Co-OCCURring disorders

When it comes to the concept of addiction, it can be divided into two types: substance and behavioral addiction. Substance addiction involves being addicted to drugs or alcohol.

While behavioral addiction is when an individual has a compulsive desire to undergo a particular activity or behavior. Both substance and behavioral addictions produce similar effects on the body.  

Some of the examples of behavioral addiction are listed below

Gambling addiction

According to the American Psychiatric Association (APA), gambling disorder is classified as an addictive disorder.

Different studies have shown that gambling addiction affects the brain in a similar way to drugs and alcohol. This is one of the reasons why gamblers hardly quit this activity because it provides them with a refreshing experience when they make little wins.

They are often self-motivated to record higher wins. So, they will not mind spending more money to make this a reality.

Internet addiction

We live in a digital age where people spend several hours on their phone, going from one social media platform to another. This pattern of online activity has made many people unproductive in many aspects of their life.

After spending much time on the internet, it becomes hard for them to handle other important tasks at work, school and the home.

Shopping addiction

When shopping gets out of control, it can be classified as a compulsive disorder.

If you often go shopping to make yourself happy, without having any real use for the products or services you are getting, you might be struggling with shopping addiction. This addiction type is common in women and young ladies.

Food addiction

Food addiction or Binge Eating Disorder is a problem that some people struggle with. Some people obsessively eat food for different reasons other than satisfying their hunger.

Video game addiction

Another type of addiction that people struggle with is video game addiction, and it is common in men and boys. Once video games begin to take the place of other important activities in your life, a disorder is at play.

When substance addiction develops, it begins as a pleasurable activity where the individuals take alcohol or drugs to improve their mood and behavior, and for emotional stability.

However, it gets to the point where they need to increase their intake of these substances because they need more to achieve the desired level of ‘excitement’.

Here are some of the signs of substance addiction

Physical signs

Anyone addicted to substances is likely to have bloodshot eyes, sudden weight loss or weight gain, inability to sleep properly, change in complexion, and poor personal hygiene.

These physical signs are easily noticeable when you see someone struggling with either drug or alcohol addiction.

Behavioral signs

One of the common behavioral signs of substance addiction is isolation or secretive behavior. This means that they will prefer to keep to themselves instead of staying around people.

Most times, it is also because they don’t want people to keep talking about their addictive behavior. It could also be due to being accountable to some of their close loved ones. So, they will prefer to use those substances in private.

Another behavioral sign is ignoring responsibilities. Substance addiction can make someone negligent in their duties at work, school, or home.

Financial distress is another behavioral sign of substance addiction. This is when the individual lacks the financial capacity to keep their addiction going.

Hence, they keep taking loans and spending more than necessary to fund their alcohol or drug addiction.

Psychological symptoms

Depression and anxiety are common psychological symptoms that come with substance addiction. Another symptom is low self-esteem. People addicted to substances struggle with keeping their confidence levels high.

It is quite unusual for an addicted individual to make good decisions. According to research, drugs, and alcohol affects a person’s judgment.

Therefore, they are likely to do things that will not go down well with the people around them. Worse still, they might not see anything wrong with their decisions, and it will be hard to convince them of their mistakes.

In the world, the notable types of addiction and drug and alcohol. Besides, they are the top types of addiction that plague people from all walks of life irrespective of age, status and the likes.

Drugs and alcohol are substances that tamper with the reward system of the brain. When these substances are taken, the reward center of the brain is triggered. Hence, the individual looks forward to taking more of the substances which results in an abuse.

Drug and alcohol abuse develop into addiction and at this point, it is difficult to quit because the individual is completely hooked. The surprising part is, a number of these individual know there are adverse effects but they are less concerned about it.

There are several negative effects of being addicted to drugs and alcohol which transcends the physical effects. It would interest you to know that people who are addicted to alcohol and drugs encounter mental health problems.

Often, one challenge that addicts face is, owning up to the fact that they are addicted. They don’t like hearing that fact and that is why they shy away from anything related to it. More so, another challenge they face is, the stigma attached to drug and alcohol addiction is overwhelming.

