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Managing Co-Occurring Conditions

If you have met very many adults with mental health conditions, you may have noticed that a large number of them have also struggled with addiction. When a person has two or more diagnoses at the same time, such as a substance use disorder and a mental illness, these are called co-occurring or dual diagnoses. At Highland Hospital in Charleston, West Virginia, we offer specialized treatment and care for people in this situation to maximize their chances of successfully recovering from both.

How Common Are Dual Diagnoses?

Between 17 million and 22 million adults in the United States have co-occurring mental health and substance use disorders. It is estimated that around half of people with a mental health diagnosis will also struggle with substance use at some point in their lives, with up to eight out of ten people with certain mental illnesses misusing substances. 

Potential Causes of Mental Illness and Substance Use Disorder

There is sometimes a tendency to try to blame people with substance use disorders for causing their mental illnesses by misusing drugs, but research does not seem to indicate anything that simple. The most popular theories for why mental illness and substance use disorder are so frequently found together are:

  • Shared risk factors The same things that can increase a person’s risk for addiction also increase their risk for mental illness. Some examples are trauma, genetics and brain differences. One study of rats found that damage at birth to the amygdala (the part of the brain that handles fear, anxiety and other emotions) triggered behavioral changes and increased sensitivity to some drugs.
  • Mental illness frequently leads to substance use – Studies have found that people with mental health disorders frequently attempt to self-medicate their symptoms by drinking, smoking cigarettes, or using illegal substances.
  • Existing co-occurring conditions can lead to additional mental health disorders – Even in cases where a person developed a mental illness after they started misusing substances, studies frequently found that the new mental health condition wasn’t the first mental illness they developed and that their first mental health condition potentially predated their substance use.

Mental Illnesses Likely to Be Found Alongside Addiction

The mental health conditions that are most likely to be found in a person who also has a substance use disorder are:

Substances Likely to Be Misused By People With Mental Illnesses

The substances that are most often misused by people with mental illnesses include:

  • Legal drugs – alcohol, tobacco, and prescription medications
  • Opioids
  • Stimulants
  • Marijuana
  • Hallucinogens

Impact on Treatment for Dual Diagnoses

When a person struggles with both their mental health and a substance use disorder, it can make treatment more complicated. Medications that are used to support sobriety can have adverse reactions to commonly prescribed anxiety medications, for example. There may also be a need for more comprehensive assessment in dual diagnosis scenarios because the symptoms of substance use disorder and those of certain mental illnesses can be similar and lead to misdiagnosis, which can result in incorrect treatment. For the best results, it is generally recommended that mental health concerns and substance use disorders be treated simultaneously.

The Process for Treating Co-Occurring Diagnoses

Because it is more complicated to treat co-existing conditions, people who struggle with addiction and mental illness may require more steps and time to recover. Some of the treatments they might receive include:

  • Detox – In this initial stage, a person who has been actively using alcohol or other drugs is getting sober and letting the drugs leave their system.
  • Inpatient rehabilitation – This level of treatment may be more commonly recommended for people who are fighting both addiction and mental health concerns. 24/7 professional supervision and support are available at this level of care.
  • Therapy – Several different therapy options could be considered, some of which are listed below.
  • Medication – Not only can medication help to make mental health symptoms more manageable, but some medications can make it easier to maintain sobriety.
  • Supportive housing – Living amongst other people in recovery can sometimes help to reinforce the gains made during treatment.
  • Self-help and support groups – AA, NA, and other recovery groups may offer additional support. 

Recommended Therapy Types for Dual Diagnoses

People with dual diagnoses should receive therapy as part of their treatment. Some of the modalities that are known to work well for co-occurring diagnoses in adults include:

  • Cognitive-behavioral therapy (CBT)
  • Dialectical behavior therapy (DBT)
  • Assertive community treatment (ACT)
  • Therapeutic communities (TC)
  • Contingency management (CM)

Because of their different developmental levels, different therapy modalities are recommended for children and adolescents with dual diagnoses. For them, the recommended therapies are:

  • Brief strategic family therapy (BSFT)
  • Multidimensional family therapy (MDFT)
  • Multisystemic therapy (MST)

At Highland Hospital, we take an integrated approach to dual-diagnosis treatment, with a team of caring and knowledgeable professionals who are trained to address mental health and addiction together. We offer treatment, including detox services, for young people ages 10-17 and for adults. 

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