Mental illness and substance abuse are frequently treated as separate, independent issues by physicians and experts, even though studies have shown that they’re connected. When it comes to mental problems and drug abuse: where there’s smoke, there’s fire: one often doesn’t occur without the other. That’s why, according to a recent Orlando Sentinel story, the two are increasingly being treated as co-occurring disorders by care providers. It’s a big change from the “dual diagnosis” approach that experts have taken in the past, and one that calls for newer, smarter and more customized treatment methods that take both factors into consideration.
What’s in a Number?
The Sentinel story cites statistics from the National Alliance of Mental Health that are as eye-opening as they are troubling: almost 50 percent of Americans with mental disorders also wrestle with substance abuse. “Similarly, more than one-third of alcohol abusers and more than half of drug abusers also have at least one serious mental illness,” the article said. “Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.” That’s what is driving the new emphasis on “co-occurring disorders” rather than setting mental illness and substance abuse apart from one another.
“It’s treating the whole person; it’s not focusing only on the addiction side of things,” Jessica Lipsey, a Registered Clinical Social Worker (CSW), told the Sentinel. “With co-occurring [treatment], it’s more inclusive. Usually, there are multiple factors going on, multiple challenges that somebody is dealing with. Many people with mental health disorders self-medicate or cope by using drugs and/or alcohol. Then it gets to the point where it becomes unmanageable and a problem.” Still, bundling the two treatment methods together is a thorny, complex undertaking—one that doesn’t have everyone convinced.
New Approaches
Some believe the “co-occurring” diagnosis is a step in the right direction but it’s not the end-all/be-all solution. “Many people who are diagnosed with a mental health disorder indulge in drugs, and vice versa. As severity of both increase, problems arise and they become more difficult to treat,” a Science Daily story observes. “But why substance involvement and psychiatric disorders often co-occur is not well understood.” And it’s that lack of understanding that some experts point toward, cautioning for more research before combining the two.
In fact, the National Institute on Drug Abuse warns that just because drug abuse and mental illness very often happen together, it doesn’t automatically mean there’s a direct link between the two: “[It] does not mean that one caused the other, even if one appeared first,” the Institute noted. “Establishing causality or directionality is difficult for several reasons,” including the fact that symptoms may not emerge until their drug use has hit a certain level. The Institute does, however, note that drugs can spur symptoms of mental illness, citing psychosis in marijuana abusers as an example. They also argue that mental issues can drive drug abuse “as a form of self-medication,” with tobacco products used by patients with schizophrenia. Overall, drug abuse and mental illnesses have “overlapping factors such as underlying brain deficits, genetic vulnerabilities and/or early exposure to stress or trauma” that can complicate the co-occurring approach.
“A Holistic View”
Despite some criticism, co-occurring treatment is gaining support and traction in all the right places. There’s mounting evidence in favor of a holistic view “in published statistics from organizations like the Substance Abuse and Mental Health Services Administration,” the Sentinel piece notes. Experts at the Administration say that there are nearly 10 million people who “suffer from co-occurring mental health conditions and substance use disorders,” while less than eight percent of them actually get the right kind of treatment. Instead, they bounce from treatment center to treatment center because, currently, there isn’t anywhere to go that caters for the specialized, if not customized treatment they so desperately need. It’s especially true of people in prison with addiction and mental illness problems: traditional treatments simply aren’t for them. “[Incarcerated individuals’] co-occurring problems are too complex and require a more specific level of individualized care and treatment which may require a multi-faceted approach,” one article said. “Defendants can sometimes experience significant cognitive and emotional disruptions as a result of their arrest which can make them difficult to engage with.” Only a co-occurring treatment method seems to work with them.
Patients who undergo co-occurring treatment methods “receive an evidence-based substance abuse evaluation” that canvasses a wide range of symptoms and causes, including “depression, mania, anxiety, suicidal ideation, psychosis, sleep problems and other disorders as a way to enhance treatment and prognosis.” One way or the other, uncovering the link between mental health and substance abuse is the only true way of successfully treating both problems. “The goal (in co-occurring disorders) is to treat mental health issues that are made worse by addiction or at the root of the addiction,” Lipsey says. If nothing else, while the complex connection between addiction and mental health problems remains unclear, co-occurring treatment might be the only approach to make the path for many people’s recovery clearer than ever.
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