A number of people who are not addicted fail to realize that an individual’s addiction is not often their fault. And they should not be treated as outcasts. However, people show prejudice against those who are addicted without minding the negative toll it takes on their health.

For drugs and alcohol addicts to help themselves, it is important for them to seek help promptly. There are several top-quality rehabs that helps addict to properly manage and treat their addiction condition.

The process of treating addiction is not an easy one. However, the individual must be willing to walk through the process, and he will need the support of his loved ones for sustained focus that leads to success in addiction treatment.   

Addiction is broadly categorized into substance and behavioral addiction. Substance addiction is the compulsive and obsessive use of drugs or alcohol. And even though the individual is aware of the adverse consequences, they will still take those substances.

There are some people who need to take alcohol or drugs before they do something. Without these substances, it is impossible to perform any task. Hence, these substances make people feel normal and when they do not take them, they experience withdrawal symptoms.

It would interest you to know that substance addicts are physically dependent on those substances. And people can easily tell because the long-term physical health effects are obvious.

On the other hand, behavioral addiction does not involve any substance. It is a condition where the individual is dependent on some behaviors that induce pleasure. Some examples of behavioral addiction are sex, gambling, video, shopping, pornography and a host of others.

Behavioral addiction is characterized by regular cravings which must be urgently satisfied. And one of the major differences between substance and behavioral addiction is, there are no withdrawal symptoms involved.

For both substance and behavioral addiction, they tamper with the normal functioning of the body’s system. And this is why addicts view their addiction condition as normal.

Someone who is addicted to substances would find it challenging to lead a normal life because their focus is on the addiction. The same applies to behavioral addiction. The addicts will ensure they dedicate a good amount of their time to satisfying themselves.

The good part is, both forms of addiction can be treated effectively provided the individual is willing to cave in. The primary step in treating both substance and behavioral addiction is by acknowledging that you have an addiction problem.

Then, the individual would be required to either stay within the confines of the rehab or not. For most behavioral addiction, the major treatment feature is counseling and some form of therapy which is not as demanding as substance addiction.

The term addiction, is a physical and psychological inability to stop the usage of a drug, chemical, activity or substance, irrespective of being aware of the fact that, they come with detrimental and dire consequences.

Addiction does not only mean dependence on chemicals or substances. Someone who finds it difficult to stop an act or take a drug, has substance dependence.

In some cases of addiction, it becomes difficult to quit some activities like working, gambling, eating and the likes. In a good number of these circumstances¸ the person comes with a behavioral addiction.

When an individual is addicted, they find it difficult to regulate how they take a substance or take part in an activity. Hence, they depend on it to cope with their everyday life.

Spotting someone who is addicted is very easy. First off, the person would obsessively seek those substance or activity which keeps him or her motivated.

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Due to the fact that there is a high volume of dopamine production, the person would seek to continue taking the substance, or indulging in the activity, so that they would remain okay.

In addition to this, they lose interest in activities which does not involve either the substance being abused, or the behavior.

What they prefer is, indulging in activities which would give them the liberty to use the substance or take part in the addictive activity.

They also have serious difficulties in relationships. The reason for this is not far-fetched. Due to the fact that their addiction has taken full control of their attention, they prefer to keep to themselves.

This happens because there is a supposed fear of rejection from their loved ones.

Also, they would also find it difficult to stop the use of the substance or the act. It gets even worse when there are health problems attached to it.

However, they do not mind, the ultimate aim in this case, is the pleasure derived, and they would continue at all cost to ensure they are continually motivated.

Addicted individuals are also known to be great risk-takers when it comes to accessing either the activity or the substance.

