Treatment Options for Co-Occurring Disorders

Learn about the details and available treatment options for co-occurring disorders.

What Is a Co-Occurring Disorder?

It is estimated that as many as half of those who seek treatment to help manage and recover from the symptoms of a mental health condition also have a substance use disorder.
A co-occurring disorder (COD) means a person simultaneously struggles with a mental health condition and a substance use disorder.¹ 

Risk Factors

A variety of factors can lead to the development of co-occurring disorders. For some, there is a genetic risk factor for both addiction and certain mental health challenges that increases one’s risk of COD diagnosis. Other factors, including family history, environmental factors, trauma history, elevated stress levels, and other overlapping factors, may also contribute to COD illness.

Another significant risk factor is the use of drugs or alcohol to manage or “self-medicate” mental health symptoms instead of seeking mental health and substance abuse treatment at a treatment center. Although using substances can be helpful in the short term, it is not a permanent fix and often leads to worsening mental and physical health problems. In addition, ongoing drug and alcohol use can also lead to changes to the structure and function of the brain, which can cause worsening mental health symptoms.

Common Symptoms

If someone struggles with a co-occurring disorder, there may be a range of indicators. Some of the most common symptoms of co-occurring conditions include:

• Worsening mental health due to ongoing substance use.
• Difficulty finding integrated treatment for co-occurring disorders.
• Using substances to manage pain or discomfort from a mental health condition.
• New or worsening substance abuse problems that stem from self-medication.

Mental Health Conditions That Occur Commonly Alongside SUDs

Co-occurring disorders and substance abuse are common problems for millions of Americans. There are several conditions that frequently occur alongside substance use disorders. According to the U.S. Department of Health and Human Services, more than one in four U.S. adults living with a severe mental health condition also meets the criteria for a co-occurring diagnosis.²  Although any mental health condition can co-occur with a substance use disorder, some are more common than others.

Anxiety Disorders

Data from the Anxiety and Depression Association of America suggests as many as 20% of people diagnosed with anxiety also have a co-occurring disorder.³ 

Mood Disorders

Recent studies suggest as many as 32% of people with a mood disorder (including depression and bipolar disorders) could benefit from treatment for co-occurring conditions.⁴ 

Personality Disorders

Approximately 23% of people with a personality disorder also have a substance use disorder. This number is slightly higher for individuals with borderline personality disorder, which is 38%.⁵ 

Post-Traumatic Stress Disorder (PTSD)

PTSD and SUD are common co-occurring disorders. Some studies indicate as many as 46.4% of people with lifetime PTSD also have a co-occurring substance use disorder.⁷ 

Attention-Deficit/Hyperactivity Disorder (ADHD)

Children and adults with ADHD are at a greater risk for co-occurring disorders. Some studies show up to 50% of adults with ADHD need co-occurring disorder treatment.⁷ 

How to Treat Co-Occurring Disorders?

For many years, mental health and substance abuse treatment professionals believed addiction and mental health should be addressed as part of individual programs. Fortunately, treatment for co-occurring disorders has changed, and providers understand that mental health and substance abuse treatment programs are more effective when integrated treatment for co-occurring disorders is used.

Diagnosis

The first step in co-occurring disorder treatment is diagnosis. It is essential for treatment providers (mental health or primary care providers) to conduct a comprehensive intake assessment to examine patients’ conditions and determine if other factors are contributing to their symptoms.

Treatment Program

Once an evaluation is complete, it is important to find a treatment program that meets patients’ needs and goals. This is especially true of co-occurring disorder treatment as not all programs address co-occurring conditions.

Treatment Plan

Upon entering treatment, the treatment team will work with each patient to develop a treatment plan that incorporates evidence-based treatment models designed to address mental health and addiction. As the patients progress through therapy, medical professionals will determine their aftercare plan, including essential post-treatment care, is in place and ready for them to transition out of the treatment environment to an outpatient program or similar ongoing care environment.

Integrated Treatment for Co-Occurring Disorders

Data from the Substance Abuse and Mental Health Services Administration shows combining mental health and addiction treatment into an integrated treatment plan leads to positive treatment outcomes and improved relapse prevention. There are several benefits to integrated treatment, including:

• Reducing the impact of adverse symptoms of both conditions through one treatment program.
• Addressing addiction and mental health symptoms using therapy and pharmacological interventions simultaneously addresses both problems.
• Significant reduction in the relapse of mental health or addiction symptoms as coping tools learned during co-occurring disorders treatment can be applied to triggers for both conditions.

Inpatient and Outpatient Care

Co-occurring disorder treatment can be applied in inpatient and outpatient treatment environments. Because the therapeutic models in these care levels are often similar, many of the therapeutic approaches mentioned above are used across all co-occurring disorder and substance abuse disorder care levels.


Read on to learn more about the treatment process for co-occurring disorders.

Co-occurring Treatment Process

Integrated co-occurring disorders treatment can be provided at various treatment care levels.

Detox

When someone seeks help to overcome a co-occurring diagnosis, the first step is often detox. During detox, patients go through the process of getting rid of the chemicals and toxins in their bodies. Part of detox for some people often includes powerful withdrawal symptoms that can have mental health effects. At a program that offers treatment for co-occurring disorders, skilled professionals will help manage all the withdrawal symptoms.

Therapy

There are various types of therapy that can be integrated into a treatment plan, depending on what will be most effective for the patient’s recovery.

Behavioral Therapy

Evidence-based techniques like cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), contingency management, and motivational enhancement are all proven effective in helping patients manage mental health conditions and substance use disorders.

Group Therapy

Also, as part of co-occurring disorders treatment, patients can participate in peer support groups during therapy. The relationships forged during these groups can offer guidance and support during difficult times.

Barriers to Treatment Options for Co-Occurring Disorders

Despite the growing need for treatment for co-occurring disorders, several barriers to treatment limit the ability of many to get the help they need.

Stigma

It is not uncommon for someone struggling with a mental health condition or addiction to fear seeking help due to the stigma surrounding these conditions. People worry about what others might think, losing their jobs, etc. These worries about how others view their decision to seek help cause many to avoid contacting a co-occurring disorder treatment center.

Finances and Costs

Financial barriers are another significant problem. Although insurance companies are required to provide coverage for mental health and addiction treatment needs, there is often an out-of-pocket cost that remains. For some, this cost puts seeking help out of financial reach.

Access

There are also barriers within the mental health system. Many states struggle to provide access to care due to a lack of facilities or staffing. This makes the waitlists for mental health treatment long, and often, people give up before they have the opportunity to begin treatment.

Availability

Along the same lines, managed care plans and primary care challenges often limit the types of programs people can use to address their treatment needs. It is possible that the programs available as part of a managed care system are not equipped to address the unique nature of co-occurring disorder treatment.

Treatment at Alta Centers

At Alta Centers, we are here to help you begin your journey to recovery. We understand there are fears and challenges associated with seeking mental health and substance abuse help. Let our admissions team show you how we can help. Contact us at Alta Centers today for more information about our co-occurring disorder treatment programs.

https://www.samhsa.gov/medication-assisted-treatment/

medications-counseling-related-conditions/co-occurring-disorders

https://www.mentalhealth.gov/what-to-look-for/mental-health-substance-use-disorders

https://adaa.org/understanding-anxiety/co-occurring-disorders/substance-abuse

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851027/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241194/

https://www.ptsd.va.gov/professional/treat/cooccurring/tx_sud_va.asp

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414493/