Co-Occurring Disorders: Addiction and Dual Diagnosis

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Co-occurring disorders are a huge problem, looming in the background of the addict’s substance abuse, not far from the surface. (Truthout.org/Flickr)
Co-occurring disorders are a huge problem, looming in the background of the addict’s substance abuse, not far from the surface. (Truthout.org/Flickr)

Those who are unfamiliar with the nature of alcoholism and drug addiction may think that the issue is cut and dry. After all, if addiction is truly a disease, then there certainly must be a cure. Unfortunately, however, this is not quite the case. Many people relapse every day, often because they tried to stay clean and sober without truly addressing the underlying causes of their substance dependency. And while there may be many underlying causes such as personal history and genetics, there are also many co-occurring disorders that come into play. This is the point at which you may ask:

“But what, pray tell, are co-occurring disorders?” This is an excellent question, and we’d like to take a moment to answer it for you. We’d also like to take a look at a few of the most common co-occurring disorders which accompany some of the primary substances associated with addiction. Finally, we will discuss the treatment options for a person who suffers from co-occurring disorders related to dependency.

What Are Co-Occurring Disorders?

Co-occurring disorders often affect mood, making it hard for some addicts to face the sight of their own reflection. (Shutterstock)
Co-occurring disorders often affect mood, making it hard for some addicts to face the sight of their own reflection. (Shutterstock)

The simplest answer to this question is that co-occurring disorders are mood-related disorders or mental disorders which occur at the same time. For our purposes, co-occurring disorders are any such disorders or mental illnesses suffered by an addict or alcoholic. These types of disorders can make addiction rather difficult to treat, since they must be addressed at the same time as the patient’s rehabilitation.

While it would be a little bit outlandish to call this a benefit, there is one aspect of co-occurring disorders that can be somewhat helpful. Co-occurring disorders naturally affect a person’s behavior, which means that addicts who suffer from certain mood disorders and mental illnesses may be more likely to exhibit certain signs of addiction. If you read that link, as well as our post on the seven signs of alcoholism, then you will see how mood and behavior play a large role in identifying a person who is struggling with substance dependency. Again, it is not right to call this a benefit, as the effects on the addict in question are regrettable to say the least. Nonetheless, one may rest assured that any co-occurring disorders which make the disease of addiction easier to identify will also be relatively easy to diagnose.

Now, for the purposes of this discussion, we are referring to co-occurring disorders as the mood disorders and mental illnesses frequently associated with substance dependency. However, this is a two-way street in the sense that addiction may also be considered a co-occurring disorder suffered by those who suffer from other mood-related and mental issues. In fact, many of those who abuse mind-altering substances may have begun to do so because they felt that the substance in question helped them to quiet their mind or return them to normalcy. Unfortunately, as their use increased over time, they soon found themselves developing a physiological dependence which caused them to use more and to suffer from withdrawal symptoms when they attempted to mitigate their use. Some of the substances most frequently abused to this extent (alcohol, cocaine, heroin, opioids and marijuana) are addressed below.

Co-Occurring Disorders for Alcohol

Believe it or not, depression isn’t even the biggest thing we’re going to touch on. (Shutterstock)
Believe it or not, depression isn’t even the biggest thing we’re going to touch on. (Shutterstock)

The first co-occurring disorder for alcohol dependency is technically not co-occurring at all, depending upon your point of view. There are some who do not consider alcohol to be a drug, whereas others believe drugs and alcohol to be on the same level. In any case, drug addiction and alcoholism frequently go hand-in-hand.

Alcoholics can be beset by other co-occurring disorders as well. One of these is Korsakoff’s syndrome, which inhibits a person’s ability to create new memories. There are also basic mood disorders, such as anxiety and depression. Schizophrenia, mania, dementia and bulimia have also shown correlations with alcohol dependency. To be fair, some of the studies on this are imperfect, and have produced widely varying results. For instance, the correlation between alcoholism and bulimia is believed to rank at anywhere from 33% to 83%, which is a remarkably sizable range. However, while all of the above disorders show levels of comorbidity with alcoholism, one of the greatest is antisocial personality disorder.

While some belief that “antisocial” indicates a disinclination toward socialization, this is not quite the case. Antisocial personality disorder is actually characterized by an extreme disregard for social conventions. Those who suffer from ASPD may have trouble feeling sympathy for others, and may engage in harmful or illegal behaviors. They may also show a penchant for frequent dishonesty. Alcoholism and antisocial behavior are so closely linked that alcoholism is actually one of the criteria for diagnosing ASPD. And this can be troublesome, because the decreased inhibitions which accompany alcohol abuse can exacerbate the alcoholic’s antisocial tendencies.

