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Double Whammy: Mental Illness and Substance Abuse

Mental health issues such as depression, bipolar disorder, and anxiety disorders common co-occur with substance use disorders—and the co-occurrence is more common than you might think.

By Thomas Pettry, MHS, CADC, Addictions Counselor III

Anxiety & domestic violence. Depression & substance abuse. Diabetes & depression.

These are all examples of what clinicians call “co-occurring disorders,” or the occurrence of two or more illnesses or complexities at the same time in the same person. Also sometimes called co-existing conditions or comorbidity, two separate issues can occur at the same time or one after the other in succession. Mental health issues such as depression, bipolar disorder, and anxiety disorders commonly co-occur with substance use disorders—and the co-occurrence is more common than you might think. The important thing to remember is that these conditions, which will worsen if ignored, are treatable when addressed.

The Role of Trauma in Co-Occurring Disorders

An important aspect of integrated care is having caregivers who recognize the role that violence and psychological trauma plays in the lives of clients. A traumatic event is one that leaves a person feeling overwhelmed, out of control, helpless, and unable to process what has taken place. This can include child abuse, physical or sexual assault, vehicular accidents, combat, hate crimes, hostage situations, exposure to natural disasters, and other events. A traumatic experience can overwhelm a person’s capacity to cope and dramatically alter their lives. An estimated 90 percent of behavioral health clients have experienced trauma in some form, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

Attempting to cope, trauma survivors have a tendency to seek tension-reducing behaviors to regulate their distress, including substance use, sexually acting out, binge eating, and self-harm. As we learn more about the role that trauma plays in an individual’s life, the importance of trauma-informed care becomes increasingly obvious. A trauma-informed approach focuses on the empowerment of the client, and the caregiver works closely with them to establish individualized treatment plans that meet their needs, highlighting their strengths, talents, and interests. Trauma-informed care seeks to restore power and agency in the lives of clients where that control has been lost.

Multiple Voices Needed for Treatment

We all experience unique challenges that require unique responses. To solve life’s most intricate puzzles, we need to work together—and that’s also true with co-occurring disorders.

Addiction is a complex but treatable disease that affects brain function and behavior. People who work to address substance use disorders are at a high risk for relapse, even after long periods of abstinence and persistent negative consequences. To be effective, treatment must address not only the substance use, but any associated medical, psychological, social, vocational, and legal problems—anything that could stand in the way of becoming productive, independent, and substance-free. It is also crucial that treatment be appropriate for each individual’s age, gender, ethnicity, and culture.

“Integrated care” is a team-based approach that blends the knowledge and experience of mental health, substance use, and primary care clinicians with feedback from patients and their caregivers, providing a unique and holistic approach to treatment. Pillars Community Health is one of the first nonprofit providers in the state to integrate primary medical and mental health care, but it is becoming increasingly common across health care settings. This is important because we want to make sure all expertise relevant to person’s condition is taken into consideration. For example, a primary care doctor may go straight to medication as a solution for mental health disorders. While medication is an important element of treatment for some patients and clients, their potential for success is vastly increased when combined with counseling and other behavioral therapies. The combination of treatments and highly individualized treatment plans also leads to a reduction in health care costs and an increase in quality of care.

Tailoring the Treatment Plan

The first step toward recovery is an “assessment,” or a time during which the client and counselor meet to discuss their goals and motivations for treatment. The clinician can then develop an individualized treatment plan. Because there is no one-size-fits-all in recovery, treatment plans can be drastically different from person to person. At Pillars Community Health, we are able to address multiple aspects of a person’s life at one organization—any existent medical disorders, domestic violence, mental illness or other factors that might contribute to or worsen substance use disorders. It is possible, for instance, for someone to engage in substance use counseling, receive mental health treatment, and address chronic physical illness all at Pillars Community Health.

Once treatment begins, it remains dynamic: As a client progresses or their circumstances change, the treatment plan is modified to fit new goals. A client may express an interest in different or additional forms of treatment over time such as group therapy, family therapy, or vocational rehabilitation. The key is keeping an open mind and a continuous and honest flow of communication between caregiver and client. One of the hallmarks of Pillars Community Health is that we seek to provide each client with their own pathway to success and walk alongside them as they accomplish their goals.

If you or someone you know would benefit from Mental Health and/or Substance Use Disorder Services, call us at 708-PILLARS (708-745-5277) or learn more here. We are currently offering same-day assessments and virtual “telehealth” appointments during shelter in place. You are not alone, and recovery is possible.

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