope with the addiction, or the addiction could have emerged to deal with depression or anxiety. Either way, individuals who have substance use disorders, as well as mental health disorders, are diagnosed as having co-occurring disorders, formerly referred to as dual diagnosis. There are many types of co-occurring disorders, and any combination of a mental health disorder and an addiction is possible.
Type of co-occurring disorders
Individuals who struggle with depression may turn to substances such as Xanax or cocaine to lift their mood while individuals who have an addiction to opioids may develop depression over time. Co-occurring disorders come in all shapes and sizes, and any combination can exist.
PTSD and opioid addiction
Alcohol abuse and anti-social personality disorder
Cocaine addiction and anxiety disorders
Heroin addiction and depression
Anorexia nervosa and cocaine addiction
Bulimia nervosa and OCD
Eating disorders and OCD as a type of co-occurring disorder
Approximately 40% of individuals with an eating disorder are diagnosed with obsessive-compulsive disorder, and two-thirds of individuals with eating disorders have a previous history of at least one anxiety disorder. Obsessive-compulsive disorder and eating disorders often co-occur together because they both exhibit a need to perform compulsive ritualistic behaviors to attempt to remove the anxiety-provoking thoughts that precede these behaviors. Whether it is self-induced vomiting to rid the body of calories in the case of anorexia nervosa or continually checking whether the stove is switched on in the case of obsessive-compulsive disorder, these behaviors exert a need for control to reduce the severe underlying anxiety.
Diagnosing co-occurring disorders
Co-occurring disorders can sometimes be challenging to diagnose. Symptoms of substance abuse or addiction can mask symptoms of mental illness, and symptoms of mental illness can be confused with signs of addiction. Individuals with mental health disorders sometimes do not address their substance use because they do not believe it is relevant to their problems. However, some typical patterns do emerge among those with co-occurring disorders:
Worsening of mental health symptoms even during treatment: Individuals diagnosed with mental health disorders often use substances to feel better. Anxious individuals may want something to make them feel calm, those who are fearful of others may want something to make them feel more relaxed and less inhibited, and individuals who are in psychological pain may want something to make them feel numb.
Using alcohol or other drugs not only fails to repair the mental health disorder but also prevents an individual from developing practical coping skills, having satisfying relationships, and feeling comfortable with themselves. Alcohol also interferes with medications prescribed for mental health disorders. In short, drug and alcohol use will make mental health disorders worse.
Alcohol or substance use problems that seem resistant to treatment
Individuals with co-occurring disorders may stop using alcohol or other drugs, but they will find difficulties as the symptoms of their mental health disorders persist. Treatment centers and clinicians and addiction specialists may not be prepared to address both conditions, and even some traditional peer recovery groups may insist on abstinence from all drugs, even medications prescribed for mental health disorders. As a result, individuals with co-occurring disorders find it very difficult to treat their substance-use problems without also treating their mental health disorders. However, many treatment facilities do specialize in treating co-occurring disorders.
Treating co-occurring disorders
All types of co-occurring disorders are treatable as there is a multitude of psychotherapy approaches and medications that can be used. It is essential to seek a treatment center that specializes in treating co-occurring disorders and uses a compassionate tone with each client.