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Co-Occurring Disorders and Sober living

This article is written to inform and educate members of the sober living community, including recovery residence operators and those who live in or work in a sober house. The treatment of all underlying mental health problems should be integrated when treating those with co-occurring mental health issues and addiction. Co-occurring medical conditions, also known as dual diagnosis, occur when a person meets the requirements for a drug use disorder while also being diagnosed with one or more other mental health disorders. Any of the disorders will appear first, causing the introduction of the others.

Sober living operators and managers should not attempt to diagnose co-occurring disorders but should be aware that “problem” residents may be dealing (or not dealing) with a mental health issue.

Substance use disorders (SUDs) and mental health conditions have a close connection. About half of people with one illness will experience at least one other co-occurring mental health problem over the course of their lives. Co-occurring disorders can exacerbate one another’s severity.


  1. Contributing Factors to Co-Occurring Disorders


Researchers have discovered three potential explanations for why co-occurring disorders are so common:


  1. Overlapping Risk Factors


SUDs and other mental health disorders have a lot of risk factors in common. These causes may include both genetics and environmental factors, such as trauma exposure, which can make an individual more likely to experience these problems.


  1. Self-Medicating


As a means of dealing with symptoms, mental illness may lead to drug abuse. This concept is often referred to as “self-medicating,” but that word can be misleading because, while drug use can mask symptoms, it can also worsen them in the short and long term.


  1. Drug-Induced Brain Changes


Substance abuse can damage parts of the brain that are disrupted by mental health conditions, making it more likely for someone to experience signs of a mental illness. Substance misuse tends to affect regions of the brain that are often connected to impulse control, mood, and anxiety disorders, as well as schizophrenia.

  1. Frequently Occurring Mental Health Disorders


Co-occurring disorders are associated with increased severity of mental illness, with around 25% of individuals with serious mental illness having co-occurring disorders. This information is for educational purposes only. Sober loving owner/operators and house managers should never attempt to diagnose a resident.


  1. Anxiety Disorders


Around 18% of the general population suffers from a co-occurring anxiety disorder of any kind. Marijuana usage issues have a particularly strong correlation to social anxiety disorders. An increased risk of co-occurring conditions is linked to generalized anxiety disorder, social anxiety disorder, and panic disorder.


  1. Mood Disorders


About 20% of people with SUD may have one or more mood disorders, such as bipolar disorder or depression.


  1. Personality Disorders


In the general population, about 10-15% of people have a personality disorder, while patients in alcohol treatment have a prevalence rate of 35-73 percent. Antisocial, borderline, avoidant, and paranoid personality disorders are the most common in people with SUD.


  1. Post-Traumatic Stress Disorder (PTSD)


According to one nationwide study, people with PTSD were up to four times more likely than those without it to also meet the requirements for a drug use disorder.


  1. Attention Deficit/ Hyperactivity Disorder (ADHD)


ADHD is linked to a younger age at which drug use begins and a greater probability of using several drugs. According to Brook et al20, having an ADHD diagnosis increases the likelihood of developing SUD in adulthood; meeting requirements for an ADHD diagnosis in adolescence is linked to developing SUDs in a subject’s 20s and 30s. The number of inattention, hyperactivity, and impulsivity symptoms experienced by people with ADHD is linked to the risk of drug abuse.


  1. Symptoms of Co-Occurring Disorders

It can be difficult to tell the difference between addiction and mental illness at times, particularly because their symptoms sometimes overlap. A mental health diagnosis should be made when a person is abstinent and without drugs in their system to prevent misunderstanding. Although the symptoms of each mental health condition vary, there are several common indications that suggest the likelihood of mental illness. Following are a few of the symptoms:

  • Changes in eating and sleeping habits.
  • Dropping hobbies or activities that were once important.
  • Experiencing extreme emotional highs and/or lows.
  • Frequently feeling afraid without cause.
  • Having difficulty focusing or thinking clearly.
  • Inability to see these changes in one’s behavior or personality.
  • Increased irritability.
  • Increased or decreased libido.
  • Isolating from friends and family.
  • Lack of attention to personal hygiene.
  • Loss of touch with reality, such as hallucinations, paranoia, or delusions.
  • Participating in risky behaviors such as substance use or promiscuousness.
  • Suffering from physical complaints with no cause.
  • Thoughts of suicide or suicide attempts.
  1. Warning Signs