Co-Occurring Disorders for Cocaine

Cocaine doesn’t necessarily cause its co-occurring disorders, but it certainly doesn’t help. (Gallo Images/Thinkstock)
Cocaine doesn’t necessarily cause its co-occurring disorders, but it certainly doesn’t help. (Gallo Images/Thinkstock)

Antisocial behavior disorder is also one of the primary co-occurring disorders for cocaine, although there are certainly several more. Depressive disorders and post-traumatic stress disorder are among them. In fact, the depression and antisocial tendencies of cocaine addicts can be so bad as to interfere with the addict’s susceptibility to psychiatric therapy and addiction recovery counseling. This is why it is absolutely paramount that these disorders be diagnosed early in recovery if the addict is to receive proper treatment.

While the above issues are all troubling, anxiety disorders can actually be among the most prominent co-occurring disorders suffered by cocaine addicts. This certainly ties into the cocaine user’s susceptibility to disorders such as PTSD. In addition, those who suffer from cocaine dependency have been found to be at least three times more likely to experience panic attacks. Other anxiety-related issues, such as agoraphobia, have also been associated with cocaine usage (and substance abuse at large, for that matter). Bipolar disorder has also been associated with cocaine dependency. Studies have shown that those who seek therapy for cocaine addiction will often seek therapy for one or more of the above disorders as well.

In much the same fashion as alcohol dependence may exacerbate the alcoholic’s antisocial behaviors, cocaine addiction may worsen any co-occurring disorders related to anxiety. Fortunately, this does not work the other way around. In other words, the comorbidity of anxiety disorders will not necessarily increase the severity of the user’s cocaine addiction. However, the co-occurring disorders of anxiety and cocaine dependency are likely to heap a great deal of stress upon the addict. For this reason, anxiety disorders must be targeted early on once the cocaine user has agreed to seek treatment for their addiction.

Co-Occurring Disorders for Heroin/Opiates

There is generally a link between the abuse of heroin and the abuse of Demerol, Oxycontin, and other opioids. As such, the major co-occurring disorders of these substances tend to exhibit some overlap. One of the major issues facing those who abuse these substances is depression. In fact, this problem is so great that in 2010, somewhere around 1600 fatal overdoses were discovered to have been successful suicide attempts rather than accidental deaths. And these were only the overdoses that were discovered and recorded. Accounting for failed suicide attempts by heroin and opiate users would be much more difficult.

Depression is certainly one of the major co-occurring disorders related to heroin and opiate abuse, but PTSD is arguably a much greater concern. The link between PTSD and opiates has been assumed for quite some time. In the 1970s, it was discovered that many of the American soldiers sent to fight the Vietnam War were suffering from heroin dependency. And while their rates of use were much lower upon their return to the United States than the relapse rates of addicts who used domestically, there was still a correlation of 60-80% between Vietnam veterans who were treated for PTSD and those who were treated for substance dependency.

Sufferers of PTSD are not exclusively limited to members of the armed forces. Any particularly traumatic event, such as physical or sexual abuse, can lead to this disorder. This can result in outbursts of rage and general aggression, anxiety, sleep disruption, nightmares and flashbacks. These symptoms are especially bad when the sufferer is reminded of the trauma that led to the disorder, even when the reminder in question is a simple sensory stimulus. In addition to substance abuse, PTSD has its own list of co-occurring disorders, such as depression and ADD, as well as more psychosomatic issues such as chronic pain and high blood pressure.

Co-Occurring Disorders for Methamphetamine

Meth puts the user through the wringer, actually playing an active role in the cause of co-occurring disorders. (SA Breaking News)
Meth puts the user through the wringer, actually playing an active role in the cause of co-occurring disorders. (SA Breaking News)

There are many co-occurring disorders associated with methamphetamine abuse, some of which are experienced mostly during active addiction while others tend to surface during periods of withdrawal. During active addiction, meth users will often experience periods of hypomania and extreme sleeplessness. They also tend to suffer from sever psychosis, which can lead to hallucinations and paranoid delusions. Disruptions to the user’s circadian rhythms will often exacerbate some of these issues, and their delirium may become more severe during especially prolonged periods of insomnia. Depression and ADD may also be seen as co-occurring disorders, especially since many amphetamine-containing medications are prescribed to combat these very issues.

Most of the co-occurring disorders listed above, with the exceptions of ADD and depression, are generally caused by the substance abuse itself. However, they can take such a toll on the user that many of these symptoms will continue for quite some time after the addict has stopped using. Withdrawal periods may also exacerbate such issues as depression, and insomnia will be replaced with narcolepsy-like crashes that cause the user to sleep more than usual. This particular withdrawal symptom is known as hypersomnia, and is one of the most common co-occurring disorders exhibited by meth users during periods of reduced substance use.

