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Exploring Co-occurring Disorders During Mental Health Month

The Significance of Mental Health Month

May is Mental Health Awareness Month, or more commonly, Mental Health Month (MHM).

Founded by Mental Health America (MHA) in 1949, and certified as a national event by presidential proclamation in 2013, the primary purpose of MHM is to educate the public and raise awareness of the nature and extent of mental illness while also disarming the stigmas that surround them.

Each year, MHM focuses on a particular theme. The theme for 2020, for example, was designated as #Tools2Thrive, homing in on the “unprecedented anxiety about a world pandemic.” For 2021, the MHA will continue this theme, given the ongoing impact of the COVID-19 crisis on mental health globally.

Every May, MHA creates a toolkit of materials, which it circulates widely to its affiliates, community groups, public health centers and media organizations, in order to promote mental health awareness throughout the month. The toolkit includes materials on adapting to trauma and stress, dealing with anger and frustration, recognizing unproductive thought patterns while processing changes, and taking time for self-care and self-acceptance. You can access the toolkit here.

The Co-occurrence of Mental Health Disorders and Substance Use Disorders

In pursuit of the educational mission of Mental Health Month, we introduce below some of the most common kinds of co-occurrences.

Co-occurring disorders (also called co-morbid disorders or dual diagnosis) are the mental health disorders that exist alongside a substance use disorder (SUD). For example, someone might struggle simultaneously with both depression and alcoholism, or anxiety and abuse of prescription pills. 

While it’s unclear in general which comes first, two things are clear.

First, it’s undeniable that abused substances alter the brain’s functioning, changing patterns of thought, emotion, mood and action. This can compound co-occurring cases of a mental health disorder and contribute to their further generation.

Second, as we discuss below, those suffering from a mental health disorder are at a higher risk of turning to self-medication, leading to substance abuse.  There is a mutually reinforcing tendency, then, between the two, whereby having mental health disorders increases the chances of developing SUD, with addiction in turn worsening mental health.

In fact, the statistics are staggering. According to one of the largest studies of its kind, nearly eight million Americans suffered from co-occurring disorders in 2014. Recent research has found that nearly half of those who experience mental illness also experience substance abuse and vice versa. Further, people suffering from SUD are twice as likely to suffer from mood and anxiety disorders, and people with a severe mental illness are four times more likely to suffer also from alcohol use disorder.

Tragically, many of these individuals don’t get the treatment they need, exacerbating both conditions, and sometimes leading to homelessness, incarceration and suicide. 

Varieties of Co-occurring Disorders

To raise awareness, as a first step toward recognition and treatment of the problem, here are some common mental health disorders that co-occur with substance use disorder:

  • Anxiety is a common mental disorder, leading some in its grip to abuse alcohol, marijuana and anti-anxiety pills, among other substances, in order to disburden themselves of persistent unease, treat insomnia and manage social encounters. Self-medication induces a felt reliance on substances for functioning and can very well trigger the cycle of addiction.
  • Bipolar Disorder sees its sufferers swinging between intense, involuntary bouts of both depression and mania. This is among the most common of co-occurrences, with many estimates concluding that half of all people with bipolar disorder are also dealing with some form of SUD. 
  • Borderline Personality Disorder (BPD) is a personality disorder characterized by extreme swings in mood and temperament, pathological fear of abandonment along with an inability to maintain relationships, erratic behavior, and warped thoughts of oneself and others. This population turns to drugs as a way of containing or controlling their symptoms, though the desired effect is fleeting at best, compounding them on the whole. 
  • Depression is one of the most common mental health disorders worldwide, with many turning to drugs and alcohol as a form of self-medication. Alcohol is an especially prevalent pairing with the pain of depression. While it might offer some temporary relief, dulling discomfort, dampening anxiety, or stirring some short-lived pleasure, alcohol itself induces depression. And once it’s euphoric effects have worn off, it creates a vicious cycle of consuming more to escape the pain and recapture the pleasure, generating the dependence, tolerance and withdrawal characteristic of addiction. 
  • Eating Disorders (ED), such as anorexia and bulimia, see 50% of sufferers also contending with some form of SUD, making this group five times more liable to addiction than the general population. According to a 2010 SAMHSA review of data across various studies, women with one or the other were four times more likely to develop the other kind of disorder than women with neither. Moreover, 14% of women with SUD had anorexia and another 14% with SUD had bulimia. The forms of cognition and behavior are largely similar between ED and SUD, both marked by obsessive-compulsive behavioral patterns, general unmanageability and inability to stop in the face of negative consequences.  
  • Obsessive-Compulsive Disorder (OCD) itself is evidenced by unwanted obsessive thoughts and an uncontrollable compulsion to behave in certain ways. For example, an OCD patient might feel as though their hands are constantly contaminated, even though they have no objective reason to suppose they are, and so feel compelled to compulsively wash them. Many of these people abuse alcohol and other substances to gain some temporary relief from this burden in thinking and behaving, which, as with all others, does not last and reinforces the vicious cycle. 
  • Post-Traumatic Stress Disorder (PTSD) is a persistent mental condition generated by experiencing or witnessing a traumatic event. Common symptoms include intense anxiety, depression, flashbacks, obsessive thoughts and avoidance. Many veterans return from war suffering from PTSD, as do first responders, who repeatedly witness violent and extreme events. Because of the intensity and tenacity of PTSD symptoms, many turn to drugs and alcohol. PTSD-like symptoms can emerge due to negative occurrence with a major public impact, such as 911 or the current global pandemic.

Recovery Centers of America’s Integrative Approach to Co-occurring Disorders

We at RCA will deploy a comprehensive treatment program, integrating mind, body, and spirit, while also taking each patient’s background and individual needs into account.

Our clinicians will use proven therapeutic approaches, reconnecting patients to their deepest values, teaching them how various drugs affect brain and behavior, developing productive ways of thinking and effective coping mechanisms. We focus on the interaction between the myriad concerns that may be impacting the functioning of an individual and utilize an integrated approach of education and intervention.

Individual and group counseling (extending to both patient and family), along with a number of specialized inpatient programs are reinforced with a bundled care package encompassing mindfulness and wellness, nutrition and fitness, as well as immersion into 12-Step program.

Some of our detailed treatment offerings include:

If you or a loved one is struggling with drugs or alcohol, call Recovery Centers of America now 1-800-RECOVERY.



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