Co-occurring Disorders and Integrated Treatment
What is a Co-Occurring Disorder?
Substance use disorder (SUD) is a mental health disorder affecting the brain’s reward circuit that changes how a person behaves.1 There are varying degrees of SUD, with symptoms ranging from mild to severe. Addiction is the most severe form of SUD because the uncontrollable compulsive use of substances can lead to life-threatening consequences.1
People who have a substance use disorder and other mental health conditions are commonly referred to as having a co-occurring disorder (dual diagnosis).2 In the U.S., 7.7 million adults have a co-occurring disorder and struggle with addiction and mental health each year.3 Research demonstrates a strong link between substance use disorder and mental illnesses. Of the 20.3 million people diagnosed with a substance use disorder, 37.9% have a co-occurring mental illness.3
There are many effective treatments. According to the National Institute on Drug Abuse, however, only 9.1% of people receive both mental health care and substance use treatment.3 The most reported reasons people with co-occurring disorders do not receive care are due to cost and not knowing where they can go to get treatment.3
Approximately 90% of Nevada’s 81 substance abuse treatment facilities provide one or more integrative treatment options.4 Residents of Nevada are now able to access non-state-funded facilities through the expansion of the state Medicaid program.5 The state expansion program allows more people to access treatment as it is more affordable.
The purpose of this article is to show how addiction and other mental illnesses can be related and explain what integrated treatment options are available.
Common Co-Occurring Disorders
Many mental illnesses affect how people think, behave, feel, and respond to situations, themselves, others, and daily life responsibilities.4 The co-occurring diagnosis classification is applied when one or more mental health conditions exist along with a substance use disorder. Substance use disorders and mental illnesses are common, recurrent, and can be serious. It’s important, however, to know that these conditions are treatable.6
Co-occurring disorders include, but not limited to:2
- Anxiety disorder.
- Bipolar disorder.
- Post-traumatic stress disorder (PTSD).
- Major depressive disorder.
- Attention deficit hyperactive disorder (ADHD).
- Anger Management.
- Antisocial Personality Disorder.
- Borderline Personality Disorder (BPD).
- Eating Disorders.
- Obsessive-Compulsive Disorder (OCD).
- Sexual Addiction.
- Technology Addiction.
Signs You May be Dealing with a Co-Occurring Disorder
Co-occurring disorders affect all groups of people, regardless of age, income, or ethnicity.6 Symptoms of each co-occurring disorder may vary; however, there are some common symptoms and signs that identify a problem with a co-occurring disorder.
Broadly, a person may notice that they or a loved one uses substances that directly cause health problems, disability, and/or failure to meet major responsibilities at work, school, or home. These are indications of a substance use disorder (SUD) and should not be ignored.6
Signs you may be dealing with a co-occurring disorder:7
- Compulsively and habitually using substances (legal, illegal, or prescribed).
- Taking substances in larger amounts to “feel better.”
- Trying to cut down or stop using substances without success.
- Having cravings, a strong desire, or urge to use substances.
- Continuing to use in physically hazardous situations.
- Having a tolerance to a substance; either more is needed to get the same effect or using the same amount as before no longer affects you the way it used to.
- Showing signs of withdrawals when heavy and prolonged use is stopped or reduced.
- Experiencing significant disturbance in thinking, emotional responses, or behavior. 7 (p 4)
- Feeling excessively sad or low.8
- Experiencing extreme mood changes, including uncontrolled highs or euphoria.8
- Changes in sleeping habits; low energy.8
- Changes in eating habits such as overeating or lack of appetite.8
- Change in sex drive.8
- Avoiding friends and social activities.8
- Confused thinking or inability to concentrate.8
A co-occurring disorder may be present when SUD is accompanied by other mental illnesses, negatively interrupting life activities and significantly interfering with family, work, or school life.6
Integrated Treatment for Co-Occurring Disorders
Integrated treatment for drug use disorders and mental illness is the best evidence-based option to manage co-occurring disorders.9 Treating both disorders together, concurrently, has shown to yield the best results, according to research-based methods.9 Multiple treatment options are available.
Integrated treatment involves therapies that focus on how a person thinks, responds, and behaves in their relationships and work/life routines.9 Cognitive-behavioral therapy (CBT). helps a person work through a process toward understanding their behaviors. They learn to develop positive coping skills and use new approaches that help to motivate themselves and function in a sober living environment (recovery).9
Some programs or treatment centers use the term “dual-diagnosis” as one of their treatment offerings. This term is used interchangeably with co-occurring disorders. Co-occurring disorder treatment is a newer term for treating both a substance use disorder and mental health disorder simultaneously.
Integrated treatment is usually initiated at the onset of care. These services may be scheduled after a person is medically stable (after detoxification) depending on the severity of illness and level of care being provided. The sooner both disorders can be treated, the better the health outcome.
Quality programs collaborate between clinical providers (e.g., medical, nursing, counselors) and community agencies that offer support services for people experiencing issues such as homelessness, poor health, unemployment, and legal problems.9 Advantages of offering multiple services under one program umbrella include comprehensive care coordination. Care coordination improves the timeliness of care and reduces delayed treatment access when integrative treatment is established.
What to Expect From an Integrated Treatment Plan
Integrated treatment is when addiction and mental health specialists work together with patients to improve their health long-term. Health providers individualize care through the use of comprehensive care plans. During medical and mental health assessments, they gather the patient’s history and current details, such as their social and employment situation.
After the information-gathering period, the team collaborates to map out treatment options that best meet the person’s needs. The plan outlines the person’s priorities, their main problems, and a primary goal for each problem they’ve identified. Those who seek care need to be included in the decision-making process, as they will be responsible for following through on the plan’s goals.
Detox is usually one of the top priorities. Detox is a period when substances are cleared from the body. The goal of this priority is to complete the detox process. The second priority may be to address an anxiety disorder. This should begin at the same time as the detox process. Treating both the substance use disorder and the anxiety disorder together will improve treatment outcomes.9
Integrated treatment plans allow providers to coordinate services, work seamlessly together towards the individual’s goals, share communications, and access patient records.9 Integrative treatment supports the delivery of comprehensive care and better outcomes for the patient. During treatment, providers and the patient discuss the progress that has been made and adjust any goals as needed.
Common behavioral therapies (alone or in combination with medications) used in an integrated treatment plan include:9
- Cognitive-behavioral therapy (CBT) – designed to modify harmful beliefs and behaviors.
- Dialectical behavioral therapy (DBT) – designed to reduce self-harm behaviors.
- Assertive community treatment (ACT) – designed for smaller groups; highly individualized.
- Contingency management (CM) or motivational incentives (MI) – designed to improve a person’s compliance with a treatment program via vouchers or prizes.
- Therapeutic communities (TCs) – structured, peer-supported, sober living environments.
- Pharmacotherapy (medication) – medically prescribed medication therapy with oversight.
- Seeking Safety (SS) – present-focused therapy designed for trauma-related problems.
- Support groups (e.g., Alcoholics Anonymous, Narcotics Anonymous) – peer support meetings.
- Integrated group therapy (IGT) – designed specifically for patients with bipolar disorder and SUD to address both disorders simultaneously.
- Mobile medical application – FDA-approved CBT app used for outpatient therapy for those in treatment for alcohol, cocaine, marijuana, and stimulant use.
Behavioral treatment is a cornerstone of the long-term health management of co-occurring disorders.9 Most integrated treatment plans combine multiple therapy methods. Behavioral therapy is action-focused; it’s about change. Individuals are expected to engage over time in what is being taught, as it takes time to learn and put into practice new techniques and life skills. The goal is a long-term change that will support healthy living.