Psychiatric Disorders, Substance Abuse Often Go Hand in Hand

Co-occurring mental-illness and substance-use disorders in the same individual are shockingly common. Nearly 60{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of people with substance-use disorders also have mental illness, according to the National Institute on Drug Abuse.
As an acute-care medical facility specializing in addiction treatment, AdCare Hospital has long treated individuals with co-occurring substance abuse and psychiatric disorders. AdCare inpatient data for last year reveals that 82{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the individuals treated had at least one co-occurring psychiatric disorder. Outpatient data indicates that 36{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of clients treated at an AdCare outpatient-services clinic during the same 12-month period had a co-occurring mood disorder; 24{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} had an anxiety disorder.
Depressive disorders are among the most prevalent psychiatric conditions to occur with addiction. The existence of mood disorders, such as bipolar disorder and depression, can exacerbate suicidal ideation and the incidence of suicide in persons struggling with alcohol and other drug addiction.
Anxiety disorders are another common group of psychiatric disorders found in people battling chemical dependency. These include post-traumatic stress disorder, panic disorder, and generalized anxiety. Intense nervousness, trouble falling asleep, worry, and an inability to concentrate are symptoms of anxiety disorders.
Because anxiety and depression are often present in early sobriety, care must be exercised when making a diagnosis of a psychiatric disorder. Psychologists with specialized training in addiction can differentiate between substance-induced symptoms of anxiety and depression and co-occurring disorders. Consulting psychiatrists are also utilized for medication recommendations for individuals with co-occurring disorders.
Psychiatric disorders can begin before, during, or after the onset of addiction. Often, alcohol and other drugs are used to self-medicate anxiety or depression that is already present. In other cases, addiction leads to psychiatric symptoms. Whichever came first — the addiction or the psychiatric illness — both disorders are primary and require treatment.
Patients often have difficulty accepting the existence of co-occurring disorders. This tendency of many patients and their families to be more comfortable with one illness rather than both can jeopardize their recovery. Some patients, for example, believe that treating their bipolar illness will ‘cure’ their addiction. Others believe that treating their addiction will eliminate a bipolar disorder. In reality, patients and families need to be educated that both illnesses require integrated treatment and recovery plans.
Useful treatment concepts applicable to both addiction and psychiatric disorders include denial, minimization, recovery, and relapse. Teaching patients how to apply these similar concepts in addressing their addiction and psychiatric disorder can make treatment more patient-friendly.
For example, working with patients to identify signs of their denial of their mental illness and/or addiction can be a beneficial exercise. Because relapse triggers also exist for both addiction and mental illness, assisting patients in identifying the signs for both illnesses can help them to develop a more realistic relapse prevention plan.
AdCare Hospital offers integrated inpatient treatment and specialized outpatient services for individuals with co-occurring disorders. Co-occurring disorder groups emphasize recovery and relapse-prevention strategies specific to the needs of persons with co-occurring addiction and psychiatric disorders. Psychotherapy also assists patients in examining their unique issues so that they may maximize benefit from other treatment services.
Patrice M. Muchowski is vice president of Clinical Services at AdCare Hospital, based in Worcester.

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