Co-Occurring Disorders and Rehab

When someone is suffering from both a mental health illness and a substance use disorder, it is referred to as having co-occurring disorders. For example, someone who is a drug addict but also suffers from PTSD would have a co-occurring disorder. More than 25% of the population will face issues with addiction and/or mental health at some point in their life. Unfortunately, the stigma of mental illness has caused many people to hide their illness and try to cope without getting any help. People often think they are to blame not only for their mental illness, but also their addiction, and this shame is one of the main reasons people often wait so long before seeking help. And this also explains why mental illness often leads to addiction, as many people self-medicate with alcohol or drugs as a way to mask or deal with the symptoms of their mental illness in secret.

Living with a mental illness is hard and people with mental health disorders are more likely to experience an alcohol or substance use disorder, or addiction. Co-occurring disorders can often be difficult to diagnose due to the complexity of symptoms, as both may vary in severity. In many cases, people receive treatment for one disorder while the other disorder remains untreated. This may occur because both mental and substance use disorders can have biological, psychological, and social components. And it is not always possible to determine which came first, the mental health issue or the addiction. Sometimes one causes the other and sometimes they simply show up around the same time. But most of the time, they are related.

The good this is that there is hope. There are many ways to successfully treat both addiction and mental illness, especially if they are treated at the same time. People with co-occurring disorders are best served through integrated treatment, where practitioners can address mental health and substance use disorders at the same time, often lowering costs and creating better outcomes. At Choice House, Ladies’ Choice and The Lookout Boulder, we have qualified staff who will guide you through recovery while treating any mental health issues at the same time. If you are suffering from addiction, you owe it to yourself to choose a recovery facility that will treat any mental health issues you may be suffering from as part of your recovery program. Treating co-occurring disorders at the same time will increase your chances of a successful recovery and greatly reduce your chances of relapsing.

Use these links to jump to a particular topic on this page: Depression, Anxiety Disorders, Trauma Disorders, Bipolar Disorder

 


 

Depression

Depression is one of the most common mental health disorders in the United States. It are characterized by a sad, hopeless, empty, or irritable mood, along with physical and mental changes that significantly interfere with daily life. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. Adverse childhood experiences and stressful life experiences are also known to contribute to risk for depression. In addition, those with closely related family members (for example, parents or siblings) who are diagnosed with the disorder are at increased risk. Regardless of the cause, depression can also lead to addiction.

If someone has been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, they may be suffering from depression:

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness, or pessimism
  • Irritability
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy or fatigue
  • Moving or talking more slowly
  • Feeling restless or having trouble sitting still
  • Difficulty concentrating, remembering, or making decisions
  • Difficulty sleeping, early-morning awakening, or oversleeping
  • Appetite and/or weight changes
  • Thoughts of death or suicide, or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment.

 


 

Anxiety Disorders

Occasional anxiety is a normal part of life. You might feel anxious when faced with a problem at work, before taking a test, or making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The feelings can interfere with daily activities such as job performance, school work, and relationships. There are several different types of anxiety disorders. Examples include generalized anxiety disorder, panic disorder, and social anxiety disorder.

People with generalized anxiety disorder display excessive anxiety or worry for months and face several anxiety-related symptoms. Generalized anxiety disorder symptoms include:

  • Restlessness or feeling wound-up or on edge
  • Being easily fatigued
  • Difficulty concentrating or having their minds go blank
  • Irritability
  • Muscle tension
  • Difficulty controlling the worry
  • Sleep problems (difficulty falling or staying asleep or restless, unsatisfying sleep)

People with panic disorder have recurrent unexpected panic attacks, which are sudden periods of intense fear that may include palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath, smothering, or choking; and feeling of impending doom. Panic disorder symptoms include:

  • Sudden and repeated attacks of intense fear
  • Feelings of being out of control during a panic attack
  • Intense worries about when the next attack will happen
  • Fear or avoidance of places where panic attacks have occurred in the past

People with social anxiety disorder (sometimes called “social phobia”) have a marked fear of social or performance situations in which they expect to feel embarrassed, judged, rejected, or fearful of offending others. Social anxiety disorder symptoms include:

  • Feeling highly anxious about being with other people and having a hard time talking to them
  • Feeling very self-conscious in front of other people and worried about feeling humiliated, embarrassed, or rejected, or fearful of offending others
  • Being very afraid that other people will judge them
  • Worrying for days or weeks before an event where other people will be
  • Staying away from places where there are other people
  • Having a hard time making friends and keeping friends
  • Blushing, sweating, or trembling around other people
  • Feeling nauseous or sick to your stomach when other people are around

For information about the treatment of anxiety disorders, visit SAMHSA’s Treatments for Mental Disorders page. Find more information about anxiety disorders on the National Institute of Mental Health (NIMH) website.

 


 

Trauma Disorders

The defining characteristic of trauma- and stressor-related disorders is previous exposure to a traumatic or stressful event. The most common disorder in this category is post-traumatic stress disorder (PTSD).

