Mental illness and substance use disorder (SUD) have common symptoms and may appear alongside each other. These conditions result in what is commonly known as co-occurring disorder (COD). According to the National Institute on Drug Abuse (NIDA), COD is referred to as a condition in an individual manifesting two or more disorders such as a mental illness appearing alongside SUD (Gimeno et al., 2017). The dual diagnosis disorders overlap each other and may appear at the same time or later, after diagnosis of a particular psychological health condition. In psychiatric health disorders, the chances of developing SUDs are increased when mental illnesses are left untreated. Besides, because of addiction resulting from SUDs, the frequency and severity of mental health conditions are worsened (Rush, 2015). Moreover, due to the close association between addiction and several mental health illnesses, diagnosing co-morbid disorders is often difficult. Therefore, identification of issues related to the diagnosis and treatment which ensure proper management of mental illness indicates the various nature and effects of COD.
On a global scale, CODs are disastrously common with a high prevalence rate. In the US, there were about 19.7 million persons with COD in 2014 (Center for Behavioral Health Statistics and Quality, 2020). Approximately 50% of individuals with SUDs will ultimately cultivate one or more CODs in their lifetime (Grant et al., 2015). Researchers have studied commonly occurring CODs for many years. They have acknowledged that certain mental illnesses have been concomitant to SUDs more regularly than others (MacKillop et al., 2016). These CODs include such conditions as anorexia and post-traumatic stress disorder (PTSD) among other commonly known CODs.
PTSD is a trauma and nervousness disorder which can advance due to strongly stressful and life-threatening experiences. Moreover, PTSD can develop as a result of emotional, psychological, somatic, or sexual abuse. It is manifested by a range of signs and symptoms, such as hallucinations, invasive memories, night horrors, and hyper-attentiveness. Substances such as marijuana can momentarily relieve the indications of PSTD (Lowe et al., 2018). However, overreliance on cannabis can make PTSD last longer, causing more extreme undesirable emotions and disturbed sleep patterns (Lowe et al., 2018). The symptoms of PTSD can be incapacitating, weakening, and debilitating, leading to the patients continuing to misuse alcohol as a way of coping with its effects irrespective of the long-term consequences.
In anorexia, there are numerous connections between the condition’s consequences and alcohol addiction. Both encompass the actions which upset the reward trail paths in the brain, subsequently leading to recurrent craving to participate in harmful activities (Dingemans et al., 2017). This anxious, reoccurring yearning of the brain to reengage in these activities becomes an addictive, habitual response activity (Dingemans et al., 2017). Eating disorders and drug misuse often energize one another leading to adverse health conditions. For instance, many patients of anorexia initiate abuse of cocaine to subdue their appetite. As they repress to loss of weight because of the substance misuse, they excessively use more of the drug, hence, an addiction soon commences.
Addiction and several psychological conditions have comparable symptoms, thus, the appropriate diagnosis of either disorder is often challenging. Due to the strains in the medical diagnosis of CODs, one illness might be assessed and treated while another is left unmanaged or unattended because of misdiagnosis, leaving the patient susceptible to a setback or deteriorating mental condition. Therefore, each diagnosis must be managed and treated instantaneously to ascertain proper control. For instance, the presence of overlapping risk factors for substance abuse and mental illnesses in an individual’s genetic makeup and other environmental causes such as contact with traumatic life situations can make a person more prospective to cultivate these CODs issues.
Most patients with CODs undergo self-medication, a marker which may be deceptive to the patients in the long run. For instance, self-managing CODs result in poor assessment and difficulties in treatments because while substance abuse can relieve adverse symptoms, they more often aggravate the indications in both the short and long runs (Lowe et al., 2018). In this regard, self-medication is a known adverse issue which leads to failed assessments and treatments of CODs and should be avoided as such.
Alcohol and other drugs abused by the individuals suffering from CODs cause drug-induced brain changes. Substance misuse can affect variations in the functions of the brain because of damages caused by mental illness. This can intensify an individual’s chances of evolving the symptoms of a mental condition, further masking essential roles of the brain (de Bartolomeis et al., 2017). The zones of the brain aggravated by drug misuse appear to be related to the sections allied to impulse-control, attitude, and uneasiness (de Bartolomeis et al., 2017). In this way, assessing such conditions is problematic and tiresome, resulting in misdiagnosis and underdiagnosed mental illness.
In conclusion, there are several problems connected with the assessment and treatment of CODs. For example, due to the high rate of CODs, addiction and several psychological conditions have comparable symptoms, thus, the appropriate diagnosis of either disorder is often challenging. CODs cause drug-induced brain changes when an individual uses the substances which can affect the alterations in parts of the brain damaged by mental illness. Most patients with CODs undergo self-prescription, an indicator that may be elusive to the patients in the long run. Consequently, there is an urgent need for a comprehensive treatment and management approach which recognizes and assesses CODs. Accordingly, the patients pursuing treatments for substance use, misuse, or addiction, or other mental conditions should be appraised for both illnesses and treated immediately.
References
Center for Behavioral Health Statistics and Quality. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health [PDF document].
de Bartolomeis, A., Buonaguro, E. F., Latte, G., Rossi, R., Marmo, F., Iasevoli, F., & Tomasetti, C. (2017). Immediate-early genes modulation by antipsychotics: Translational implications for a putative gateway to drug-induced long-term brain changes. Frontiers in Behavioral Neuroscience, 11(1), 240.
Dingemans, A., Danner, U., & Parks, M. (2017). Emotion regulation in binge eating disorder: A review. Nutrients, 9(11), 1274.
Gimeno, C., Dorado, M. L., Roncero, C., Szerman, N., Vega, P., Balanzá-Martínez, V., & Alvarez, F. J. (2017). Treatment of comorbid alcohol dependence and anxiety disorder: Review of the scientific evidence and recommendations for treatment. Frontiers in Psychiatry, 22(8), 173.
Grant, B. F., Goldstein, R. B., Saha, T. D., Chou, S. P., Jung, J., Zhang, H., Pickering, R. P., Ruan, W. J., Smith, S. M., Huang, B., & Hasin, D. S. (2015). Epidemiology of DSM-5 alcohol use disorder: Results from the National epidemiologic survey on alcohol and related conditions III. JAMA Psychiatry, 72(8), 757–766.
Lowe, D. J., Sasiadek, J. D., Coles, A. S., & George, T. P. (2018). Cannabis and mental illness: A review. European Archives of Psychiatry and Clinical Neuroscience, 269(1), 107-120.
MacKillop, J., Woo, W., Ryan, C., Sousa, S., Romano, I., Ropp, C., Cameron, R., & Vedelago, H. (2016). Concurrent substance use disorders and PTSD in an inpatient addiction treatment program in Canada. Canadian Journal of Addiction, 7(4), 33.
Rush, B. R. (2015). Addiction assessment and treatment planning in developing countries. In N. el-Guebaly, G. Carrà, & M. Galanted (Eds.), Textbook of addiction treatment: International perspectives (pp. 673–689). Springer.