TREATMENT STRATEGIES FOR CO-OCCURRING DISORDERS

The thought of trying to recover from a mental health disorder or a co-occurring disorder can be overwhelming, which is why a comprehensive treatment plan, as well as a supportive team, is essential for recovery success. Below show strategies to be employed for Co-occurring disorder recovery;

1. Residential treatment programs: These programs provide structured, supervised support as you go through rehab. Removed from the stresses and triggers of your daily environment, you may find that it’s easier to focus on your recovery.
2. Outpatient treatment options: Many rehabilitation facilities offer outpatient alternatives for clients who don’t need 24-hour supervision. For younger teenagers, parents or people with work commitments, outpatient care may be the best way to get the proper treatment without interrupting important life routines.
3. Individual therapy: Individual therapy for co-occurring disorders centers on tasks like building motivation, identifying self-defeating thoughts and learning positive new behaviors. Today, the leading rehab facilities have abandoned the old, confrontational style of therapy in favor of a non-confrontational, collaborative approach to treatment that focuses on reinforcing the client’s sense of self-worth and preventing relapses in the future.
4. Medication therapy: Psychotherapeutic medications, such as antidepressants, antipsychotic medications, and anti-anxiety drugs, are often prescribed as part of a co-occurring disorders treatment program. Anti-addiction medications may also be prescribed to minimize cravings and withdrawal symptoms.
5. Peer support groups: Social withdrawal is often the result of living with a serious mental health disorder. When an individual adds drugs and alcohol to the mix, isolation can get even worse. Peer support groups and 12-step programs like Dual Recovery Anonymous (DRA) let you know that you’re far from alone in your efforts to lead a healthy, stable life. Group counseling and 12-step programs are an integral part of many rehab programs.
6. Education and counseling for families: Supporting a loved one with a mental illness and a substance abuse problem can be frustrating and heart-breaking. Whether you’re the patient or someone who’s close to the patient, education and support can make all the difference in the world when it comes to surviving co-occurring disorders.
7. Holistic therapies: Increasingly, mental health clinicians have come to appreciate the role of alternative therapies in drug and alcohol rehab. Acupuncture, hypnotherapy, massage, equine-assisted therapy and yoga are now offered by many rehabilitation programs as part of a treatment plan for co-occurring disorders.
8. Ongoing support after rehab: After the individual has completed a rehabilitation program, the recovery journey is really just beginning. Finding a program that offers comprehensive aftercare services is as important as choosing a facility that provides integrated care. The individual should have access to counselors, support groups and other recovery resources after being discharged from treatment, so one can continue to evolve in recovery. Many facilities offer transitional housing for graduates who need a partially structured, secure environment to minimise their chance of a relapse.

Fig 1.1: Core treatment principles for adolescents with substance use disorders

 

 

WHAT ARE CO-OCCURRING DISORDER?

The co-occurring disorder also known as dual diagnosis refers to combined mental disorder and substance use disorders. People who have substance use disorders, as well as mental health disorders, are diagnosed as having co-occurring disorders, or dual disorder.

Fig. 1.1: A pictorial chart showing Co-occurring disorder from drug Addiction and Mental illness (source:kaksoisdiagnoosi.blogspot.com)

Common Co-occurring disorders include;

1. Anxiety disorder
2. Attention deficit hyperactivity disorder
3. Autism spectrum disorder
4. Depression
5. Eating disorder
6. Personality disorder
7. Schizophrenia

Co-occurring disorders can sometimes be difficult to diagnose. Symptoms of substance abuse or addiction can mask symptoms of mental illness, and symptoms of mental illness can be confused with symptoms of addiction.

Signs to show the presence of co-occurring disorder include;

1. Drug or alcohol withdrawal symptoms like cravings and withdrawals
2. Depression, anxiety, grief, anger and so on that intrude on everyday living
3. High tolerance for the substance being used
4. Risky behavior to maintain the addictive habit
5. Extreme changes in behavior
6. Perceived inability to function without alcohol or drugs
7. Difficulties in relationships at home, in the community and at work or school caused by symptoms.
8. Physical and mental health problems.

Historically, Co-occurring Disorders were treated separately in non-integrated services. While the singular focus in treatment is beneficial for an individual with one condition, the failure to treat the co-occurring disorder in those with more than one condition may exacerbate the problem and prolong recovery time. some treatment plans for co-occurring disorder include:

1. Assessment
2. Detox
3. Residential Inpatient
4. Partial Hospitalization
5. Intensive Outpatient
6. Outpatient therapy
8. Addiction and other disorders interact in a number of ways.

