Co-Occurring Disorders Treatment

Medical knowledge about the relationship between addiction and mental health disorders grows tremendously each year. Instead of old-fashioned ideas about a person’s character making addiction worse, researchers know a whole combination of factors contributes to addiction.

So when a person has both depression and a heroin addiction, where should he go for help? It’s a common question. In fact, statistics from the National Survey on Drug Use and Health reveal at least 7.9 million adults suffer with co-occurring addiction and mental illness. That’s around 40% of the 20.2 million who report substance use disorder. Some experts believe that number is low and many more people with mental illness also have an addiction. For people with co-occurring disorders, specialized treatment that cares for the symptoms of mental illness and addiction at the same time is needed. When treatments for both conditions are combined in this way, patients have better outcomes and a higher chance of avoiding relapse.[1]

At The Canyon, addiction counselors carefully screen patients to determine important factors contributing to addiction, which commonly include struggles with mental health disorders.

Instead of ignoring mental illness, therapists treat all of a patient’s symptoms giving them a higher level of care that improves mental health and makes fighting temptations to use easier.

Getting Integrated Treatment

Introduction to Integrated Treatment

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A person with a mental disorder and an addiction is diagnosed with co-occurring disorders. This diagnosis gives the patient the opportunity to receive specialized care – a treatment plan that addresses all of his symptoms. For example, a plan may include reducing anxiety symptoms with medication and behavior strategies to control alcohol use.

For someone with severe symptoms, such as addiction symptoms made worse by depression, a top strategy for recovery is a strong relationship with a therapist. When a therapeutic relationship develops between a patient and therapist, the therapist is in an excellent position to recognize when her patient’s symptoms are getting worse and conditions seem ripe for a relapse. The ability to recognize such a situation, gives the therapist the ability to offer additional guidance and motivate the patient to make important changes and healthier choices.[2] This type of relationship is integral to treatment at The Canyon, where therapists work closely with patients.

Understanding Vulnerabilities

The progression of addiction and/or mental illness is different for every person. Due to a host of individual characteristics, everything from a unique personal chemistry to a different home and community background plays a role in a person’s risk of developing mental health problems.

Breaking down the root causes of these conditions is difficult, as each person is likely to have a distinct story and a unique cause to share. Experts who conduct studies on the causes of addiction and mental illness believe there are four different models to explain the prevalence of co-occurring disorders:

  • A DISEASE MODEL: a person who begins abusing substances develops subsequent changes to brain chemistry, an imbalance of neurotransmitters and damage to neural networks that is then responsible for the development of mental illness
  • A SELF-MEDICATION MODEL: a person with a mental illness begins using substances in order to self-medicate her symptoms; over time, the substance use becomes compulsive, rather than therapeutic, and addiction sets in
  • A COMMON PATHWAY MODEL: a genetic or environmental factor produces both the addiction and the mental illness.
  • A BIDIRECTIONAL MODEL: factors such as poverty, the availability of drugs and poor social connections contribute to both mental illnesses and addictions

Just one of these models may impact some people, while other people face risks from multiple models. In the end, the reason the two conditions develop isn’t as important as how the two conditions are treated. Research suggests many people who have co-occurring disorders don’t get the help they need to get well. One study indicated about half of people with co-occurring disorders don’t get any type of treatment at all. Fortunately research suggests there are many effective treatments for people with co-occurring disorders, so patients who do get help see significant progress.[3]

A Need for Individualized Treatment

It’s important to know when a person suffers with an addiction and mental disorder, because the treatments needed by people with co-occurring disorders are different from typical addiction treatment. Because addictions and mental illnesses can strengthen and augment one another, people with a mental disorder who receive only addiction treatment face an acceleration of negative mental health symptoms during the recovery process. Similarly, people who receive treatment only for mental health disorders face deep and unresolved cravings for drugs. In either situation, a relapse is much more likely, unless targeted care is provided to address both issues.1

The term co-occurring disorder covers almost any combination of mental health disorder and substance use, but some mental illnesses are more common than others. For example, one study found the following combinations of disorders were most common:

  • Mood disorders (40% to 42% of patients)
  • Anxiety disorders (24% to 27%of patients)
  • Post-traumatic stress disorders (PTSD (24% to 27% of patients)
  • Severe mental illnesses (16% to 21% of patients)
  • Antisocial personality disorders (18% to 20% of patients)
  • Borderline personality disorders (17% to 18% of patients)[4]

While these mental disorders are common in the general population, evidence suggests that having both a mental illness and an addiction causes more serious discomfort and distress. One study of patients in an outpatient addiction treatment program found those with co-occurring disorders had a level of mental health functioning lower than the 25th percentile of the United States population norm. These figures show how untreated mental health symptoms make recovery more difficult.[5]

Targeted Programs

Facilities that provide the kind of specialized care needed by people with mental disorders and addiction are the gold standard in addiction care.

At The Canyon, staff members provide integrated treatment plans for patients with co-occurring disorders. These plans ensure patients are treated for all of their conditions with interventions that address symptoms at the same time. Programs for people with co-occurring disorders also screen patients at the beginning of treatment to diagnose any illnesses and determine the most appropriate course of action.[6]

Some programs provide a patient with assessments to help therapists identify any mental illnesses missed up to that point. Other programs ask patients to provide medical records, including notes from previous therapy sessions, so they can determine how a patient’s mental illness was treated in the past. In addition, the programs might ask patients to detail the substances they have been taking and undergo a urine drug test. With all of this information in hand, staff members gain information about the help a patient needs and the best treatment going forward.

