Frequently asked questions about co-occurring disorders
How many people have co-occurring disorders?
About half of the people treated in mental health settings have had at least one substance use problem in their lifetime, if not within the past year.
About 25 percent to 33 percent of people treated in mental health settings have experienced substance use problems either currently or within the past year.
As many as 50 percent to 75 percent of people in addiction treatment settings also suffer from a current psychiatric disorder.
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What are the primary symptoms of co-occurring disorders?
The primary symptoms of co-occurring disorders vary somewhat based upon the specific substance use and psychiatric disorders.
Some typical symptoms of co-occurring disorders do exist, however, and here are several:
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Using drugs or alcohol to reduce the difficulty or pain associated with the psychiatric problem, and finding out that even if substances worked at first or in the short term, they have not been the solution for the psychiatric problem.
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The psychiatric problem has generally got worse because of drugs and alcohol.
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The addiction to alcohol or drugs has generally got worse because of the psychiatric problem.
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It seems harder to get treatment for both, or harder to benefit from treatment because of having both disorders.
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It seems harder to find and talk with others who share the same common problem, co-occurring disorders.
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What is a substance use disorder?
A substance use disorder refers to both substance abuse and substance dependence (as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision [DSM-IV-TR] published by the American Psychiatric Association) and encompasses the use of both alcohol or other psychoactive substances.
Alcohol abuse (also referred to as alcoholism, alcohol addiction) and drug abuse (drug addiction) is diagnosed when a person's use of a substance persistently interferes with functioning in work or school, social relationships, a medical condition, or when the person uses in dangerous situations.
Alcohol or drug dependence is a more severe condition than alcohol or drug abuse. A person with dependence has failed at attempts to abstain or control his or her use of substances. In some cases, physiological dependence, indicated by tolerance (needing more of a substance to get the same effect) and withdrawal (symptoms occur when the person does stops using the substance) may also exist.
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What is a mental health disorder?
A psychiatric disorder or mental health disorder is when someone has problems with their feelings, thinking, functioning, or relationships that are not due to drug or alcohol use, and are not the result of a medical illness.
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What is a substance-induced disorder?
Some people develop mental health issues after excessive drinking or other drug use. This may be called a substance-induced disorder. With these disorders, the symptoms of depression, anxiety, or other mental health issues often improve when the person stops using alcohol or other drugs.
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How does the use of drugs and alcohol affect a co-occurring mental health problem?
Most people with a mental health problem try substances to feel better. If you are anxious, you may want to try something to make you feel calm; if you are depressed you may want something to make you feel more animated; if you are fearful of others you may want something to make you feel less inhibited and loose; and if you are in psychological pain, you may want something to make you feel numb.
These substance-related solutions, often develop into substance related disorders, and not only fail to repair the mental health problem but also prevent a person from developing real coping skills to have a fulfilling life, satisfying relationships, and feeling comfortable in their own skin.
Illicit drugs and alcohol abuse complicate and compound a mental health problem.
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How can chemical use and mental health symptoms interact?
Some symptoms of substance use mimic symptoms of mental disorders. Examples include:
| Chemical |
Symptoms of use |
Withdrawal symptoms |
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Alcohol (beer, wine, liquor, moonshine, hooch, booze, vino, sauce)
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Depression; anxiety
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Insomnia; anxiety issues; paranoia
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Amphetamines (Crank, crystal, ice, speed, Ritalin, Dexedrine; Ecstasy)
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Possible psychosis; inconsistency in mood; mania; paranoid delusions; anxiety; auditory and visual disturbances; loss of appetite
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Depression; loss of pleasure; sleep difficulties; paranoia; violent behavior
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Cocaine (crack, C, coke, flake, dust, blow, nose candy, rock, white lines)
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Mania; possible psychosis, hyperactivity
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Depression; anxiety; loss of pleasure
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Cannabis (dope, hemp, weed, ganja, grass, reefer, Mary Jane, hashish, hash, hash oil, chronic, gangster, boom, marijuana, pot, THC)
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Memory difficulties; depression; lethargy; euphoria; lack of motivation
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Memory difficulties; lethargy; paranoia
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Benzodiazepines (Valium, Ativan, Halcion, Serax, Klonopin, Xanax)
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Masks anxiety; reduces symptoms of anxiety
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Concentration difficulties; anxiety; agitation; panic attacks; fear
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How does a mental health disorder affect co-occurring addiction and treatment and recovery?
Having a mental health disorder could make a person even more sensitive to the effects of substances. The consequences from excessive use or chronic long-term use happen more rapidly. With the best of intentions, a person with a mental health disorder may try to stop using substances, but after doing so they notice that their psychiatric symptoms return, sometimes more severe. They wonder, "why bother getting clean and sober?"
A mental health disorder complicates and compounds the challenges in overcoming an addiction to drugs or alcohol.
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What is the difference between severe and non-severe mental health disorders?
Co-occurring substance use disorders occur in people with severe and non-severe mental health disorders. Severe disorders include schizophrenia, bipolar disorder, schizoaffective disorder, and major depressive disorders. Non-severe mental health disorders include mood disorders, anxiety disorders, adjustment disorders, and personality disorders. Of course, severity can vary substantially within any given diagnostic condition.
For example, depression can be mild, moderate, or severe. PTSD can likewise be well-managed or debilitating. Severity, therefore, is more complex than any specific disorder.
In general, a disorder is diagnosed as "severe" when the patient has many more symptoms than the minimum criteria specify, or some symptoms are especially, severe, or functioning in society or at work is especially compromised.
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