The co-occurring disorder involves the interaction of addiction and other disorders in a number of ways. The following are examples of co-occurring disorders;

1. Addiction and psychiatric symptoms occurring at the same time, but arising from independent conditions.
2. Addiction increasing the severity of psychiatric and/or medical conditions (substance-exacerbated conditions).

• Psychiatric conditions increasing the severity of the addiction (through self-medicating).

1. Addiction or withdrawal symptoms can mask or mimic a psychiatric disorder (for example, substance-induced mood swings can mimic bipolar disorder, withdrawal can mimic psychosis).

In conclusion, a co-occurring disorder which is a combination of an addiction and a mental disorder affects individuals and arise from various conditions. Self-medication is one of the factors influencing the increase of co-occurring disorder, as the victim may self-medicate to treat symptoms of a mental illness and end up addicted to the particular substance. Right diagnosis and psychotherapies are useful treatments for effective recovery from co-occurring disorders.

MENTAL DISORDERS AND ADDICTION

A mental disorder is a wide range of conditions that affect mood, thinking, and behavior (Mayoclinic, 2015). Most common types of mental disorder include; Clinical depression which is characterized by persistently depressed mood, Anxiety disorder, which is characterized by feelings of worry, anxiety or fear and Bipolar disorder, characterized by episodes of mood swings. Although many people have a mental health concern, it becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect the individual’s ability to function.

Addiction, on the other hand, can be defined as the uncontrollable and compulsive use of a particular substance or as the uncontrollable and compulsive indulgence in a particular act despite adverse consequences (Wikipedia, 2018). Addiction varies from person to person. The individual’s biology, age, social environment and stage of growth affects how likely the person becomes addicted to a particular drug. Also, a strong genetic link to addiction can affect an individual also.

Many individuals who develop substance use disorder (SUD) according to the National Institute on Drug Abuse (NIDA) are also diagnosed with mental disorders, and vice versa. Findings showed that about half of those who experienced a mental illness during their lives also had experience in substance use disorder (addiction). This is due to the fact that these individuals self-medicate the mental health symptoms that they find disruptive or uncomfortable by using alcohol and drugs. Unfortunately, drugs and alcohol often do little to address the underlying mental health symptoms and ultimately create a whole new batch of problems for the patient while also increasing the severity of the original mental health symptom or symptoms.

The figure below shows that more than half of patients with an addiction problem also have a mental disorder and vice versa, leading to co-occurring disorders.

Fig. 1.1: a pictorial chart of Drug Addiction and Mental illness relationship (source:kaksoisdiagnoosi.blogspot.com)

From the above chart, we can infer that over 50% of individuals who are addicted to any substance are mentally ill, as well as a cross-relation between mental illness and addiction.

In conclusion, there is clearly a connection between mental disorders and substance abuse, and any number of combinations can develop, each with its own set of unique causes and symptoms, as well as its own appropriate intervention and dual diagnosis treatment method.

HOW TO RECOVER FROM CO-OCCURRING DISORDER

A Co-occurring disorder treatment should have all the resources an individual need to build a foundation of recovery for both substance abuse disorder and co-occurring mental health disorder. The mental health disorder being the disorder which involves an alteration in mood, the pattern of thinking or behaviors of an individual is as detrimental to the health of that individual as a co-occurring disorder which involves the struggle of an individual with abuse of a particular substance.

People struggling with co-occurring disorders often find themselves between a rock and hard place when seeking treatment for substance addiction. This is due to the fact that if they stop using the substance, the symptoms of their mental health disorder will return or worsen, and if they do not stop, their addiction will continue to worsen the symptoms of their mental health issues. For these reasons, it is imperative that these individuals with co-occurring disorder receive recovery treatments that simultaneously address their mental health and addiction issues.

Fig. 1.1: Steps to be taken for co-occurring recovery(source:slideplayer.com)

The above shows the steps required for a co-occurring disorder recovery. For an individual to recover from a co-occurring disorder,

First, he has to work towards a program of recovery. The individual has to prepare a program for recovery. This can be done by consulting rehab and detox centers, as well as psychological professional health personnel.

