As if life were not challenging enough for people struggling with mental illness or substance use disorder, many people are faced with both at the same time. The condition of experiencing both addiction and mental illness is called co-occurring or dual diagnoses. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 9.2 million Americans face this problem.
Which Comes First?
According to the National Alliance on Mental Illness (NAMI), some people develop a mental health condition first and then addiction later. Other people don’t experience mental illness until they have misused substances. Each case is unique.
Why Both?
According to the National Institute of Mental Health, researchers have found three reasons why substance use disorder and mental illness are often found in the same people:
- Shared risk factors – stress, trauma, genetics, and environment can all increase a person’s risk for abusing drugs and developing mental illnesses.
- Self-medicating – in an effort to address anxiety, depression and other mental health symptoms, people may turn to substances. They are then more likely than the rest of the population to develop a dependence on those substances.
- Substances create/aggravate mental illnesses – a person may have had a mild mental illness before or none at all, but the introduction of alcohol or drugs can cause them to now have a substantial issue with their mental health.
Treating the Entire Condition
It is generally accepted that a client with a dual diagnosis is best able to make progress on their mental health and addiction by addressing both simultaneously, as the illnesses tend to be deeply intertwined.
Because co-occurring diagnoses can happen in a number of different combinations, with a variety of different mental health struggles and different substances being used, there is no single solution that works for everyone. There are also different treatments for adults and children.
Co-Occurring Diagnoses: The Process
The path to recovery from either substance use disorder or mental illness is long and complicated. When both are involved, the journey can have even more steps. NAMI suggests the following in co-occurring diagnoses:
- Detox – A person who has been actively using alcohol and other drugs may need to first enter a detoxification program to get sober, before they can move forward with any other treatment.
- Inpatient Rehabilitation – A person who is trying to simultaneously overcome addiction and mental illness is more likely to need 24/7 support to do so. Therapy, support, medication, and health services can all be offered simultaneously in such a setting.
- Therapy – Treating mental health conditions requires the right modality. See below for some of the more commonly used options.
- Medications – These might be used to treat the mental health portion of the diagnosis. Medication Assisted Treatment (MAT) might also be utilized to support the recovery from substance use disorder.
- Supportive Housing – After treatment, it can be beneficial to spend some time living in a setting with others who are also in recovery.
- Self-Help and Support Groups
- Double Trouble in Recovery is a 12-step program for people in recovery from substance use disorder and mental illness
- Alcoholics Anonymous and Narcotics Anonymous are 12-step groups for people fighting addiction. Look for a group that understands the connection between mental health and recovery.
Mental Health Treatments for Adults
- Cognitive Behavioral Therapy (CBT) – a type of therapy meant to help people learn how to cope with difficult situations by addressing flawed thinking and poor decision-making.
- Dialectical Behavior Therapy (DBT) – this method teaches people ways to control their emotions by better understanding them and improving their relationships with themselves and others.
- Assertive Community Treatment (ACT) – an intensive, community-based mental health approach with individualized treatment.
- Therapeutic Communities (TC) – long-term residential treatment to help people build values, attitudes, and behaviors that can support long-term sobriety and mental health.
- Contingency Management (CM) – offers incentives for behaviors that support recovery.
Mental Health Treatments for Children
Because children are in a different place developmentally than adults, if they are experiencing co-morbid mental illness and substance use disorder, the recommended treatment options are somewhat different, according to the National Institute of Mental Health:
- Brief Strategic Family Therapy (BSFT) – this therapy targets family dynamics to address the underlying issues contributing to mental health struggles and addiction.
- Multidimensional Family Therapy (MDFT) – an approach that works with the whole family to address substance use, mental health, school problems, illegal behaviors, and anything else that could be going on.
- Multisystemic Therapy (MST) – primarily used to treat antisocial behavior in clients with substance use disorders.
Highland Can Help
If you or a loved one needs help addressing your mental health, substance use concerns, or both, Highland Hospital is here to help.
