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Co-Occurring Disorders; A Delicate Treatment Balance

Addiction and mental illness often go hand in hand. Indeed, SAMHSA (Substance Abuse and Mental Health Services Administration) estimates that almost 9 million adults suffer from both addiction and mental illness – co-occurring disorders1. They further estimate that only about 7% of those adults receive appropriate care for both conditions. The burden often falls on the addiction counselor to diagnose and properly address these co-occurring disorders – formerly called dual diagnosis. The co-occurring condition may have caused the addiction or may be a result of it – only a thorough evaluation can offer some clarity. No matter what disorders manifest themselves, they are a significant challenge to the clinical team. Not only must we navigate the intricacies of addiction and the adjunctive illness separately, but also the dynamics of how they interact together.

While the term mental illness conjures up thoughts of psychosis, schizophrenia, multiple personality disorder and other severe illnesses, those seen as relatively benign, such as depression or excessive anxiety, can be just as destructive if left untreated. Mental illness is a leading cause of addiction and vice versa.

While not technically considered co-occurring disorders, physical illnesses can also complicate the treatment process. It is not uncommon to see various infectious diseases in injection drug users or those who have engaged in unprotected sex. Some may be malnourished due to months or years living in poor conditions due to their habit. Yet others may present with physical injury if they were involved in an all-too-common altercation. Each patient, and the challenges to their recovery, is different.

Taking a holistic and integrated approach to co-occurring disorders can improve the quality of care, reduce the cost of treatment and ultimately give the patient a better chance of long-term recovery. Everyone from the counselor and patient to the treatment facility’s administrative staff and the addict’s family can contribute constructively to excellent care and outcomes.

1Substance Abuse and Mental Health Services Administration, Office of Applied Studies, National Survey on Drug Use and Health, 2008 and 2009