SUD symptoms vary depending on the drug used, but general symptoms may suggest that a person has a substance abuse problem. These are some of the warning signs:

  • Difficulty or inability to stop using drugs even when they want to.
  • Experiencing withdrawal when substance use is stopped.
  • Having difficulty functioning or coping with stress without alcohol or drugs.
  • Having trouble completing tasks at home, school, or work because of substance use.
  • Inability to stop using even after it has caused or worsened physical or mental health conditions or interpersonal relationships.
  • Isolating from family and friends or spending time with different friends.
  • Frequently tardy or absent from school or work.
  • Not appearing intoxicated after ingesting large amounts of a substance (increased tolerance).
  • Participating in risky behaviors such as driving under the influence.
  • Spending a lot of time getting, using, or recovering from the effects of a substance.

Co-occurring disorders may cause additional issues or intensify problems caused by either or both disorders. People with co-occurring disorders face difficulties retaining jobs and housing, relationship difficulties, health issues, and an increased risk of arrest and suicide, particularly as the disorders become more severe. Furthermore, each condition can exacerbate the others, making recovery more difficult.

Integrated Treatment

Patients are screened and assessed for drug use disorders as well as other mental health disorders in integrated recovery services. Additional support services, such as accommodation, jobs, and socialization, can be offered as part of integrated recovery programs.

Clients should undergo comprehensive medical and psychological intervention and care for both conditions at the same time for recovery purposes. This helps them to deal with the effects of the mental health condition without consuming narcotics or alcohol and exacerbating the symptoms — or causing an untreated mental health disorder to intensify the temptation to drink or get high. The best way to start a new life in recovery from co-occurring conditions is to get comprehensive care that starts with detox and continues with aftercare treatment and help.

  1. Benefits of Integrated Treatment

The integrated care treatment model is considered by the Substance Abuse and Mental Health Services Administration a best practice when treating individuals with co-occurring substance abuse and mental health disorders. Patients are more likely to stay engaged and participate in treatment when care is integrated and comprehensive.

Integrated care plans are customized to each patient’s specific needs. Many positive results have been related to the treatment strategy. People who receive integrated care are more likely to stay sober, have a substantial reduction in their symptoms, visit the hospital less often, live independently, have secure jobs, and report feeling happy about their lives, according to studies.

  1. What is Integrated Treatment

The goal of integrated treatment is to help people learn how to maintain sobriety or significantly reduce their substance use and manage the symptoms of their mental illness at the same time. This is accomplished using effective counseling and behavioral therapy interventions and, sometimes, with medications. Integrated treatment may utilize multiple therapeutic techniques proven effective in the use of mental health disorders as well as substance abuse issues, such as:

  • Cognitive behavioral therapy, or CBT, which explores a person’s thoughts and beliefs to change their behaviors.
  • Dialectical behavioral therapy, or DBT, which is used to treat borderline personality disorder by reducing negative actions such as self-harm, substance use, and suicidal behavior.
  • Contingency management, which provides small incentives for clients who exhibit desirable and positive behaviors such as staying sober or avoiding self-harm.
  • Motivational enhancement, which can help people increase their motivation to make positive changes in the treatment process.
  • Mutual-support groups tailored towards people with co-occurring disorders. Narcotics Anonymous also offers meetings for people with co-occurring disorders.


An integrated treatment approach can be provided at all levels of care, including:

  • Detox: A medically managed detox normally requires medical monitoring 24 hours a day, seven days a week. Staff is on hand 24 hours a day, seven days a week, and physicians can prescribe medications when required to ensure protection when detoxing from drugs.


  • Inpatient Care: There are many types of inpatient care, all of which require patients to stay at an addiction hospital 24 hours a day, seven days a week for the duration of treatment. As patients learn to control their co-occurring conditions, medical and mental health staff are always on hand to provide care, treatment, and other resources.


  • Outpatient treatment allows patients to receive similar (if not identical) services to those received in inpatient treatment, albeit on a less comprehensive basis. Patients may go to school or work and engage in daily activities at home while also seeking treatment for co-occurring conditions at this level of care.



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