Co-Occurring Disorders: What Does the Term Actually Mean?

Guest blog post from Romas Buivydas, PhD, LMHC
Vice President of Clinical Development at Spectrum Health Systems

You may have heard of the above in some way, shape or form. But what does ‘Co-Occurring Disorders’ really mean?

Co-Occurring Disorders (COD) is a term that describes at least one psychiatric disorder and at least one substance-use disorder simultaneously occurring in a person. There may be more to this definition – and this label is still very broad. It can range from someone developing mild depression from binge drinking, to a person’s bipolar disorder symptoms becoming more severe when they use heroin or other opioids during periods of mania.

Other labels with similar meanings used to describe co-occurring mental health and substance-use disorders include:

• Dual disorders or dual diagnosis
• Mentally Ill Chemically Addicted (MICA)
• Mentally Ill Substance Abuser (MISA)
• Chemical Abuse and Mental Illness (CAMI)
• Substance Abusing Mentally Ill (SAMI)

That’s a lot of acronyms.

I prefer to describe problems with substances and mental health as Co-Occurring Disorders because dual diagnosis, implies that there are only two disorders present. As for the other labels, such as “co-morbid disorder,” most of my colleagues and I are not fans because terms like these can lead to confusion, fear and stigma among the general public.

Throughout all the labels and chatter lies an initial and important take away: One of the co-occurring disorders can develop first.

Co-Occurring Disorders and Substance Use

A person experiencing a mental health condition may turn to drugs and alcohol as a form of self-medication to improve the distressing emotional symptoms or behaviors they’re experiencing. Research, however, demonstrates that drugs and alcohol make those symptoms and behaviors only worse. [1,2,3,4]

The reverse dynamic is also true. Abusing substances can also cause mental health problems where there never used be any because drugs and alcohol can affect a person’s mood, thoughts, brain chemistry and ultimately behavior. [1]

Many individuals with co-occurring disorders unfortunately have more than one mental health issue and more than one substance-use problem which typically creates more distressing troubles.

Mental health difficulties can range from mild depression or anxiety to severe and persistent psychiatric illnesses such as schizophrenia, bipolar disorder, or Post Traumatic Stress Disorder (PTSD). Substance-use issues can range from abuse of alcohol or marijuana to dependence on drugs such as heroin or methamphetamine [1].

Although the symptoms of one disorder may have begun to manifest well before the other, both disorders tend to exacerbate one another, sometimes making it almost impossible to differentiate symptoms caused by one disorder from the other – even for experts [5]. Individuals who try to muffle depression symptoms associated with a mood or personality disorder by taking prescription opioid painkillers like Vicodin, or injecting heroin, soon discover that their first few “highs” quickly disappear, and their psychiatric symptoms return faster. So now, not only are these individuals suffering from symptoms of depression, they also find themselves struggling with substance-use symptoms such as:

• Cravings
• A tolerance to substances which requires higher and higher amounts
• Increased episodes of psychiatric symptoms
• More intense or longer-lasting psychiatric symptoms
• Withdrawal symptoms

Co-Occuring Disorder Treatment

So which disorder do you treat first? Both. It’s considered a best practice that individuals struggling with distressing co-occurring disorders receive what is called integrated medical care and therapeutic interventions for both disorders during treatment [6, 7]. This form of integrated treatment helps the individual manage symptoms caused by the mental health disorder without using drugs or alcohol which would exacerbate those symptoms. And conversely, it also helps the individual manage the behaviors associated with their substance-use disorder, such as the urge to drink or get high. Truly integrated treatment that begins during medically monitored detox and continues throughout treatment, along with support, is the ultimate way to begin recovery from co-occurring disorders.

References

1. National Institute of Drug Addiction (NIDA), DrugFacts—Comorbidity: Addiction and Other Mental Disorders. Revised March, 2011.

2. Volkow ND. The reality of comorbidity: Depression and drug abuse. Biol Psychiatry 56(10):714-717, 2004.

3. Anxiety and Depression Association of America (ADAA), 2016.

4. Morton, W.A. “Cocaine and Psychiatric Symptoms”, Primary Care Companion – Journal of Clinical Psychiatry.

5. Ramesh, M.D et al. “Alcoholism and Psychiatric Disorders: Diagnostic Challenges”, National Institute on Alcohol Abuse and Alcoholism, 2002.