Let’s start by defining the term “co-occurring disorder”. Simply, a co-occurring disorder is when someone has a mental health diagnosis along with a substance use disorder. Another term for the same thing is dual diagnosis. However, in recent years the language has shifted away from saying dual diagnosis because it implies that someone is only coping with two disorders. The word dual means consisting of two parts. Many people have more than one diagnosed mental health disorder or more than one diagnosed substance use disorder. Therefore, the mental health profession has shifted to calling them co-occurring disorders.
According to SAMHSA more than 7.9 million people in the United States have a mental health disorder and a substance use disorder. This means that co-occurring disorders are not an uncommon phenomenon. Given the prevalence, it is important to make sure that if you are getting the best possible treatment for your co-occurring disorders. Treatment can often be trickier than it is when only one diagnosis is present. If you are coping with co-occurring disorders you might want to ask yourself a few questions to see if you are getting the best possible care.
It can be very difficult to correctly diagnose co-occurring disorders. This is because you need to get the correct diagnosis for the substance use disorder and the mental health disorder. It is made even harder by the fact that some symptoms of drug or alcohol withdrawal can mirror the symptoms of other mental health disorders. For example, irritability and agitation are symptoms of alcohol withdrawal and they are also symptoms of depression. It is important for clinicians to tease out which symptoms are part of the substance abuse disorder and which are part of the mental health diagnosis.
An additional problem is that some mental health disorders have symptoms that look similar to drug or alcohol intoxication. For example, someone who is having a psychotic episode related to schizophrenia might be experiencing somatic hallucinations. An example of a somatic hallucination is the sensation of bugs crawling on the skin. This type of hallucination is also common in people who are taking methamphetamine.
Experienced diagnostic clinicians should be able to take a full history, preform drug testing, and speak with you in order to determine what the correct diagnosis is. Some clinicians prefer to hold off on making any official diagnosis until you have completely detoxed from drugs and alcohol. Once you have stabilized in a treatment facility for some time they feel more confident making a diagnosis. This can be helpful because it means that clinicians are able to weed out symptoms that might have been the result of intoxication or withdrawal.
Is Your Treatment Team Taking an Integrated Approach?
Integrated treatment is considered the best approach for treating co-occurring disorders. An integrated treatment approach usually means having all parts of your care being addressed. This might include therapy, medically assisted detox, psychiatric care, medical care, and case management. Then, all of these care providers work together in order to support you in the best way possible.
Sometimes integrative care means having a therapist who can help you track any side effects you might be having from medication. A case manager who takes an integrated approach can work with your treatment team to help you decide the best time to return to work. They can also help you find somewhere to live once residential treatment is over and more. All of these people take an integrated approach to make sure that you are getting the most support possible.
Are You Doing Psychotherapy and is it the Right Kind?
According to the APA, a number of research studies have shown that therapy can be helpful for many different disorders. Therapy can be particularly helpful for co-occurring disorders. It can help you come up with coping strategies for recovery from substances and mental health issues. Therapists can provide support with medication management, relapse prevention, and processing old trauma.
In addition to actually doing therapy it is important to consider if it is the right kind of therapy for your particular disorders. For example, dialectical behavioral therapy (DBT) is considered especially effective for treating borderline personality disorder. If you are someone who has borderline personality disorder as a part of your diagnosis it might be important to find a therapist who specializes in DBT. Other examples of targeted therapy include eye movement desensitization and reprocessing therapy for trauma, systematic desensitization for phobias, and cognitive behavior therapy for most mood disorders.
Does Your Medication Need Adjustment?
Medication can be a vital part of treatment for many people with co-occurring disorders. However, navigating the world of medication can be difficult. In some communities, there is a myth that you cannot really be sober if you are taking psychiatric medication. This is truly a myth. Many people need medication in order to function normally. Taking medication as prescribed for your disorder is not jeopardizing your recovery, it is making it stronger.
Psychiatrists are often doing all they can in order to give you the best medications. However, these medications might need to be adjusted over time. When picking the right medications it is important to take into account how the side effects are effecting you. It might take some time to adjust medication so that you can find one that is the most effective with the least amount of side effects.
We would like to pause here and remember the importance of talking to your doctor before you stop taking any medication or change your medication. It is always important to trust the judgement of your care provider when it comes to medication. That being said, you do have the right to be in charge of your mental health care. If you need different medication you can and should advocate for yourself!
Are You Being Treated for Long Enough?
A study published in the journal of Social Work and Public Health found that when people with co-occurring disorders spent more time in inpatient treatment or a community living facilities they were more likely to stay sober than people who did not. This indicates that there might be some benefit to staying in a sober living environment or a treatment center for a while. Of course, it can be hard to stay in a facility like this. Depending on where you are, these places might be expensive or they might prevent you from being able to work full time. However, given the expense of having to do it all over again it is more than worth it to stay for the recommended amount of time.
This often leads people to the question, “how long is long enough?” The truth is that as of right now we do not have one clear answer to this question. We know that drug and alcohol withdrawal lasts a relatively short period of time. If you are interested in the length of withdrawal and symptoms for different drugs this guide from the National Institute of Health is very helpful. Most drug withdrawal is over in about a week. You definitely want to be in treatment and kept safe until withdrawal is over. But there is new evidence to suggest that you actually might want to stay quite a bit longer than that.
Delta Fos B is a molecule found in the brain that has been associated with both substance addiction and process addictions. It is found in the brains of people who have some kind of addictive behavior. There is evidence to suggest that this molecule is still found in the brain two months or more after the addiction behavior has been stopped. This means you might want to spend at very least three months in some kind of treatment until your brain has stabilized.