Co-Occurring Disorders: Addiction and a Mental Health Disorder
When used today, the term co-occurring disorders refers to the simultaneous presence of addiction and a mental health disorder (e.g., depression, anxiety, panic disorder). There are widely divergent estimates about the prevalence of co-occurring disorders among addicts with some reports alleging that as many as 75% of adult addicts and an even higher percentage of adolescent addicts are victims of co-occurring disorders.
It is our experience at LMRC that it is quite true that many patients arrive in treatment for addiction exhibiting depression, anxiety and other mood disorders. We find, however, that those conditions, rather than being co-existing separately defined maladies, are often the consequences stemming from this prolonged use of psychoactive substances. Alcohol is a sedative drug and as such depresses the central nervous system and impairs the neurotransmission system of the brain. Prolonged addictive use causes a depressed feeling state that, with abstinence and a program of recovery, usually resolves itself in a month to 6 months. In one study, 72% of the male alcoholics reported that (Peratis et al, 2002) alcohol addiction preceded the onset of a mood disorder. Stimulant addicts also report a great deal of anxiety in withdrawal that may continue in a post acute withdrawal phase. In all these cases, the disorders appear to be caused by the disruption in the limbic reward system of the brain and the lack of production of certain neurotransmitters (dopamine, serotonin etc). The brain has an amazing ability to “reset” itself and, with time, return normal functioning to the neurotransmission system.
Teenagers present a special problem in the diagnosis of co-occurring disorders. The frontal cortex is the part of the brain that acts as a “brake” on the mesolimbic reward system and the eventual progression of chemical addiction. In the early stages of the disease, the adult victim may be able to override the impulse to drink/use more by employing the rationality that resides in the prefrontal area of the brain. The prefrontal cortex, however, does not fully develop in humans for 20-25 years. Teenage addicts thus have a limited ability to make wise and safe decisions when alcohol and drugs are ingested. Flagrant mood swings and risky behavior are the norms for teenagers trapped in addiction and may easily be misdiagnosed as mental health disorders.
In the diagnosis of addicts suspecting of having a co-occurring disorder, one central question must always be posed, “When did the alleged mood disorder begin?” If the maladaptive behavior began after the child began drinking and using drugs, the chances are great that a substance-induced state is present. The chances are also great that the “disorder” will abate with a commitment to abstinence and structured recovery.
At LMRC, less than 4% of admitted patients are found to be suffering from co-occurring mental health disorders requiring mental health treatment. Most often these patients are referred, after intensive treatment, to professionals knowledgeable about both addiction and mental health.