If you or a loved one are in recovery, you might often hear the term “co-occurring disorder” (COD). Also known as a “dual diagnosis,” the Substance Abuse and Mental Health Services Administration (SAMHSA) of the United States prefers the term “COD.” See what it is, why it matters, and how it applies to people in recovery.
What Does “Co-Occurring Disorder” Mean?
In professional terms, COD describes situations when a person has a mental health diagnosis and a substance use disorder (SUD) or alcohol use disorder (AUD). It recognizes that everyone’s needs differ and allows professionals to create treatment plans to help you work in recovery with a higher chance of success.
The mental health diagnosis does not need to be anything specific. It can range from something severe like a major mental health diagnosis on the schizophrenia spectrum to an adjustment disorder. Common diagnoses include:
- Anxiety disorder
- Borderline personality disorder
- Bipolar disorder
- Attention deficit hyperactivity disorder (ADHD)
- Post-traumatic stress disorder (PTSD)
You might wonder about warning signs of a co-occurring condition. No one should ever try to self-diagnose or diagnose others, as it could be inaccurate. One thing that makes COD complicated is that it could be the substance causing the appearance of a mental health disorder—or the other way around.
For example, a person experiencing depression will have some warning signs. They might feel hopeless, lack interest in life, or have trouble focusing. While specialists can certainly monitor this, if the same person is also misusing alcohol, it can be challenging to know if the signs of depression are really from a problem with alcohol.
Why Does Your “Dual Diagnosis” Matter?
People who have underlying mental health issues often turn to substances like drinking alcohol to cope and regulate. (They are also at an increased risk of alcohol dependence and other addictions.) If you’ve ever heard of the term “self-medicating,” this is where it comes from. When people enter treatment, some will be diagnosed for the first time in their lives with a mental health disorder which explains why they couldn’t stop drinking. They feel much better knowing the reason for binge drinking and heavy drinking after being diagnosed through integrated treatment.
Such a diagnosis also helps reduce the shame and guilt they felt during the active period of addiction. You may not have had a great understanding of why you could not feel at ease like your peers without using substances such as alcohol before benefiting from treatment programs.
Trauma and Dual Diagnosis
When people hear the word “trauma,” they associate it with something awful beyond comprehension, but trauma is prevalent. Terrible things happen to people every day that can produce a trauma response, and many things can happen throughout a lifetime that people might not think of as serious.
You may not imagine seemingly ordinary events could trigger a trauma response. Nobody can predict how a person is going to respond to an incident or what may have a traumatic effect. It is important to never downplay the way you feel about your experiences.
When you enter substance abuse treatment, you may realize you have been living with trauma or have been through traumatic events. Sometimes you can become desensitized with a lack of support. Others may have also normalized the trauma, but about 90 percent of the population experiences a traumatic event in their lifetime. 70 percent can experience at least one severe trauma.
Trauma matters because people with a SUD or AUD will often find themselves in uncomfortable situations. While active in their addiction, people place themselves in situations where trauma can occur. When this happens, they create a vicious cycle by turning to alcohol or another substance to drown out the trauma. When this happens, it can worsen alcohol abuse, addiction, and mental health conditions.
Treatment for Co-Occurring Disorder
What does COD treatment look like? Entering a treatment facility looks differently depending on what level of care is most appropriate for you. If you use alcohol or drugs daily and need detoxification services—detox and rehab will probably be the best choice.
If there is concern from your family or friends, instruction by the court, or you are just wondering if there might be a problem—an outpatient facility assesses where your best level of care would be.
Any time you enter a treatment facility, you will be given an initial assessment. This is when initial diagnoses are identified. Doctors and specialists can then form initial treatment plans for treatment. Sometimes when entering treatment, a provider will give an AUD or SUD diagnosis without more mental health assessment when it’s difficult to identify mental health disorders beyond withdrawal symptoms.
The withdrawal from a substance itself can cause behaviors that might appear like a mental health condition but are not. Healing from the effects of the substance can resemble mental illness. When this is the case, it can take a few months to identify if there is a true mental health disorder or if they were usage symptoms.
How is Co-Occurring Disorder Treatment Different
One of the biggest differences is that the professional needs specialized training in mental health and addiction or a team of treatment professionals: one who specializes in mental health and one who specializes in addiction.
Either approach is effective, but it is important to make sure the correct professionals are in place to ensure the best treatment for your identified needs. Treatment will look a little different because two diagnoses are treated simultaneously.
There are multiple treatments for a COD, including:
- Support groups such as family treatment options or AA meetings and other 12-step, peer-based programs.
- Behavioral therapies like Cognitive-Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) to help with coping and adjustment skills.
- Individualized psychotherapies such as Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive Processing Therapy (CPT).
Co-Occurring Disorder Avoids One-Size-Fits-All Treatment
One of the biggest things to remember about treatment for co-occurring disorders is that there will never be a one-size-fits-all treatment. Skilled professionals need to look at several factors to help you with your treatment goals. Other factors that go into helping you manage your co-occurring symptoms include:
- Coping strategies for alcohol or substance cravings
- Coping strategies for identified mental health diagnosis
- Identification of triggers
- Education around mental health diagnosis
- Discussions of appropriate medication if necessary and how to appropriately navigate that while in recovery
These are just some of the basic needs that will need to identification while in treatment—and, the need for individualized care is of utmost importance.
How to Get Help
While COD conditions can be complex, help is available. Many treatment facilities work specifically with COD clients. If you or a loved one are looking to get help, know that you are not alone: many treatment options are available. Consider these factors when thinking of entering a treatment facility:
- Experience of the staff
- Ability to meet diverse needs
- Spiritual component
- Medical assistance if necessary
- Insurance coverage
If you have decided that now is the time to look into treatment options, The Haven offers comprehensive treatment for people with AUD, COD, and many mental health concerns. We offer cutting-edge therapies and aftercare services to support your successful recovery alongside medically supervised detox. Contact us today for more information on treatment options for AUD.