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Guide to Alcoholism Treatment

Treating Co-Occurring Mental Health and Substance Use Disorders

Research has shown that both substance use disorders and serious mental health conditions regularly exist side by side. Learn more about how to treat these co-occurring disorders.

On its own, alcoholism can be a huge weight to carry, and one that might seem impossible to overcome. But if you’re also struggling with mental health issues, the combination of the two can feel even more overwhelming. Research has shown that often times, both substance use disorders and serious mental health conditions exist side by side.1 Such a situation is referred to as co-occurring disorders or a dual diagnosis.

How Prevalent Are Co-Occurring Disorders?

In the U.S., more than 50% of people will be diagnosed with some form of mental illness in their lifetime.2 Last year, the National Survey on Health and Drug Use reported that more than 14 million people aged 12 and older had an alcohol use disorder (AUD).3 An estimated 9.2 million adults aged 18 or older had a co-occurring substance use disorder and mental health illness in 2018.3,4

Additionally, nearly 1/4 of all adult stays in U.S. community hospitals involve mental health disorders such as depression, bipolar, schizophrenia or substance use-related disorders.11 Unfortunately, 90.4% of individuals with substance use disorders and mental health illnesses didn’t seek any type of treatment in 2018.3

Which Comes First?

When considering which came first—the mental health disorder or alcoholism—the answer isn’t always as clear-cut as you may expect. Both substance use disorders and mental health conditions have their own characteristic set of symptoms (which sometimes overlap each other). When they co-occur, regardless of whether or not one developed first, each condition may influence the course of the other; a situation of co-occurring disorders, should they go untreated, could potentially result in both increased drinking or other substance use behavior and an exacerbation of mental health symptoms.

Among those with a dual diagnosis, the most commonly involved mental health disorders include mood, anxiety, psychotic, and personality disorders. Left untreated, these could potentially contribute to the ongoing abuse of substances such as drugs and/or alcohol in an attempt to self-medicate or as coping mechanisms. On the other hand, when a person is a chronic, heavy drinker they may be more susceptible to developing certain mental health issues.5 It can also lead to a worsening or triggering of underlying mental health issues and their associated symptoms.5,7

Although establishing which issues developed first may not be entirely straightforward—nor necessary, in terms of initiating simultaneous or integrated treatment for both—research supports there being three possibilities for this common co-occurrence:7

  • Mental Illnesses and SUDs Share Common Risk Factors. Research has shown that genes can influence how a person responds to drugs or alcohol, such as how much of a euphoric reward they elicit. Our genetic makeup also contributes to the risk of developing both a mental illness and a substance use disorder. Additionally, certain environmental exposures—such as stress or trauma—can result in what’s known as heritable epigenetic changes (although they don’t directly change our DNA sequencing). When passed on, these changes can increase the likelihood of mental illness and SUDs for generations to come.
  • Mental Illnesses Can Contribute to SUDs. Some mental health conditions put individuals at additional risk for developing a SUD. Research has suggested that those with mental illnesses may self-medicate with drugs or alcohol, which can ultimately make symptoms worse. Further, some of the brain changes involved with mental illnesses may also be associated with an increase in the rewarding effects of substances, which could in turn increase the likelihood of that individual continuing to use drugs and/or alcohol.
  • Substance Abuse and Addiction Can Increase the Risk of Developing a Mental Illness. Excessive alcohol use can lead to alcohol–induced psychiatric syndromes, such as alcohol-induced depression, alcohol-induced bipolar disorder, alcohol-induced sleep disorders, alcohol-induced psychotic disorders and more.8,9 In many cases, these types of conditions may resolve with abstinence. Additionally though, drug and alcohol use may be associated with certain brain changes that also make a person more likely to develop a mental illness that isn’t otherwise linked to the more acute intoxicating effects of these substances.

How to Treat Co-Occurring Disorders

In the past, patients seeking treatment for both disorders were commonly treated separately for each and were offered isolated treatment plans for each diagnosis. However, current research supports using an integrated approach to treatment for optimal recovery outcomes.10

Integrated models utilize specific therapeutic techniques or treatment strategies that address both disorders within the same session, interaction, or series of sessions. Treatment may include both substance abuse and mental health education to better inform patients on their inter-relatedness while also teaching healthy coping skills.

Several behavioral therapies may also be used to treat comorbid conditions, whether used alone or in combination with medications.7 A few effective behavioral therapies for treating co-occurring disorders include cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and contingency management (CM).7

If you have, or think you may have, a co-occurring substance abuse and mental health disorder(s), it may be beneficial to look into treatment centers that offer an integrated approach to treating both disorders.

AAC’s Approach to Co-Occurring Disorders

Across its portfolio of treatment centers, AAC’s facilities are equipped to treat co-occurring disorders such as PTSD, depression, anxiety disorders, and others. AAC’s team of treatment staff, ranging from nurses to doctors, psychiatrists, therapists, life skills coaches and residential counselors are knowledgeable in treating alcoholism as well as specific mental health disorders. Your therapeutic team can tailor your mental health and recovery treatment plans in order to best address the comorbidity. An integrated treatment plan within an AAC facility may include:

  • Medical detox.
  • Evaluation (to ascertain a full substance use and mental health history).
  • Diagnosis of both substance use and mental health disorders.
  • Treatment plan (focused on both the mental health and alcohol use disorders).
  • Personal therapy.
  • Group therapy.
  • Family therapy.
  • Aftercare planning.

While there may be no cure for mental illnesses and alcohol use disorders, numerous evidence-based therapies and treatment interventions may be integrated to help manage dual diagnosis disorders. Intensive, comprehensive treatment along with long-term aftercare support can help individuals make continual progress in their recovery journeys.

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[1]. National Alliance on Mental Illness. (2010). Mental Illness and Substance Abuse.

[2]. Centers for Disease Control and Prevention. (2018). Learn More About Mental Health.

[3]. Substance Abuse and Mental Health Services Administration. (2018). The National Survey on Drug Use and Health, 2018. 

[4]. Substance Abuse and Mental Health Services Administration. (2019). Key Substance Use and Mental Health Indicators in the United States. 

[5]. National Institute on Alcohol Abuse and Alcoholism. (2002). Alcoholism and Psychiatric Disorders.

[6]. National Alliance on Mental Illness. (2019). Mental Health by the Numbers. 

[7]. National Institute on Drug Abuse. (2018). Comorbidity: Substance Use Disorders and Other Mental Illnesses. 

[8]. Ramesh Shivani, M.D., R. Jeffrey Goldsmith, M.D., and Robert M. Anthenelli, M.D. (2002). Alcoholism and Psychiatric Disorders. Alcohol Research & Health. 26(2): 90-98.  

[9]. American Psychiatric Association. (2013). Diagnostic And Statistical Manual Of Mental Disorders (5th ed.). 

[10]. Substance Abuse and Mental Health Services Administration. (2019). Detoxification and Substance Abuse Treatment, Tip 45.

[11]. American Psychological Association. (n.d.). Data on Behavioral Health in the United States.