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Co-Occurring Mental Health Disorders

Mental illnesses impact the way one thinks and feels. They can alter one’s mood, and even their ability to function in everyday life. Mental illnesses are diseases, and must be treated as such.

The Substance Abuse and Mental Health Services Administration’s Behavioral Health Barometer in 2014 reported that 4.2% of American adults (or an estimated 10 million individuals) have a serious mental illness. This same report indicated that 26.5% of insured American adults did not receive treatment for these illnesses.

Furthermore, it is estimate that 8.9 million Americans have a co-occurring disorder, or the presence of two or more disorders at the same time. In this case, the number refers to Americans having both a mental and substance use disorder. A whopping 55.8% of these individuals receive no treatment at all.ipants in their own care. By learning to self-manage their addiction, individuals can live successfully in long-term recovery.

Individuals suffering with mental health disorders often use substances to feel better, whether it’s to feel calmer, happier, or more energetic. Not only does this fail to repair the problem, it can actually exacerbate it by magnifying symptoms or interfering with prescribed medications.

In order to help such individuals it’s important to seek out integrative treatment centers—a place where one can receive care for both their addiction and mental illness at the same time in one, stable setting. This means approaching both illnesses as chronic, relapsing conditions that require long-term support.

While there are many variations of co-occurring disorders, some mental health illnesses leave sufferers at a higher risk of substance abuse, including: anxiety, bipolar disorder, depression, and personality disorders.

Anxiety Bipolar Disorders Personality Disorders Trauma


Anxiety is a normal part of everyday life. It's our body's way to warn us of danger or trouble, so that we can get out of harm's way or take action against it. But for millions of Americans, feelings of anxiety are persistent and excessive. They have overwhelming and uncontrollable feelings of worry or dread that interfere with their ability to function.

When this happens, anxiety becomes more than a normal reaction to life, it becomes a disorder. An individual suffering with an anxiety disorder often report physical symptoms alongside psychological ones, including:

  • Muscle tension
  • Weakness
  • Impaired memory
  • Hot flashes or sweaty hands
  • Shortness of breath
  • Heart palpitations
  • Stomach pain or discomfort

There are several types of anxiety disorders that individuals can suffer from, depending on their personal experiences with different symptoms and severity of anxiety. The most common anxiety disorders are generalized anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety, specific phobias, and panic disorder, which is characterized by reoccurring panic attacks.

While there are many differences in these disorders, the foundation of these diagnoses is based on excessive and irrational fear and dread. In order to combat these extreme emotions, individuals with anxiety disorders very frequently turn to drugs and alcohol in order to self-medicate.

These substances provide temporary relief from the fear permeating their lives, but in the long run, they actually damage the brain's mechanisms that fight the symptoms of anxiety. This creates a vicious cycle of substance use and reoccurring, often stronger, feelings of anxiety. The addicted person then falls further into the cycle of using higher doses of drugs or alcohol to outrun their mental health disorder.

Successful treatment for co-occurring anxiety and substance use disorders must include teaching the individual healthy, sober ways to manage the symptoms of anxiety. Only then can the individual achieve the stable, balanced state of mind needed to live successfully in long-term recovery.

Bipolar Disorders

Bipolar disorder, sometimes called manic depression, is characterized by extreme mood swings, often called highs and lows, which range from depression to mania. It's a very serious condition that can lead to dangerous and risky behavior, such as attempts of suicide.

When individuals with bipolar disorder are experiencing a low, they often report feeling sad and hopeless and a loss of interest in most daily, pleasurable activities. On the other end of the spectrum, individuals report feeling overly joyful, euphoric, and energized. For some individuals, these mood shifts can happen several times a day.

The stress and discomfort these episodes cause in an individual's life often leads them to drugs or alcohol. Typically, the goal is to balance the mood swings, or even decrease their affects. Sufferers are just trying to find a way to manage their disorder in the best way they can.

According to a study conducted by the American Journal of Managed Care: 56.1% of individuals with bipolar disorder were dependent on substances-with 46% reporting alcohol abuse or dependence and 41% reporting drug abuse or dependence. The study also found that people with bipolar disorder were more than 3 times as likely to abuse or be dependent on alcohol, and about 7 times more likely to abuse or be dependent on drugs than the general population.

