Understanding Comorbidity
Co-occurring, comorbid and Dual diagnosis are relatively interchangeable terms that mean an individual has more than one mental health diagnosis or a mental health diagnosis and a substance disorder. When an individual has more than one mental health diagnosis, treatment is more complex and the prognosis is more guarded. Statistics very, but anywhere from 4-12% of the population qualify for a co-occurring disorder, with Bipolar Disorder and ADHD (Attention Deficit Hyperactivity Disorder) as the two diagnoses with the highest co-occurring overlap with other mental health or substance disorders at 80%.
Despite the negative impact co-occurring disorders can have, only 50% of individuals seek treatment. If the co-occurring diagnosis is substance use, individuals frequently only seek out treatment for either the mental health or the substance issue, but not both. This phenomenon seems to be reflective of not wanting to accept having multiple diagnoses, as well as lack of access to programs that offer both substance and mental health treatment.
Treating Co-occurring Disorders
The presence of multiple disorders can exacerbate symptoms and make treatment more challenging. However, with the appropriate interventions and support, significant improvements in quality of life are possible. The most important components of successful treatment of comorbid disorders include:
- Early intervention:
The sooner substance and/or mental health symptoms are recognized and receive treatment, the higher the likelihood of recovery. Because multiple mental health or substance disorders can have a correlational or causational relationship, treating early symptoms of one disorder can help prevent the development or severity of a co-occurring disorder. - Simultaneous treatment:
Research has shown that treating both (or more disorders) at the same time has the highest rate of success. Treating the diagnoses separately can cause the non-attended-to symptoms to become more severe and overwhelm any progress being made with the attended-to symptoms. - Combined interventions:
Medication management in conjunction with psychotherapy and group counseling have been shown to offer the highest rates of success in individuals with co-occurring disorders. As the symptomology is more complex, finding the correct combination of medication can take longer. Motivational interviewing (a strength-based approach), CBT (cognitive behavioral therapy) and DBT (dialectical behavioral therapy) are most often used when working with individuals with a dual diagnosis. - Integrative approach:
Having all members of the treatment team (i.e., the therapist, psychiatrist, primary care physician, etc.) communicating and working together improves the prognosis. Addiction/mental health issues need to be known to the MD just as medical concerns need to be known to the therapist/psychiatrist so that the treatment team is focused on the “whole person.” - Social support:
Having supportive and informed friends and family as part of the support team is also essential to helping someone with a dual diagnosis. Family and friends can offer motivational support and remind the individual that they are cared about, without crossing the line into enabling.
Supporting Someone with Co-occurring Disorders
Watching someone you care about struggle with mental health and/or substance abuse can take a toll on you personally and on the relationship. However, offering support is important in your loved one having success in their treatment goals. Below are ways to offer support.
- Focus on your own self-care:
“An empty bucket cannot put out a fire.” Helping a loved one with co-occurring disorders will be long commitment. Taking care of yourself, maintaining physical and emotional boundaries and avoiding enabling behaviors is essential to helping others. - Educate Yourself:
Learn about the specific disorders your loved one is facing. Understand their symptoms, triggers, and treatment options. This knowledge will help you provide informed support and empathy. - Encourage Professional Help:
Motivate your loved one to seek professional help from mental health providers, be it individual counseling, group counseling or a higher level of care such as an PHP (partial hospitalization program) or an IOP (intensive outpatient program). Offer assistance in finding suitable treatment options and accompany them to appointments, if needed. - Foster Open Communication:
Create a safe and non-judgmental space for your loved one to express their feelings. Encourage open conversations about their challenges and be an active listener. Roll with resistance and avoid escalation.
Finding a balance in offering support without losing yourself or enabling your loved one’s behaviors are key in helping them recover. Focus on the positive steps your loved one is taking, avoid having rigid expectations of what recovery should look like, and above all, make sure you remain focused on taking care of yourself.
