Co-occurring Disorders

Psychiatric disorders and problems with substance abuse can coexist. In fact, it has been found that one disorder may prompt the emergence of the other, or either disorder may exist independently. It is difficult to determine whether the disorders are related or not. However, diagnosing that they are co-occurring disorders may benefit the individual greatly if they have endured these combined disorders long-term. For example, a 32-year-old patient with bipolar disorder may have started abusing alcohol and began having manic episodes at age 18, and continues to experience alcoholism in addition to manic and depressive episodes. At this point, the individual could be considered to have two co-occurring well-developed independent disorders that both require treatment.

Mental illness can mimic behaviors associated with drug and alcohol addiction and abuse. Dysfunctional and maladaptive behaviors that seem to be associated with drug and alcohol addiction may have other causes, such as psychiatric, emotional, or social problems. This is why assessment tools, drug testing, and information from loved ones is critical to confirm drug and alcohol disorders.

Studies show that individuals with psychiatric disorders have an increased risk for drug and alcohol disorders. Likewise, individuals with drug and alcohol disorders have an increased risk for mental disorders. In fact, an estimated one-third of patients who have a psychiatric disorder also experience bouts of drug or alcohol abuse or addiction at some point, which is about twice the rate among people without psychiatric disorders. It has also been found that more than half of the people who use or abuse drugs or alcohol have experienced co-occurring psychiatric symptoms significant enough to fulfill diagnostic criteria for a psychiatric disorder. Many of these symptoms however may be drug and alcohol related and might not represent an independent condition.

It has been found that the symptoms of a co-occurring psychiatric disorder may be misinterpreted as poor or incomplete "recovery" from drug or alcohol addiction. Mental illness may interfere with the individual's ability and motivation to participate in addiction treatment, as well as their compliance with treatment guidelines. Mental health issues most prevalent among dually diagnosed patients include mood disorders, anxiety disorders, personality disorders, and psychotic disorders.

Individuals with anxiety and phobias may fear and resist attending Alcoholics Anonymous or group meetings. Individuals suffering from depression may be too unmotivated and lethargic to participate in treatment. Individuals experiencing psychotic or manic symptoms may exhibit bizarre behavior and poor interpersonal relations during treatment, especially while taking part in group-oriented activities. This type of behavior may be misinterpreted as signs of treatment resistance or symptoms of addiction relapse.

As compared to individuals who have a mental health disorder or a substance abuse problem alone, individuals with co-occurring disorders often experience more severe and chronic medical, social, and emotional problems. Because these individuals have co-occurring disorders, they are vulnerable to both drug and alcohol relapse and a worsening of the psychiatric disorder. Furthermore, drug and alcohol addiction often leads to worsening of psychiatric problems which can often lead to addiction relapse. This is why relapse prevention must be specially designed for individuals with co-occurring disorders. Individuals struggling with co-occurring disorders often require longer treatment, have more crises, and progress more gradually in treatment.