Medication management often plays an important role in the treatment of co-occurring disorders.

In addition, some addictions, including addictions to alcohol and opiates, respond to medications that reduce cravings, while some mental illnesses respond to medications that balance brain chemistry. With combined medication treatments, many patients achieve significant relief from symptoms. Education also plays an important role. Psychological counseling, including evidence-based therapies like cognitive behavioral therapy, allow patients to understand the conditions, how they interact and how to control them in the future. This education might take place in one-on-one therapy sessions as well as in group counseling sessions.[7]

The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that co-occurring disorder counseling sessions may be quite short.People with mental disorders sometimes have impairments that make long counseling sessions difficult, and they might have a significant amount of information to learn and understand. By packaging the information in small chunks, and pairing it with skill-building lessons people can use right away, therapists hope to ensure their patients get the most out of therapy. In this way, the sessions focus on providing real-life solutions to the practical problems patients face.[8]

Support group meetings also play an important role in treatment programs. Support groups allow patients to meet others who have similar issues and backgrounds, reducing isolation and allowing them to learn how to help one another. Support group meetings are often a mandatory part of the addiction care process, but these meetings also are crucial elements of an after-care program, giving people access to support when their treatment programs are complete. By providing patients with an ongoing method of support, therapists hope to ensure they remain committed to healthy habits and behaviors for the rest of their lives.
Family therapy sessions also have a vital role for people with co-occurring disorders. During guided sessions, the entire family learns more about co-occurring disorders and discusses the trauma and distress they all felt as the addiction and mental illness progressed.

Through the treatment process, therapists help the family learn coping techniques to use in the future, allowing them to create a plan for success they can put into place when the patient’s formal treatment program is complete. Since people with co-occurring disorders need family support when they leave treatment, these therapy sessions are incredibly important.

Sometimes, aftercare programs also include regular drug testing. These screening tests allow addiction counselors to spot a relapse to drug use and amend therapies almost immediately. Some programs provide people with prizes or other gifts, based on their participation in this screening. Such vouchers or gifts are known as contingency management. With each negative urine screen, the person might be given a small gift, such as a coupon for a restaurant or a discount at a grocery store. Tying immediate rewards to participation in this way can help people to stay motivated to participate in their care programs.[9]

Find Out More

Many people feel relief when they receive a diagnosis for their symptoms and have a plan for going forward. Anyone who lives with a mental disorder along with addiction knows life can be chaos without help. At The Canyon, we specialize in integrated treatment for co-occurring disorders and our counselors have decades of experience helping people just like you. Our integrated treatment programs treat the whole person, not just a few symptoms.

If you’re ready to start the process, contact us right now at 424-387-3118. Our admissions coordinators are standing by to take your call.


Sources

[1] Substance Abuse and Mental Health Services Administration. (2016). Mental and Substance Use Disorders. Retrieved Nov. 28, 2016 from http://www.samhsa.gov/disorders.

[2] Snow, Diane. (2015). What Does it Take to Achieve Recovery for Persons With Severe Mental Illness Co-occurring With Substance Use Disorders? Journal of Addictions Nursing. Retrieved Nov. 28, 2016 from http://journals.lww.com/jan/Citation/2015/10000/What_Does_it_Take_to_Achieve_Recovery_for_Persons.1.aspx.

[3]Kessler, R. C., Nelson, C. B., McGonagle, K. A., Edlund, M. J., Frank, R. G. and Leaf, P. J. (1996), The Epidemiology of Co-Occurring Addictive and Mental Disorders: Implications for Prevention and Service Utilization. American Journal of Orthopsychiatry. Retrieved Nov. 28, 2016 from http://onlinelibrary.wiley.com/doi/10.1037/h0080151/abstract.

[4] McGovern, Mark P. et al. (2006). Addiction treatment services and co-occurring disorders: Prevalence estimates, treatment practices, and barriers. Journal of Substance Abuse Treatment. Retrieved Nov. 28, 2016 from http://www.journalofsubstanceabusetreatment.com/article/S0740-5472%2806%2900143-7/abstract

[5] Watkins, Katherine E.; Hunter, Sarah B.; Wenzel, Suzanne L.; Tu, Wenli; Paddock, Susan M.; Griffin, Anne, et al. (2004). Prevalence and Characteristics of Clients with Co‐Occurring Disorders in Outpatient Substance Abuse Treatment. The American Journal of Drug and Alcohol Abuse. Retrieved Nov. 28, 2016 from http://www.tandfonline.com/doi/abs/10.1081/ADA-200037538.

[6] SAMHSA. (2016). Co-occurring Disorders. Retrieved Nov. 28, 2016 from http://www.samhsa.gov/disorders/co-occurring.

[7] National Institute on Drug Abuse. (2007). Addiction and Co-Occurring Mental Disorders. Retrieved Nov. 28, 2016 from https://www.drugabuse.gov/news-events/nida-notes/2007/02/addiction-co-occurring-mental-disorders.

[8] SAMHSA. (2005). Center for Substance Abuse Treatment. Substance Abuse Treatment for Persons With Co-Occurring Disorders. Treatment Improvement Protocol (TIP) Series 42. Retrieved Nov. 28, 2016 from https://www.ncbi.nlm.nih.gov/books/NBK64197/?report=reader.

[9] NIDA. (2012). Behavioral Therapies. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). Retrieved Nov. 28, 2016 from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-0

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