Comorbidity is a topic that patients, family members, physicians and stakeholders frequently ask about. Roughly 9.2 million American adults have a co-occuring disorder, meaning they simultaneously suffer from a mental disorder and a substance abuse disorder.
Despite the fact that millions suffer from comorbidity, co-occuring disorders are difficult to study, diagnose and treat. Symptoms often overlap and interact between conditions, making it difficult to determine which disorder came first. Consequently, determining the cause, diagnosis and treatment of co-occuring disorders can be challenging.
What Causes Co-Occuring Disorders?
Abuse of substances like alcohol, prescription drugs, opioids and marijuana can lead to the onset of mental health disorders. Likewise, conditions like depression, post-traumatic stress disorder, anxiety and mood disorders may also lead to substance abuse as a method of self-medication.
Regardless of which disorder causes the other, there’s usually a close relationship between the two. Moreover, there are a few factors that may increase the risk of one developing comorbidity.
Genetic Vulnerability
Individuals with co-occuring disorders have genes that predispose them to develop both addiction and other mental illnesses. For example, studies have concluded that genetics are 50% to 60% to blame in cases of alcoholism and anorexia nervosa. Meanwhile, anxiety disorders, PTSD, OCD, and depression are 20% to 45% inherited. Other mental disorders like bipolar disorder, autism, schizophrenia and ADHD have up to a 75% inheritable component.
Those with genetic vulnerability are also more likely to develop a second disorder. For example, the heritability of smoking among those with schizophrenia can be as high as 65% while heritability among the general population is only 20%.
Environmental Factors
Environmental factors may also play a large part in the development of comorbidity. For instance, those who experience trauma like sexual abuse or military combat are more likely to develop mental disorders like PTSD and depression. Of course, these disorders may then lead to substance abuse, especially if the individual doesn’t have access to medical treatment or another form of support.
Likewise, people who already abuse alcohol or drugs are twice as likely to develop mental illnesses, especially if they’re environmentally vulnerable. Marijuana, prescription drugs, cocaine, LSD, ketamine and other substances can easily cause mental health problems. Moreover, if a user surrounds themself with other addicts, they’ll likely use often and for a longer period of time, further increasing their chances of developing mental health disorders.
Developmental Influences
Childhood substance abuse and mental disorders can also influence the development of co-occuring disorders. Many times, drug use starts in adolescence when the brain is still developing. This substance disorder can affect their memory, learning ability, decision making and behavioral control. Consequently, a child may become more vulnerable to addictive tendencies and developing a co-occuring mentla health disorder as they mature.
Similarly, childhood mental problems, like ADHD, may prompt drug addiction later on if they don’t undergo treatment as an adolescent. This correlation can present challenges when treating children with behavioral disorders since effective treatment also involves stimulant medications with abuse potential — like Adderall or Concerta.
Diagnosing Co-occuring Disorders
Symptoms of comorbidity often overlap, making accurate diagnosis difficult. Therefore, it’s important to evaluate each disorder concurrently and use assessment tools that are less likely to result in an incorrect diagnosis.
One way physicians might accomplish a comprehensive approach is by screening patients that enter treatment for one disorder to ensure they don’t have a co-occuring disorder. Additionally, a physician or psychiatrist may have to observe patients for an extended period of time after treatment in order to distinguish between substance withdrawal or symptoms of mental disorders. This practice would allow for more accurate diagnosis and effective treatment.
Treatment Approaches
The best way to help those with comorbid conditions is to provide them with comprehensive treatment that addresses both disorders simultaneously. One option for dual diagnosis treatment might include medication that addresses both disorders. For instance, some healthcare professionals prescribe bupropion for co-occuring depression and nicotine dependence. This drug can also reduce the craving for methamphetamines. Treating drug abuse with pills may sound counterintuitive. However, as long as they aren’t addictive, medications can provide effective comprehensive treatment.
Behavioral therapies — alone or in conjunction with medication — are also an effective treatment approach. This method may include therapeutic communities, assertive community treatment, integrated group therapy and exposure therapy. Adolescents with comorbid conditions might also benefit from multisystemic therapy or cognitive behavioral therapy. While each of the above offers a slightly different approach to treating co-occuring disorders, all of them have proven to be effective, comprehensive therapies.
Breaking Down Barriers
Although research suggests the need for comprehensive treatment of co-occurring disorders, not everyone has access to treatment options. In the U.S., healthcare and legal systems treat mental health disorders and substance abuse disorders as two separate issues. Thus, neither physicians nor psychiatrists may have the proper training or resources to treat comorbid patients in a comprehensive fashion. Additionally, many of those in need of treatment are in the criminal justice system and, within it, adequate treatment services are greatly lacking.
Thus, policy barriers, a lack of comprehensive healthcare providers, the stigma associated with both types of disorders and a lack of clear implementation models have created barriers in the U.S. Until the nation breaks them down, many people who desperately need treatment will go without.
