What Do I Need to Know About Co-occurring Disorders?

dual diagnosis disoders

In the past, someone who abused alcohol or drugs would “go to rehab” with the expectation that they would quit drinking and doing drugs then return home and begin attending 12-Step meetings.  After the successful completion of a 28-day program, the addicted individual was, figuratively speaking, thrown to the wolves, and suggested to attend 12-Step meetings daily for the next 90-days.  The vast majority resumed their former addiction within a year’s time. 

The fact of the matter is that many of these people were not simply drinking to excess.  Many were also drinking as a solution to another mental health issue.  This other issue is called a co-occurring disorder.  Having a co-occurring disorder means the person has one or more disorders relating to the use of alcohol and/or other drugs of abuse in addition to one or more mental disorders. 

Luckily, there is a growing number of facilities and professionals skilled at treating co-occurring disorders. Individuals struggling with addiction and co-occurring issues can obtain appropriate initial treatment and long-term planning so that relapse upon return home will not look like such a certainty as in the past for this population.  Buyer beware however, as while there are competent facilities and professionals, there are also those that market themselves as co-occurring treatment facilities yet ultimately gloss over the co-occurring mental health issues.

The Importance of Accurate Diagnosis of Co-occurring Disorders

There are many combinations of substance use disorders and mental health conditions, hence numerous co-occurring diagnoses. Determining the appropriate diagnosis and subsequent treatment plan for the individual is critical to long-term recovery.  

For example, is the person purely overindulging in cocaine and alcohol, or are they also trying to compensate for symptoms of, or a diagnosis of major depressive disorder? Is their alcohol addiction related to a past trauma?  Are they addicted to heroin and barbiturates because they are also dealing with an undiagnosed personality disorder?  Are there co-addictions at play leaving a recovering alcoholic more susceptible to an eating disorder or vice versa?

In order for any treatment to be effective, the treatment team needs to know what they are dealing with.  Patients with co-occurring disorders are at much greater risk of relapse; in fact it’s more of a certainty that they will relapse if the co-occurring conditions and underlying issues are not addressed and properly treated by competent professionals.  For example, a person with a chemical dependency disorder and bipolar disorder will find it extremely difficult, if not impossible to stop using drugs without proper treatment of their bipolar disorder.  A person who experiences anxiety disorder may be able to quit drinking for a time but without proper management will likely seek a way to self-medicate as life becomes difficult.

Dangers of Relapse and Co-occurring Disorders

Relapse for patients with co-occurring disorders can come from many angles.  If they decompensate from a mental health standpoint, they are more likely to relapse with their addiction, and vice versa. They are always vulnerable.  For this reason the old-school treatment methods (even at top-tier facilities) will not serve this population.  The expectation to stop drinking or using for 28 days, begin attending 12-Step meetings for 90 days, and merrily go on their way to a better life is simply absurd - especially for those with co-occurring disorders.   People with co-occurring disorders often require individualized assessments, longer treatment, have more crises, and progress more gradually in their recovery process.

If a co-occurring diagnosis exists, or is suspected, it is imperative to select a treatment facility and team that is experienced with co-occurring disorders.  Treatment options that are presented by an interventionist or addiction consultant should only include facilities that are skilled and capable of working with the particular (or suspected) diagnoses of the addicted individual.  Remember, not all facilities are equipped to properly assess and treat these conditions, despite how they may market themselves. 

Navigating a treatment plan when co-occurring disorders are at play can be complex and a competent professional recovery consultancy is worth every penny invested.  The differences between treatment centers should not be looked at solely on cost, location, or treatment duration, but instead on an individual level based on what facilities appear best suited to assess and initially address the combination of disorders.   With the proper care and treatment management, lasting recovery can be attained.