One-third of individuals with a mental health condition also experience a substance use disorder. When these conditions occur together, they are called co-occurring disorders and are associated with more severe symptoms and complex treatment needs. [1][2] A combination of psychiatric medications and behavioral therapies is often necessary to stabilize symptoms and support long-term recovery. [2][3]
- There is a significant overlap between mental health and substance use disorders, and rates of co-occurring disorders are high.
- Co-occurring disorder treatment often involves a combination of psychotherapy and psychiatric medication.
- Common types of psychiatric medication used in dual diagnosis treatment include antidepressants, antipsychotics, mood stabilizers, and addiction medicines.
Treatment of co-occurring disorders
There is strong evidence to suggest that substance use disorders commonly co-occur with mental illness, and the presence of one disorder increases the risk for the other. Approximately one third of people diagnosed with a mental health condition also have a substance use disorder. [1] When mental illness and addiction co-occur, the symptom severity, degree of impairment, and risk factors also increase in ways that require more comprehensive care. [2][3]
Research shows that individuals with co-occurring disorders are at higher risk for severe mental illness, suicide, overdose, and the need for emergency medical care. They are also more likely to face challenges related to housing, employment, and financial stability. [1]
Given the complexity and seriousness of these conditions, effective treatment typically involves a combination of medication and therapy to address both substance use and mental health issues at the same time. This approach is called integrated treatment and is considered best practice for the treatment of co-occurring disorders. [3]
Psychiatric medications in dual diagnosis treatment
A number of different psychiatric medications may be used in the treatment of co-occurring disorders, depending on the specific issues and symptoms being treated. The goal of psychiatric medication in co-occurring disorder treatment is often to stabilize the person and reduce mental health symptoms. This is helpful in the treatment of substance use disorders because many people with dual diagnoses use drugs or alcohol to cope with unmanaged mental health symptoms. [3]
Psychiatric medication may also be used to help reduce cravings or withdrawal symptoms associated with a substance use disorder. For example, people with opioid use disorder may be recommended to take a medication like methadone or suboxone to help ease withdrawals and prevent relapse. Normally, psychiatric medication is only recommended when combined with other psychosocial or behavioral therapies, which is considered best practice in the treatment of co-occurring disorders. [2][3]
Common psychiatric medications for co-occurring disorders
There are a number of different kinds of psychiatric medications that can be prescribed to someone struggling with co-occurring mental health and substance use disorders. Some of the most common mental health disorders that co-occur with addiction include depression, anxiety, PTSD, and bipolar disorder. Individuals struggling with symptoms of these conditions may use drugs and alcohol to self-medicate or cope. [1][2]
Sometimes, prescribed medications can help to address this problem by helping to stabilize and reduce co-occurring mental health symptoms. In other cases, individuals who have co-occurring disorders need medications to treat their substance use disorder. For example, they may need medications to help reduce cravings or ease symptoms of withdrawal. Sometimes, these medications are provided temporarily, like during the detox phase, and other times, they can be continued long-term to help prevent relapse. [3]
Antidepressants
Antidepressants are some of the most commonly prescribed psychiatric medications and can often be helpful to people with co-occurring disorders. Antidepressants are used to treat major depressive disorder, but are sometimes prescribed off-label to address anxiety, insomnia, or chronic pain. Most antidepressants are SSRIs or SNRIs that work on serotonin and norepinephrine by blocking transporters that remove these neurotransmitters to help boost mood and energy levels. [4]
Mood stabilizers
Mood stabilizers are most commonly prescribed in the treatment of mood disorders like bipolar disorder, but can also be prescribed to treat depression or other mood-related problems. Mood stabilizers can work on several different chemical receptors in the brain, including GABA, glutamate, dopamine, and serotonin. Mood stabilizers can also work on nerves and signals in the brain to help stabilize mood swings and may be helpful to some people with co-occurring substance use and mood disorders. [4]
Antipsychotics
Antipsychotic medications are another type of medication that is sometimes prescribed in the treatment of co-occurring disorders. Antipsychotics are used to treat psychotic symptoms like hallucinations, delusions, and paranoia in people struggling with severe mental illnesses. [4] These medications are less commonly prescribed because they carry a risk of severe side effects. Most antipsychotics work on dopamine receptors and affect serotonin levels in the brain.
Medication-assisted treatments
Medication-assisted treatment (MAT) involves the use of psychotropic medications to treat substance use disorder symptoms like cravings and withdrawal. The most commonly prescribed types of medications used in MAT are methadone and buprenorphine (or buprenorphine/naloxone), which are used in the treatment of opioid use disorder. Other MAT medications include disulfiram, naltrexone, and acamprosate, which can be used in the treatment of alcohol use disorder. MAT medications are always prescribed in tandem with other behavioral therapies and not used as a stand-alone treatment. [3][4]
Controlled medications
Less commonly, controlled substances are used in the treatment of co-occurring disorders. Controlled substances are those that carry some potential for abuse and addiction, and are more cautiously prescribed, especially when there is a history of addiction.
There can be several risks associated with the use of controlled medication in dual diagnosis treatment, including the risk for prescription medication abuse and addiction. For these reasons, these medications may be used less frequently, or only short-term, when treating individuals with co-occurring disorders. [3][4]
Here are some of the different types of controlled medications sometimes used in dual diagnosis treatment: [4]
- Benzodiazepines like alprazolam or lorazepam that can target symptoms of acute anxiety, and may also help to ease severe withdrawal symptoms when used short-term.
- Stimulants like Adderall or Ritalin that can treat symptoms of ADD, ADHD, or sleep disorders like narcolepsy.
Integrated treatment and why it works
The best approach to treating co-occurring mental health and substance use disorders is an integrated approach. Integrated approaches involve simultaneous treatment for both mental illness and addiction, and often use a combination of medication and therapy. A number of different types of therapies can be effective in the treatment of co-occurring disorders, including Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT). [2] Some dual diagnosis treatment programs involve a combination of group therapy for addiction and individual therapy for mental health, as well as providing medication management.
Because mental health and substance use often create a cycle that becomes self-perpetuating, treating both conditions simultaneously leads to the best outcomes. [1] Integrated treatment providers are knowledgeable and skilled in the treatment of co-occurring disorders and are usually able to provide treatment for both in the same facility. Many dual diagnosis clinics have a multidisciplinary team that meets to discuss treatment needs for clients. This helps to ensure that the treatment provided is consistent and comprehensive in nature. [2][3]
What to discuss with providers before starting medications
Before starting medication, it is important to discuss your symptoms and treatment plan with a licensed prescriber. In order to make the best recommendation for your treatment, it’s important to provide certain information during the initial appointment, including:
- Medical history including any chronic illnesses and all prescribed medications and vitamins or supplements you are taking.
- Any known drug allergies or prior adverse reactions to medications in the past.
- Current use of alcohol or illicit substances that may interact with medications.
- Your mental health and substance use diagnoses and the symptoms and impairments you are targeting in treatment.
- Recent and current treatments for mental health, addiction, or both and how the prescriber will coordinate care with current providers.
- Preferences or aversions to specific types of medication or treatments.
- Concerns about current medications, including any adverse effects or unwanted side effects you are experiencing.
- Concerns about your physical health, including any symptoms of illness, infection, or other medical problems.
- Ability to afford medications or out-of-pocket expenses and copays, which may influence what types of medications are prescribed.