Post-Traumatic Stress Disorder (PTSD)

PTSD is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event. It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. People who have PTSD may feel stressed or frightened even when they are not in danger.

Not every traumatized person develops ongoing (chronic) or even short-term (acute) PTSD. Not everyone with PTSD has been through a dangerous event. Some experiences, like the sudden, unexpected death of a loved one, can also cause PTSD. Symptoms usually begin early, within three months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. The course of the illness varies. Some people recover within six months, while others have symptoms that last much longer. In some people, the condition becomes chronic.

Some factors that increase risk for PTSD include:

  • Living through dangerous events and traumas
  • Getting hurt
  • Seeing another person hurt, or seeing a dead body
  • Childhood trauma
  • Feeling horror, helplessness, or extreme fear
  • Having little or no social support after the event
  • Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
  • Having a history of mental illness or substance abuse.
To be diagnosed with PTSD, an adult must have all of the following for at least one month:

  • At least one re-experiencing symptom
  • At least one avoidance symptom
  • At least two arousal and reactivity symptoms
  • At least two cognition and mood symptoms
Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms. These symptoms include:

  • Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
  • Bad dreams
  • Frightening thoughts
Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car. These symptoms include:

  • Staying away from places, events, or objects that are reminders of the traumatic experience
  • Avoiding thoughts or feelings related to the traumatic event
Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating. These symptoms include:

  • Being easily startled
  • Feeling tense or “on edge”
  • Having difficulty sleeping
  • Having angry outbursts
Cognition and mood symptoms can begin or worsen after the traumatic event, but are not due to injury or substance use. These symptoms can make the person feel alienated or detached from friends or family members.  These symptoms include:

  • Trouble remembering key features of the traumatic event
  • Negative thoughts about oneself or the world
  • Distorted feelings like guilt or blame
  • Loss of interest in enjoyable activities

 

It is natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a month, seriously affect one’s ability to function, and are not due to substance use, medical illness, or anything except the event itself, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months. PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.

For information about the treatment of PTSD, visit SAMHSA’s Treatments for Mental Disorders page, the NIMH website, or the National Center for PTSD maintained by the Department of Veterans Affairs.

 


 

 

Bipolar Disorder

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Scientists continue to study the possible causes of bipolar disorder. Most agree that there is no single cause. Instead, it is likely that many factors contribute to the illness or increase risk, including brain structure, genetics, and family history. People with bipolar disorder often misuse alcohol or drugs, have relationship problems, or perform poorly in school or at work. Family, friends, and people experiencing symptoms may not recognize these problems as signs of a major mental illness such as bipolar disorder.

There are four basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, and energized behavior (known as manic episodes) to very sad, “down,” or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

  • Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.
  • Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.
  • Cyclothymic Disorder (also called cyclothymia)— defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
  • Other Specified and Unspecified Bipolar and Related Disorders— defined by bipolar disorder symptoms that do not match the three categories listed above.
People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and unusual behaviors. These distinct periods are called “mood episodes.” Mood episodes are drastically different from the moods and behaviors that are typical for the person. Extreme changes in energy, activity, and sleep go along with mood episodes.

People having a manic episode may:

  • Feel very “up,” “high,” or elated
  • Have a lot of energy
  • Have increased activity levels
  • Feel “jumpy” or “wired”
  • Have trouble sleeping
  • Become more active than usual
  • Talk really fast about a lot of different things
  • Be agitated, irritable, or “touchy”
  • Feel like their thoughts are going very fast
  • Think they can do a lot of things at once
  • Do risky things, like spend a lot of money or have reckless sex
People having a depressive episode may:

  • Feel very sad, down, empty, or hopeless
  • Have very little energy
  • Have decreased activity levels
  • Have trouble sleeping, they may sleep too little or too much
  • Feel like they can’t enjoy anything
  • Feel worried and empty
  • Have trouble concentrating
  • Forget things a lot
  • Eat too much or too little
  • Feel tired or “slowed down”
  • Think about death or suicide

Sometimes a mood episode includes symptoms of both manic and depressive symptoms. This is called an episode with mixed features. People experiencing an episode with mixed features may feel very sad, empty, or hopeless, while at the same time feeling extremely energized.

Bipolar disorder can be present even when mood swings are less extreme. For example, some people with bipolar disorder experience hypomania, a less severe form of mania. During a hypomanic episode, an individual may feel very good, be highly productive, and function well. The person may not feel that anything is wrong, but family and friends may recognize the mood swings and/or changes in activity levels as possible bipolar disorder. Without proper treatment, people with hypomania may develop severe mania or depression.

 


Much of the information on this pages comes from the website for SAMHSA (The Substance Abuse and Mental Health Services Administration) and NIMH (National Institute of Mental Health). For more information about the treatment of depressive disorder, visit SAMHSA’s Treatments for Mental Disorders page or the NIMH website. If you have specific questions about how our staff can treat co-occurring disorders, please feel free to call us at 1-877-234-4770.