About Co-Occurring Disorders

When clients present with addictions and substance abuse, we typically find that other problems exist in addition to the substances and behaviors, and are part of a larger, more complex picture. Substance and process addictions are often the solution that clients use to manage a range of emotional states as well as early traumas.  Co-occurring disorders or COD refers to mental health problems that are combined with alcohol or substance abuse. The addiction or substance use aspect is often used to self-medicate a mental health issue such as anxiety, depression, ADHD, Asperger's, PTSD and personality disorders. Common examples of COD's include alcohol addiction with panic disorder, poly-substance use with schizophrenia and personality disorders such as Borderline Personality Disorder or BPD and major depression or Bipolar disorder with cocaine abuse. It's not uncommon for individuals to have more than two disorders such as anxiety and depression. More than half of all adults with mental illness are further impaired by substance use disorders either abuse or dependence related to their drug and alcohol use. The mental health issues may vary in terms of chronicity, severity and the degree of impairment in functioning. When more than one psychiatric disorder exists, both may be mild or severe and one may be more severe than the other. Thus, there is no single combination of co-occurring disorders. However, patients with similar combinations are often encountered in certain treatment settings. 

A treatment approach that addresses both the substance abuse or addiction and the mental health issue is necessary.  Neglecting one, while treating the other, often worsens either the psychiatric issue or the substance abuse. Unfortunately, treatment often focuses on just the addiction -- labeling individuals as "addicts," can be unhelpful and stigmatizing, neglecting the underlying mental health problem that the individual attempts to solve through his or her alcohol and drug use. One example is an individual who suffered trauma or abuse and attempts to manage his or her emotional pain with poly-drug use (the combination of two or more drugs). There must be a willingness on the part of the clinician or treatment team and patient to address the underlying mental health issue and the addiction, either through harm reduction or abstinence.  Treatment takes hard work and commitment and can be successful when the patient receives support from friends, family and community support from a twelve-step program such as AA or NA, or alternative program such as SMART Recovery. Ongoing individual psychotherapy that may include EMDR, SE or other treatments for difficulties related to trauma and group therapy which utilizes CBT and DBT skills is an effective strategy for recovery.