October 16, 2022

Interrupting the Devastating Cycle of Co-occurring Disorders

by Scott H. Silverman

When someone has a substance-use disorder in addition to a mental health diagnosis (like depression, trauma, or anxiety), it’s known as having a ‘co-occurring disorder,’ and it complicates the process of diagnosing and treating the whole patient.

Mental Health Problems are Growing

The pandemic exacerbating existing problems and introducing new anxieties contributed to a growth of mental health diagnoses in Americans, as well as fueling substance abuse.

According to the CDC, substance use disorders affect more than 20 million Americans aged 12 and up. Additionally, up to 50% of individuals with a mental health illness also have a substance use disorder. These numbers, when considered alongside the drastic rise in accidental overdose caused by fentanyl being mixed into counterfeit drugs spell out a national health crisis. 

The Difficulty of Dual Diagnoses

When someone comes to a treatment center presenting symptoms of anxiety and depression in addition to an opioid use disorder (OUD), the admitting physician has to make the distinction as to whether the depression and anxiety symptoms are a result of the substance use, or exist independently.

Compounding this difficulty is the substantial evidence that neurological changes can occur as a result of substance use, depending on frequency, duration and severity, among other factors. 

Working with a trained clinician who can ask the necessary questions to understand the nature of the patient’s comorbidity is a crucial step toward getting the appropriate treatment for both disorder.

Medication is a Tool that’s Growing in Usefulness

There has been a revolution in medication-assisted treatment for substance use disorders, especially for alcohol use disorder (AUD) and opioid use disorder (OUD) which are the most common and deadly substance dependencies.

At our treatment center, we encourage the use of medications like Suboxone, when appropriate, because they reduce cravings and increase success rates. MAT is always more effective when combined with evidence-based practices, like individual counseling and group therapy sessions (including support groups like Alcoholics Anonymous and its various alternatives). 

The use of medication requires close clinical monitoring so that the medicines’ effect can be noted and their use gradually reduced. Some dually diagnosed individuals are hesitant to engage in MAT as they have experienced a negative result from abusing medications like Adderall or benzodiazepines, which are prescribed for ADHD and anxiety, respectively.

Help Should Be Sought Early

The pandemic has had some positive effects on mental health and substance use treatment. For one thing, there is less stigma, and society is more open to speaking about behavioral health problems. 

We also have widely integrated telehealth options for mental health care, which has really revolutionized our ability to provide access to people, regardless of their location. 

While your personal situation is unique and requires a personalized treatment process, I can confidently encourage people who might be ‘at-risk’ of a SUD or mental health diagnosis to get help sooner than later. These disorders are usually progressive in nature, and there’s only upside in seeking the advice of a clinical qualified mental health or substance abuse professional.

If you aren’t struggling with either a mental health or substance use issue, I urge you to become informed anyway, because the likelihood that you or someone you know will at some point face one or more of these issues is essentially guaranteed.

We can all help by informing ourselves and others about the perils of addiction, the resources available for recovery, the universality of mental health issues and the reality that love and understanding are key in facing these successfully.

Where to Seek Help

We recommend resources like The Substance Abuse and Mental Health Services Administration can be reached at 800-662-HELP (4357). The 12-Step program of Alcoholics Anonymous has been a huge help to many, as well as the numerous alternatives that have emerged, like SMART recovery, Celebrate Recovery, and Narcotics Anonymous. Individuals can also talk to their doctors, who can do a screening assessment and make referrals.


About the Author

Scott H. Silverman is one of the nation’s leading experts on addiction and recovery.  He’s made countless public speaking engagements and appearances on television to raise the alarm about the opioid epidemic. He is the founder and CEO of Confidential Recovery, an outpatient drug rehab program in San Diego that specializes in helping Veterans, first-responders, and executives achieve long-term recovery.


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