Alcoholism and Co-Occurring Disorders

Dual-Diagnosis

Over 25 years ago a study about alcoholism drew attention to a budding literature describing a relationship between substance use disorders and mental health issues among substance abuse patients.

Despite those findings, the effort to create an effective response and method to treat mental health issues is a more contemporary concern of substance abuse treatment.

Many times, when someone is suffering from alcohol or substance use, they are also suffering from another mental health disorder, which is referred to as a co-occurring disorder.

The mental health disorder could be the reason some people use alcohol, or it could be a side effect of the alcohol use. Either way, the best way to treat alcoholism and co-occurring disorders is simultaneously.

Co-occurring disorders, also known as dual-diagnosis, is what is used to refer to one person having two disorders at the same time, a substance use disorder and a mental health disorder. Substance use disorders include alcohol or drug abuse, or, alcohol or drug dependence.

Individuals with substance use issues are particularly at risk for developing chronic diseases or primary conditions. The coexistence of both a substance use disorder and a mental health issue, likewise referred to as a co-occurring disorder, is quite common among patients in medication-assisted treatment (MAT).

Patients with mental illness are shown to be more likely to suffer a substance use disorder compared to  those who are not affected by a mental condition. As per SAMHSA’s 2018 National Survey on Drug Use and Health, an estimated 9.2 million adults in the US alone suffer from a co-occurring disorder

It is also worth noting that combining drugs used in MAT with anti-anxiety medications, like Xanax and Valium, can have adverse effects on the patient.

Substance use disorder can be broken into two different diagnoses:

• Drug or alcohol abuse is what it is called when someone’s use of drugs or alcohol begin to negatively impact their life, whether it be work, school, or relationships. Abuse is also used when the use of alcohol or drugs causes a medical condition, or makes it worse.
• Drug or alcohol dependency is far more severe than substance abuse. Dependency is basically another word for addiction, when someone is dependent on alcohol or drugs. There are a lot of bad consequences that happen when someone is dependent vs abusing, and people who have formed a dependency find it far more difficult to completely stop use of alcohol or drugs.
•  Dependency can be both physical and mental, leading to higher tolerances and the need to use more. It also leads to withdrawal when someone stops using or uses less. Withdrawal symptoms can range from mild to severe, and can include tremors, nausea, fever, cravings, sweating, and more.

There are multiple different types of mental health disorders. The most common for people who have substance dependency are mood related or anxiety related disorders. For people with substance use disorder, there is a higher percentage of people who also have severe mental illness.

Severe mental illnesses are described as ‘severe’ due to the length and intensity of episodes they experience. The two most common severe mental illnesses with substance disorders are schizophrenia and schizoaffective disorder.

Both have also been labeled as ‘thought disorders’ since they have symptoms such as hallucinations and delusions, where they either see or hear things that are not there.

The more common disorders for people with substance use (particularly alcohol use) disorders are:

Depression

Depression is a mood disorder that affects someone’s thoughts, feelings, and actions. It is probably the most common mental health disorder in the United States and affects people of all backgrounds, ages, or gender.

Depression consists of symptoms such as: 

• Restlessness
• Loss of interest in hobbies and activities
• Difficulty concentrating
• Lower energy
• Irritability
• Feeling hopeless
• Thinking badly about yourself

When someone stops drinking alcohol immediately, going ‘cold turkey’, it can be very dangerous due to intense withdrawal symptoms. This can increase symptoms of depression, leading to an increased risk of self-harm, or even suicide.

Bipolar disorder

• Bipolar disorder consists of two different extreme moods that go up and down between extremes: mania and depression.
• An estimated 6 million people in the United States are diagnosed with bipolar disorder.
• Mania is an elevated mood. Someone who is manic experiences extreme high from a stimulant, such as cocaine or amphetamines (Adderall or similar).
• Depressive episodes are the opposite of mania and consist of extremely low energy, lack of interests, restlessness, and other symptoms of depression listed above.
• People diagnosed with bipolar are at a much greater risk of drug or alcohol use than those who are not, and alcohol has been shown to worsen these symptoms.

Schizophrenia

Symptoms of schizophrenia include:

• Paranoid and fantasy-like hallucinations and delusions
• Emotionless expressions and experiences
• Low motivation

There was a study that found that at least 1/3 of people with schizophrenia abuse alcohol, possibly even more. Interestingly, it has been observed the drinking often begins before the schizophrenia does. This is possibly because drinking begins as self-medication when people first begin experiencing a few small hallucinations, before full-blown schizophrenia.

Panic Disorder and Anxiety Disorder

• 10-30%, maybe more, of people who abuse alcohol also suffer from panic attacks or other types of anxiety.
• 20% of people who reported suffering from anxiety also abuse alcohol.
• When alcohol users enter treatment programs, a lot of their symptoms look like anxiety symptoms.
• Some think that the connection between alcoholism and anxiety is due to self-medication for anxiety symptoms with alcohol. Unfortunately, alcohol actually worsens anxiety, and so it creates a a self-medication cycle that leads to dependency.

Obsessive-Compulsive Disorder (OCD)

• OCD is an anxiety disorder involving uncontrollable thoughts and obsessions that lead to repetitive compulsions. For example, when someone with OCD has to tap/flip the light switch a certain number of times, or wash their hands at least 3 times at once, those are compulsions.
• Alcohol is used by people with OCD to self-medicate and distract from their thoughts and obsessions. Unfortunately, alcohol has the opposite effect and worsens OCD symptoms, and easily leads to dependency. This creates ongoing health and medical complications, and emotional struggles, for people with both OCD and alcohol dependency.

A lot of people who suffer from an anxiety disorder also have alcoholism and co-occurring disorders, which could make their symptoms a lot worse and their recovery harder. As with all disorders, it is essential to find proper treatment.

Treatment for alcoholism and co-occurring disorders, aka dual-diagnosis, is best approached by treating the two disorders at the same time. Many providers have programs that understand that alcoholism, and any co-occurring disorder, often need two separate approaches.

It also requires individualized care to best guide the patient’s successful recovery. Treatment can take place at both long or short-term treatment centers. When someone first seeks treatment, it is best to withdrawal from alcohol in an inpatient setting due to the physical harm and risk from alcohol withdrawal.

Treatment programs for people who abuse alcohol and have co-occurring disorders are very different from treatment programs for people who just abuse alcohol.

The patient will be a part of more than one program during treatment at an inpatient facility to address both disorders, which means multiple professionals will be working with them as a care team. This includes therapists, doctors, nurses, case managers, and more, all focused and working together for the patient’s best interests.

The treatments include two different approaches used at the same time for each disorder, with a team of care providers. These approaches can include different therapies such as cognitive behavioral therapy, motivational therapy, marital and family therapy and more.

Medicated assisted treatment is also available and a few approved medications to assist with alcohol use disorder are disulfiram, naltrexone, acamprosate. All treatment providers for co-occurring disorders offer some form of support groups, as well as information for outside AA (or other) meetings if they are preferred. Many also hold official AA meetings at their facility.

If you or a loved one are suffering from alcohol use, drug use, and/or mental health conditions, it is very important to seek help, reach out to a treatment provider today.

Self-Harm and Alcohol Use – How-self harm is directly linked to alcohol use. How these co-occurring conditions are treated.

Eating Disorders and Alcoholism – A look at how these disorders are connected, and how they are treated.

Return from Alcoholism and Co-Occurring Disorders to Alcoholism Help Homepage