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Addiction and Co-Occurring Mental Disorders:
It’s Not a Simple Battle

by Ned Wicker

When many people examine the problem of addiction, or are asked to offer a solution, they will usually focus solely on the will power of the addicted individual and determine that if a person really wanted to quit, they could. If only it were a matter of will power—that would make the problem so much easier to attack.

But rarely is it just one thing that drives the addiction, so to have successful treatment, addiction professionals must not only focus on the addiction itself, but on ALL of the contributing factors. In most cases, there are other co-occurring mental disorders that aggravate any successful treatment program.

Depression and Addiction OFTEN Co-occur

Co-Occurring Disorders (COD) means that a person with an addiction also has another serious mental disorder occurring at the same time. Depression, Bi-Polar or PTSD are common mental health disorders that “co-occur” with substance abuse and addiction. Addiction often is caused by or causes other mental health problems and any treatment of the addiction must consider these issues.

Dr. David Mays, MD, PhD summarizes the issues

Recently, Dr. David Mays, MD, PhD summarized his conclusions about recent treatment research in this area. The remainder of this article discusses some of what he has found to be useful in treating addiction when it co-occurs with other mental health disorders.


Integrated treatment is the best option

Clinicians often try to treat the whole person, not just one condition, because the two or more conditions can effect the success of treatment. If you miss one, the characteristics of treatment become significantly less useful.

Addiction is often overlooked because it is very hard to treat and often has been present for a long time in the patient. Alcohol or Marijuana addiction often co-occur with depression but are ignored by the doctor because the time required to deal with both issues is not available.

Issues to be considered with treatment

When mental health problems like depression and addiction often co-occur and here are some treatment issues that need to be considered:

- There are worst treatment outcomes for both disorders,

- There is usually higher health care utilization and higher medical costs,

- There is increased risk of violence, trauma, suicide, child abuse, child neglect and criminal justice involvement.


More things to understand about addiction with other mental health issues

- Other characteristics to consider with co-occurrence are:

- There is likely a faster progression to addiction,

- Patient less likely to comply with treatment,

- Patient is more likely to be hospitalized,

- Patient is more likely to commit suicide and relapse faster.



Principles of COD treatment


Here are some more issues to consider when treat someone whose addiction is accompanied by other mental health problems.

Treatment is more likely to succeed if both disorders are being treated, not just one or the other.

Patience and flexibility is required, as it takes four years for 50% of patients to achieve abstinence. They go from wet, to damp to dry. It’s a process.

Clients probably benefit from mental health treatment, even when they are actively abusing a substance.

Some more ideas that can help!

Some general treatment modifications for COD patients would include:

- shorter meetings

- simplified educational components

- increased repetition

- education about proper use of medications

- education on useful vs. harmful drugs

- low confrontation and high support


What Do Clients Say helps Them the Most?


Clients report that stable housing, POSITIVE social support, relying on a higher power, participating in meaningful activity, changing how they think about their lives, attention to eating well, sleeping well and looking good are major factors in their treatment and recovery.

What Gets in the Way?

Addicts with persistent mental illness are often excluded from substance abuse programs. It is often difficult for them to negotiate their way through separate systems, multiple clinicians and different funding streams.

There is considerable research that supports the idea of combining substance abuse and mental health services.

Co-occurrence is very common with addiction

It's important to realize that MANY addicts have an underlying co-occurring mental issue that needs to be address at the same time for addiction treatment to work.

If you or your loved is trying to recover from addiction please consider the issues of co-occurrence and work with your doctor and treatment program to try to fully deal with both issues.

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- Matthew 7:7-8






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