It's important that treatment for co-occurring substance use and bipolar disorder address both conditions at the same time. Drugs and alcohol can interfere with the medication needed to treat bipolar, and a person using substances may be unable to maintain the lifestyle changes, medication regime, and therapy needed to balance the mood swings.

Personality Disorders

Personality disorders are a group of disorders characterized by a difficulty dealing with other people, as well as the stressors and problems of everyday life. This is mostly due to the individual's narrow and rigid thoughts and behaviors that are markedly different from the realities of today's culture and society. In order for these characteristics to be considered a disorder, the individual's thought and behaviors must impair personal, social, and/or professional situations.

The symptoms of a personality disorder differ depending on the diagnosis. However, a person with a personality disorder might not realize that they have a problem, because to them their thoughts and behaviors are normal. It's everyone else that's to blame.

Some examples of personality disorders include:

  • Antisocial Personality Disorder - individuals who consistently disregards another's rights, often violating those rights without feelings of empathy, sometimes referred to as a sociopath
  • Avoidant Personality Disorder - individuals who feel inadequate and are extremely sensitive to others' opinions, this often leads to avoiding work, school, or other social environments
  • Borderline Personality Disorder - individuals who exhibit instability in relationships and emotions, and act impulsively, sometimes participating in risky behaviors like promiscuity and suicide attempts
  • Dependent Personality Disorder - individuals with the constant need to be taken care of and characterized by a fear of being abandoned by important loved ones
  • Histrionic Personality Disorder - individuals who exhibit a pattern of extreme emotions and attention-seeking behavior in order to draw attention to themselves
  • Multiple Personality Disorder - individuals with two or more distinct personalities, each with its own thoughts and perspectives on one's environment and self, also called dissociative identity disorder
  • Narcissistic Personality Disorder - individuals with an overwhelming need for admiration, also characterized by grandiose and condescending attitudes
  • Obsessive-Compulsive Personality Disorder - individuals preoccupied with cleanliness, orderliness, control, and perfectionism with no regard to flexibility and efficiency
  • Paranoid Personality Disorder - individuals who are always suspect of others' motives, believing them to be distrustful, exploitive, or even malevolent
  • Schizoid Personality Disorder - individuals with patterns of detachment from social relationships and difficulty expressing emotions, often keeping communications restricted and controlled
  • Schizotypal Personality Disorder - individuals who have difficulty establishing and maintaining close relationships, also characterized by distorted perceptions and eccentricities

Individuals with a personality disorder often seek out drugs and alcohol in an effort to numb the pain or their fear of abandonment. They make seek out drugs or alcohol at the hands of their disorder, which drives their patterns of nonconformity, impulsivity, and emotional and self-esteem instability.

Individuals with co-occurring substance use and personality disorders can be the hardest to treat. Their impulsivity drives them to drop out of treatment, their difficulty engaging with others makes it hard to connect with mental health professionals, and their anti-social fears and behaviors make it difficult to establish a strong support network.

But recovery and effective treatment is possible. Individuals with personality disorders respond most positively to dialectical behavior therapy, cognitive-behavioral therapy, and psychodynamic approaches, which help them work through past issues and relationships manifesting in personality disorder symptoms and substance use behaviors.


Trauma is an emotional response to a life-changing event like an accident, natural disaster, or abuse. Individuals may report ongoing feelings of numbness, disconnect, or distrust after a traumatic event because their sense of security has been compromised. They then feel vulnerable and hopeless in what is deemed a dangerous world.

Some trauma comes from one traumatic event, and other comes from an ongoing, stressful situation. Being traumatized before makes one susceptible to being traumatized again later in life. The symptoms of trauma can be both emotional and physical, including:

  • Shock, denial, disbelief
  • Anger or mood swings
  • Guilt, shame, self-blame
  • Post-traumatic stress disorder, anxiety, or fear
  • Problems with self-esteem and relationships
  • Insomnia or nightmares
  • Aches and pains
  • Muscle tension

Individuals often turn to drugs or alcohol to cope with trauma. These substances can help one avoid thinking about or reliving the event, or numb the feelings of fear and powerlessness the event brought on. Counterintuitively, drugs or alcohol may be used as a mechanism by which the individual hopes to gain more control over their life.

Intense support from mental health professionals, family members, and peers is a critical part of treating co-occurring trauma and substance use disorders. Individuals dealing with trauma need a strong backing to feel motivated and encouraged in treatment. These elements are essential to the individual's life in long-term recovery.