Common Co-Occurring Disorders Associated with Substance Abuse

What Is a Co-Occurring Disorder?

When an individual is diagnosed with a substance use disorder and a co-existing mental health disorder, the paired disorders are referred to as co-occurring disorders, also known as dual disorders.

Common comorbid mental health disorders include depression, anxiety, manic depression (bipolar disorder), panic disorder and Attention-Deficit/Hyperactivity Disorder (ADHD). Although the association is usually linked with a mental health disorder, the comorbidity may also include a physical health disorder (e.g., heart disease, HIV infection, or Hepatitis C) or other disorders.

DSM-V Criteria for Substance Use Disorders

A substance use disorder is an addictive disorder resulting from the repeated use of psychoactive drugs that alter an individual’s mood, perceptions, thoughts, behaviors and/or consciousness. People who regularly use psychoactive drugs to the point of intoxication generally develop tolerance, dependence and addiction to their drug of choice. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V or DSM 5) lists various types of substance use disorders related to the following drugs:

1. Alcohol
2. Cannabis
3. Hallucinogens
4. Inhalants
5. Opioids
6. Sedatives, hypnotics or anxiolytics
7. Stimulants
8. Tobacco

Each substance is associated with a particular set of pathological behaviors which fall into four main categories: impaired control (over drug use), social impairment, risky use and pharmacological indicators (e.g., withdrawal symptoms). These four categories cover 11 different criteria, and the severity of the substance use disorder is determined by the number of symptoms presented by the patient. If two or three symptoms are identified, the disorder is considered “mild”; four to five symptoms indicate “moderate” severity and six or more symptoms indicate “severe.”

Impaired Control Over Drug Use

When a person’s decision to drink or use drugs is no longer voluntary, it’s a sign of psychological dependence, which may occur with or without physiological dependence, according to SAMHSA. Impaired control would mean the loss of self-control over use of substances (e.g., drinking or using longer or in larger amounts than intended); multiple unsuccessful attempts at reducing or stopping substance use; spending excessive time obtaining/using/recovering from effects of substance use; and intense cravings and urges for the substance, which becomes the focal point of the user’s life and daily activities.

Social Impairment

Continued use of drugs or alcohol results in social impairment, a substantial harm negatively affecting personal, professional/academic, and social realms of life. Examples of social harm include failure to fulfill responsibilities at work or school; losing friends or arguing with family members over drug use; giving up meaningful recreational activities with loved ones; and neglect of significant relationships. Due to dysfunctional decision-making processes caused by structural changes in the user’s brain, the negative consequences don’t seem to deter the user from misusing or abusing the substance.

Risky Use

Compulsive drug-seeking behaviors escalate to risky levels despite physical danger, possibly threatening the life of the user and others around him or her. For example, a forklift operator continues to misuse substances even though he is aware of the dangers of operating a machine while intoxicated. A woman may insist on drinking or using marijuana even though she is pregnant. Risky use also involves continued use even though it causes or exacerbates existing physical and psychological problems. A patient may insist on smoking even though he has Chronic Obstructive Pulmonary Disorder (COPD).

Pharmacological Indicators

At advanced levels of addiction, tolerance and withdrawal are the pharmacological indicators of substance use. When the user’s body builds tolerance for a drug, it needs ever-increasing doses of the drug to get the same desired effect, whether it’s a “high” or an avoidance of withdrawal symptoms. Tolerance varies from one individual to another, depending on each body’s sensitivity to various substances. When the user abruptly ceases to use drugs or alcohol, his or her body will go through a withdrawal phase during which symptoms may be very unpleasant or even fatal. It’s always important to consult an addiction professional about dual diagnosis treatment before attempting to quit on your own.

Most Common Co-Occurring Disorders

Generally speaking, certain mental health disorders go hand in hand with specific substance use disorders. The combinations of common comorbidities are listed below:

-Alcohol Use Disorder & Anti-Personality Disorder
-Cannabis Use Disorder & Bipolar Disorder
-Cocaine Addiction & Anxiety Disorders
-Opioid Addiction & Post-Traumatic Stress Disorder (PTSD)
-Heroin Use Disorder & Depression
-Stimulant Use Disorder & Attention-Deficit/Hyperactivity Disorder (ADHD)

Why Dual Diagnosis Treatment Is Recommended

The complexity of diagnosing someone for co-occurring disorders calls for dual diagnosis treatment that addresses both the substance use disorder, the comorbid mental health disorder, and the severity of symptoms of each. In today’s fragmented health care system, patients often receive treatment for one disorder, partly because many primary care physicians and clinicians may not have received adequate training in screening and treating patients for substance use disorders; other reasons may include health conditions that require medical attention, leaving co-occurring disorders undiagnosed or under treated.