Secondly, the abuse of the substance in question needs to be reduced and abstained from. Although this step may not be achievable within a short period of time, the willingness and persistence employed in the recovery process will make it achievable.

Thirdly, upon abstinence and reduced substance abuse, the individual experiences improved clearing of brain processes and thinking, as the effect of the substance on the brain is being neutralized by the preceding actions.

Fourthly, the individual experiences decreased health problems as the brain and the body heals. This is a product of recovery steps undertaken by the individual, as the brain and body begin to experience healing.

Fifthly, there is a reduction in Reduction in frequency, length, and intensity of mood swings, as opposed to the frequent mood swings experienced during the co-occurring disorder.

Six, the immune system is strengthened as well as prevention of future illnesses is achievable, as the immune system of the individual’s body is being boosted due to the recovery.

Seven, improved mental and emotional stability and

Eight, connection with spirituality and hope for recovery.

In summary, these steps on how to recover from the co-occurring disorder are to be employed by individuals who seek recovery from the co-occurring disorder.

 

WHAT IS A BIPOLAR DISORDER?

A bipolar disorder is also known as manic depression. It is a serious mental illness that can lead to risky behavior, damaged relationships and careers, and even suicidal tendencies if it’s not treated. It is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks, associated with episodes of mood swings ranging from depressive lows to manic highs.

Fig. 1.1: Facial representation of bipolar moods (source: www.ipredator.co)

There are various types of bipolar disorder, depending on the moods range from periods of extremely “up,” elated, and energized behavior (known as manic episodes) to very sad, “down,” or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes. Types of the Bipolar disorder includes;

1. Bipolar I disorder which involves periods of severe mood episodes from mania to depression.
2. Bipolar II disorder which is a milder form of mood elevation, involving milder episodes of hypomania that alternate with periods of severe depression.
3. Cyclothymic disorder describes brief periods of hypomanic symptoms alternating with brief periods of depressive symptoms that are not as extensive or as long-lasting as seen in full hypomanic episodes or full depressive episodes.
4. “Mixed features” refers to the occurrence of simultaneous symptoms of opposite mood polarities during manic, hypomanic or depressive episodes. It’s marked by high energy, sleeplessness, and racing thoughts. At the same time, the person may feel hopeless, despairing, irritable, and suicidal.
5. Rapid-cycling is a term that describes having four or more mood episodes within a 12-month period. Episodes must last for some minimum number of days in order to be considered distinct episodes.

According to Markus MacGill (2018), Some symptoms of bipolar disorder are the same in men and women, while others are more gender-specific. Symptoms that are common in both men and women include:

1. High or irritated mood
2. More energy and greater goal-driven activity
3. Elevated self-esteem or grandiosity
4. Reduced sleep
5. Higher than usual frequency of talking
6. Rapid speech flow and flights of ideas or racing thoughts
7. Being easily distracted
8. Regular impulses for pleasurable experiences, such as shopping or sex, without understanding the consequences.

Other symptoms of depression include feeling guilty without good reason and concentration difficulties. Some people experience sleeping problems or wake up unusually early. Research has suggested that women with bipolar disorder are more likely to have mainly depressive episodes. Men are more likely to experience a “mixed state” with depression and mania both occurring.

This disorder needs special medications which may be combined with psychotherapies for effectiveness. Medications generally used to treat bipolar disorder include:

1. Mood stabilizers
2. Atypical antipsychotics
3. Antidepressants

While some psychotherapy treatments used to treat bipolar disorder include:

1. Cognitive behavioral therapy (CBT)
2. Family-focused therapy
3. Interpersonal and social rhythm therapy
4. Psychoeducation.

In conclusion, a bipolar disorder which is a disorder characterized by a change of mood cannot be easily spotted, which makes it a severe illness. Although discovering the symptoms and speaking to a specialist as well as the necessary diagnosis can be employed in detecting this disorder. When treatment is done with a combination of medication and psychotherapy (also called “talk therapy”), effective recovery can be obtained.