If battling addiction is like a knight taking on a ravaging dragon, then dealing with co-occurring disorders is like fighting one with two heads and both of them spewing flames. The term “Co-Occurring Disorder” is a clinical one referring to a person being diagnosed with both addictive disease and one or more mental health disorders at the same time.
Unfortunately, it is a rather prevalent issue in society. Dr. Nora Volkow, Director of NIDA, asserts that as many as 6 in 10 substance abusers also have at least one other mental disorder. Conservative estimates from SAMHSA put the rate of comorbidity for age 18-25 at 35.3% and age 26-49 at 42.7% but other research from the Center for Substance Abuse Treatment, an agency of SAMHSA, indicated that investigators describing substance abuse treatment client populations have reported up to 70% of their clients showing lifetime histories of co-occurring disorders.[1]
McGovern and colleagues described the breakdown of co-occurring disorders by type with overall estimates of 41% mood disorders, 26% anxiety disorders, 25% PTSD, 17% severe mental illness, 18% antisocial personality disorder, and 17% borderline personality disorder.[2] The overlap in numbers illustrates multiple mental health disorders occurring in the same person.
By modest estimates, this affects 4.7% of the US population, or 8 million people.
Regrettably, in the field, many counselors still tend to see chemical dependency and mental illness as unrelated phenomena, or else they relegate one to the other. For example, it is not uncommon for drug counselors to dismiss mental health symptoms as being drug-induced or secondary to drug use, saying things like, “No wonder you’re anxious, you’re homeless and have illegal drug charges! Fix that issue and your anxiety will disappear.”
On the other end of the spectrum, we have mental health counselors that dismiss addiction as being nothing more than harmful coping skills, saying things like, “No wonder you use drugs to cope, you’re very anxious! Fix that issue and the drug abuse will stop.”
In the end, though, failing to address a client’s needs holistically by treating every issue as equally important does harm to the client and reduces their chances of full recovery. Twenty-six studies have demonstrated that integrated treatment for co-occurring mental illnesses and substance use conditions is more effective than separate treatment approaches alone.[3]
Really, this just makes sense. If your practice or treatment center’s model fails to take these realities into account, then you’re not reaching the full efficacy of which you’re capable. It may be that your company is stellar at addressing psychiatric conditions but relegates clients with known substance dependency to referrals and outside providers. Are you aware that mental health and addiction clients are essentially the same population?
Ignoring a subset of their issues will not make them go away. Likewise, no matter how fantastic your treatment agency is at addressing substance abuse, many clients are simply unable to achieve lasting recovery until their co-existing mental disorders are resolved or stabilized. How will a client overcome triggers to relapse when their impulsive manic episodes are not controlled with appropriate medication? Do you really think that a client can effectively employ addictive coping and stress management strategies when they are so depressed suicide is crossing their mind?
Similarly, treatment organizations (or any business, for that matter) often suffer from co-morbidity themselves. Calamity is likely no matter how emotionally sophisticated a company when its leadership is addicted to power and revenue expansion at any cost. Is it not common to see within these scenarios a rampant narcissism and the idea their company’s superiority outweighs necessary cooperation with others in the field?
At what point does “being the best” deteriorate into dogged resistance to new ideas or, worse, crippling financial anxiety that crushes clients in the gears of a red-lining industrial machine? I trust it’s apparent you cannot address one issue without also remedying the other.
Likewise, effective treatment depends upon therapists being trained in the latest techniques and interventions for both addiction recovery and reducing or eliminating symptoms of mental health disorders. Every client under their care must be given the opportunity to work through not only the devastation of addiction but also the wreckage of mental illness. Combining this with the power of grace-filled faith gives each valiant knight the tools they need to be victorious dragon slayers, two heads or not.[4]
Until next time, don’t just be transformed: be Kinged.
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