Treating Co-Occurring Disorders
Many people struggling with addiction also struggle with a mental illness. This is called a co-occurring disorder. In many cases, the painful symptoms of mental illness encourage the person to seek relief in the form of drugs or alcohol. For example, a person with post-traumatic stress disorder (PTSD) may drink to block out intense pain or anxiety. Treatment for co-occurring disorders requires knowledge of how each illness relates to the others. With proper support and individualized treatment, you loved one can recover from addiction and learn healthy ways to manage their mental illness.
Etiology of Treatment
Understanding how substance abuse and mental illness interact is the first step in treatment. Researchers have proposed three main models of interaction:
- The disease model focuses on substance abuse as the driving factor in mental illness.
- The self-medication model applies to people with an underlying mental illness who attempt to mitigate their symptoms via an addictive substance.
- The common pathway model identifies environmental factors (e.g. drug-using parents, abuse, bullying, etc.) that may lead to both substance abuse and mental illness.
Strategies for Treatment
Several strategies can improve treatment effectiveness for patients with a co-occurring disorder. A clinician should consider not only the individual symptoms of each disorder, but also how they interact. A treatment center should devise an integrated treatment plan or work closely with an offsite provider to ensure that all of the patient’s needs are met.
Below are general guidelines for treatment of co-occurring disorders:
- Clinicians should be well-versed in treating both the type of addiction and the mental disorder afflicting the patient.
- Barring symptoms or serious side effects, patients should not receive psychotropic medications until they become stable on the addiction medication.
- Clinicians should monitor patients’ medication frequency and dosage while prescribing drugs with minimal potential for abuse.
- Counseling (individual and family) and education can help patients understand and come to terms with their condition.
- Because addiction can intensify symptoms of mental illness, it is generally the primary target of treatment.
Even patients with the same mental illness and substance of abuse can have drastically different treatment needs. Age, gender, physiology, underlying health issues, and personality can all affect the outcome of treatment. As such, many patients benefit from holistic treatment, which considers the whole person beyond their illnesses.
Through treatments such as art therapy, music therapy, exercise, massage therapy, and yoga, a patient with co-occurring disorders can heal on physical, mental, emotional, and spiritual levels. Holistic treatments help break patients out of harmful habits and thought patterns and encourage a better understanding of self. From there, patients are better equipped to take charge of their own recovery.
The Role of Support in Treatment
A strong support network helps motivate patients to remain in treatment. Family and friends should provide ongoing love and support before, during, and after treatment. Because co-occurring disorders can harm relationships, family counseling plays an essential role in the recovery process. Clinicians should help the patient understand that they are not alone and educate both the patient and loved ones on the mechanics of each illness and how they interact.
Inpatient treatment gives patients an opportunity to build a network of support with clinicians and peers. Many people with co-occurring disorders hesitate to communicate with loved ones due to a lack of understanding. They may feel more comfortable talking to people with similar experiences or clinicians who can provide targeted advice after treatment. All of these relationships can improve a patient’s chances of recovery.
- National Center for Biotechnology Information, Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs: Chapter 12: Treatment of Co-Occurring Disorders, NCBI, 2005, http://www.ncbi.nlm.nih.gov/books/NBK64163/
- National Alliance on Mental Illness, Dual Diagnosis, NAMI, http://www.nami.org/Learn-More/Mental-Health-Conditions/Dual-Diagnosis