Alcohol, Substance Abuse, and Co-Occurring Disorders

What is a co-occurring disorder?

When someone is suffering from a substance abuse disorder, such as alcohol or drug addiction, as well as a mental health condition it is referred to as a co-occurring disorder or dual diagnosis. Common mental health conditions that occur alongside substance abuse are:

• Depression
• Bipolar disorder
• Borderline personality disorder (BPD)
• Panic disorders
• Dissociative disorders
• Mood disorders
• Antisocial personality disorder
• Social anxiety disorder
• Post-traumatic stress disorder (PTSD)
• Generalized anxiety disorder

Dealing with alcoholism and or drug dependence is not easy and it becomes even more difficult if you are also struggling with a mental health condition. However, some treatment centers are set up to deal with this situation and can offer treatment programs that tackle both issues simultaneously and offer long-term strategies for coping. Overcoming a dual diagnosis is hard but not impossible, and with time and dedication, you can reclaim your life.

With co-occurring disorders, both a mental disorder and addiction have their own symptoms that can often overlap, affecting the person's ability to function, handle upsets and difficulties, and ability to relate to others. People with co-occurring disorders are at high risk of additional problems which cause disruption and instability not only in their lives, but also affect those around them, including family, friends, and co-workers. Difficulties can cause social, economic, and psychological losses which worsen the situation and make treatment a challenge. 

When the co-occurring disorders interact with each other they can exacerbate each other and make each harder to deal with. When a mental health condition goes untreated, substance dependence and addiction can get worse as the need for drugs and alcohol to deal with the condition increases. Similarly, the more drugs and alcohol are abused the worse mental health conditions get, creating a volatile cycle that can be difficult to break out of. Some believe there are genetic causes, but environment also plays a significant role.

Addiction and mental health

Addiction is a common problem for those with mental health issues. Though substance abuse disorder is more likely in those who have issues like depression and anxiety, one does not directly cause the other in the first instance.

For most people who develop co-occurring disorders, alcohol and/or drug abuse starts as a way of self-medicating the symptoms of mental health problems. Over time, the continued abuse can exacerbate the symptoms that were initially numbed by drugs and alcohol, often resulting in dependence on the substance to maintain the effects, which can cause an addiction to form. By definition, both addiction and mental health issues coexist, without one causing the other, because of a combination of factors.

Some people may have very mild forms of mental illness and they are often not aware of them when they start abusing drugs and alcohol. Continued substance abuse, especially when addiction begins to form, can lead to underlying mental health issues coming to the surface, making them hard to deal with. As mental health disorders are caused by a complex link between genetics, environment, and other factors, it is hard to know what the cause may be and what will make them get worse.

It is also risky for people taking medication for mental health disorders to start abusing other substances. Medications such as antidepressants, mood stabilizers, and anti-anxiety pills (benzodiazepines) can all be affected by other substances, occasionally making them ineffective or causing an accidental overdose.

Diagnosing a co-occurring disorder can be difficult and will require a therapist or medical professional to identify it successfully. If diagnosed, the chances of receiving the appropriate treatment for both conditions at a rehab facility are increased, and recovery from addiction as well as developing long-term coping mechanisms for mental health will become possible. Both the addiction and the mental health problem can be treated best with an integrated approach rather than trying to treat each individually. Typically, the person is treated with a combination of cognitive-behavioral therapy or dialectical behavioral therapy and medications.