When an addiction is complicated by the presence of a mental illness, the two conditions are known as co-occurring disorders. It’s a remarkably common occurrence, as the Substance Abuse and Mental Health Services Administration (SAMHSA) suggests that about 8.9 million adults have co-occurring disorders. Unfortunately, SAMHSA also suggests that 55.8 percent of these people get no treatment at all for their distress. That’s a shame, as there are a number of excellent options that could really help people who are dealing with these issues.
Why Does It Happen?
Co-occurring disorders are classic chicken-and-egg problems, as it can be remarkably difficult for people to break the issue down into its component parts and understand why people developed both of these very different issues. Sometimes, it seems as though the issues arise spontaneously, due to no outside prompt that the person can name. In reality, however, one issue does seem to appear first, and the other follows later. Schizophrenia provides a good example of this principle.
Of those who have schizophrenia, 88 percent smoke tobacco, according to an article in the journal Advances in Psychiatric Treatment. Many of these people started smoking before they developed symptoms that would characterize schizophrenia, but the act of smoking seems to help them deal with the demands of having this disease. Tobacco seems to provide these people with the opportunity to break away, take deep breaths and calm down. It works as a form of self-medication for them, and as a result, they might be unlikely to even consider a life without cigarettes. For them, the smoking came before the mental illness, but the cigarettes seem to help them deal with the mental illness.
On the flip side, some people who have a family history of schizophrenia may experience their first episode of psychosis while they’re under the influence of marijuana.
Marijuana Works as a Catalyst
Research published in the journal Schizophrenia Bulletin suggests that marijuana use causes symptoms of dysfunction in the brain similar to those seen in people who have active schizophrenia, meaning that the drug doesn’t help people to deal with schizophrenia. Instead, the drug can seem to spur the development of the disease. For people like this, marijuana works as a catalyst.
A third group of people might have a long history of sobriety prior to developing schizophrenia but might turn to drugs when the dysfunction is in full swing. People like this might find it hard to sleep, eat or relax when they’re bombarded with difficulties from schizophrenia, and they may find that drinking alcohol makes life just a little easier to handle. They may develop symptoms of alcoholism long after they’ve been diagnosed with schizophrenia.
Not everyone who has a mental illness like schizophrenia will develop an addiction like this. In fact, many people develop symptoms of mental illnesses or addictions and never do develop another co-occurring problem. But the National Alliance on Mental Illness suggests that certain groups are more statistically likely to deal with co-occurring disorders, including:
- Those who live in poverty
- Those with existing medical illnesses
Screening and Assessments
People who have co-occurring disorders face intense difficulties that others simply do not face. For example, research released by the Oregon Health Authority suggests that people with co-occurring disorders die at age 45.1, while those who don’t have these issues die at age 76.6.
A screening process begins the path to healing. In this process, people are put through a series of tests so that experts can spot and name all of the issues that might be driving a person to the use and abuse of drugs. There are a number of different tests that experts can use in order to spot mental illnesses, and they all work just a little differently, but most require the person to answer a series of questions about what has happened in the past and how the person is feeling right now. The questions aren’t really intrusive, but they can be a little uncomfortable for some people to answer. With the results, experts can provide a firm diagnosis of mental illness and/or addiction, and they can move on to the assessment phase.
Here, experts attempt to develop a timeline that explains the disorders. They might try to determine which problem came first and what else was happening in the person’s life at the time. They might also attempt to determine how disabled the person is by either disorder, and how capable the person might be of participating in meaningful treatment programs. Experts might also attempt to determine just how motivated the person is to change his or her life.
Developing a Plan
It can sometimes be a little difficult to encourage an addicted person to participate in addiction recovery programs, particularly if a mental illness is in play. To the person, the drugs seem to provide an appropriate level of relief for a very real pain syndrome, and the person might not understand why anything should change. If drugs help, the person might be desperate to keep them.
Motivational Enhancement Therapy can help. Here, experts attempt to point out the discrepancy between what the person is saying and how the person is acting. For example, someone with an addiction and a mental illness might believe that the drugs help, but in reality, the drugs might make the person feel yet more disconnected and out of control. In therapy, the counselor asks questions that help to make this discrepancy come to light. The counselor might ask:
- Do you feel like you’re in control when you’re high?
- How do you feel right before you get high?
- How do you feel when the drug wears off?
- Do drugs really help, if you feel like you always need them?
At the end of these sessions, clients often come to a deeper understanding of the damage drugs can do and the dysfunction they’re allowing into their lives. With this information, they can learn to really participate in therapy and pull together a happier, healthier life.
Once people agree to participate in therapy, their counselors can begin to pull together targeted, individualized treatment programs. In a Dual Diagnosis program, every therapy that’s provided is designed to address both sets of problems at the same time. People who participate in counseling sessions, for example, might learn techniques that help them to avoid addiction triggers and mental illness triggers. People who use art therapy might make art that represents their experiences with both kinds of disorders. Everything is blended and connected in these programs, and the help can be remarkable.
Support group work can also be valuable for people who have co-occurring disorders, but according to the National Drug Court Institute, some people with these disorders may feel stressed out or attacked when they’re placed in a traditional support group. They may not feel as though they can discuss their concerns openly with complete strangers, or they may find it difficult to listen to others without injecting their own opinions. As a result, some co-occurring disorder programs don’t introduce the 12-Step support group model right away. They might allow people to settle into the idea of healing first, working through some of their concerns privately before they dive into support group work. Some might never get comfortable with the model at all.
A person’s co-occurring disorder treatment program should change as the person changes, meaning that screenings, assessments and planning should be revisited often, and the work should be tweaked accordingly. That’s the best way to ensure that the person gets the right kind of help at the right time.
At Black Bear Lodge, we specialize in providing help for people with co-occurring disorders. We provide intense screening and assessment at the beginning of the healing process, we provide periodic screening throughout the person’s stay, and we adjust our therapies accordingly. We’d love to help you or someone you love to improve. Please call, and our admissions coordinators can tell you more about what we can do for you.