As one might surmise, these frequent switches between periods of depression and periods of hypomania may also be associated with co-occurring disorders such as bipolar disorder and manic depression. Meth users often get caught in something resembling a negative feedback loop with these disorders. When their manic period subsides and they begin to feel depressed, they will increase their substance abuse and start the entire cycle all over again. This ranks mania and depression (or bipolar disorder/manic depression if such disorders are diagnosed) among the most important co-occurring disorders to address when treating patients who suffer from methamphetamine dependency.

Co-Occurring Disorders for Marijuana

Some people may not consider marijuana to be as extreme as some of the substances listed above, but it still carries its fair share of co-occurring disorders. In fact, one of the major mental illnesses that is often comorbid with marijuana dependency is schizophrenia. It has long been known that schizophrenia is often comorbid with substance dependency, to the extent that close to half of all schizophrenics have been found to abuse illicit substances. But in the case of marijuana, the link is so strong that it was once believed that imbibing marijuana at high levels might actually cause schizophrenia.

It is now known that this is not true. Nonetheless, schizophrenia is still undeniably one of the most prominent co-occurring disorders associated with marijuana addiction. The same study that disproved the notion that marijuana use caused schizophrenia also examined two other co-occurring disorders: depression and bipolar disorder. Marijuana was not determined to be a cause of these disorders, but it was not fully ruled out, either. The most that could be determined for certain was that both depression and bipolar disorder tend to appear in the family histories of many cannabis users.

While the use of cannabis was not determined to be a cause of bipolar disorder, it was discovered that many addicts who suffer from marijuana dependency tended to have longer and more severe affective episodes during prolonged periods of heavy use. They would also cycle between mood states with more rapid frequency. Psychiatric treatment was usually needed to lessen the rates of recurrence in these cycles. Although the two drugs are ostensibly nothing alike, this shows an interesting similarity between the co-occurring disorders associated with marijuana dependency and those which are associated with methamphetamine abuse.

Dual Diagnosis Treatment Options

When a person struggling with alcohol or drug dependency is found to suffer from one or more co-occurring disorders, the answer is often what is known as integrated treatment. This is more or less what it sounds like, immersing the patient in a treatment setting that addresses both their struggles with addiction while also examining the underlying causes and resultant symptoms. In this fashion, each session should be able to help the patient begin recovering from their addiction while also receiving therapy for the affective disorders or mental illnesses that have plagued them during (and often prior to) their addiction.

Of course, particularly bad cases may also call for pharmacotherapy as well. This is why the best option is generally an addiction recovery program at a dual diagnosis facility staffed with trained medical professionals. Such facilities provide not only a safe place for the patient to recover without access to their drug of choice, but also help the patient to undergo a thorough recovery process involving counseling (often in the form of cognitive behavioral therapy), medical care (sometimes involving medication-assisted treatment), and the development of basic life skills that will help them to become sober and productive members of society once they have graduated from treatment. This last benefit is particularly important, as those who suffer from substance dependency and co-occurring disorders will often need to work hard to repair certain aspects of their lives that have suffered as a result of their disease.

It should be stated that, much like the disease of addiction itself, many co-occurring disorders can never be truly “cured.” This means that the sufferer will need to continue working on their recovery after they have left treatment. Recommendations for post-treatment recovery include regular 12-step meetings, sponsorship, and daily meditation, among other things. Ultimately, the best process of recovery will depend upon the patient. It is important for those who suffer from co-occurring disorders to pay special attention to their aftercare recommendations when leaving treatment. Otherwise, they run the risk of relapsing on their drug of choice, not to mention the possible recurrence of symptoms associated with the co-occurring disorders they have worked so hard to treat.

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2 thoughts on “Co-Occurring Disorders: Addiction and Dual Diagnosis”

  1. I would love for my son to do this as he is 25 year old on methamphetamine. And I feel this would help. Unforunately I’m unemployed and have no means. Pls can you maybe assist as he really wants help

    1. We have an article on affording treatment, here:

      http://www.amethystrecovery.org/can-afford-drug-rehab/

      If you cannot find any suitable options, please get back to us either through this comments section or (preferably) through the “Contact” section on this site. If we believe we can help you, then we will do our best. Meth is one heck of a debilitating drug, especially for someone as young as your son. But if your son truly wants help, that is a wonderful start. We’d love to hear more from you. Please feel free to contact us at your earliest convenience.

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