Co-Occurring Disorders: Diagnosis

By: JoAnn Kukulus, M.S. Clinical Psychology
BBS Registered Intern at Adolescent Counseling Services

Increasingly at Adolescent Counseling Services, we are encountering clients who are struggling with both alcohol or substance use/abuse and mental health issues such as depression, anxiety, bi-polar disorder, and the effects of trauma (PTSD). The intersection of these conditions is rapidly gaining recognition in the treatment field and is called co-occurring disorder or dual diagnosis. For an individual with a dual diagnosis, both the mental health issue and the alcohol or substance use/abuse issue present unique symptoms that interfere with one’s ability to function, handle life’s challenges, and relate to others; the co-occurring disorders often interact and affect each other, as well. Mental health issues left untreated frequently exacerbate alcohol or substance use/abuse, and continued or increased alcohol or substance use/abuse usually results in deteriorating mental health.

Although mental health issues and alcohol or substance use/abuse issues are closely linked and often occur together, one does not directly cause the other.

Alcohol and/or substance use is often an attempt to self-medicate or cope with the symptoms of a mental health issue. Unfortunately, alcohol or substance use causes problematic side effects and in the long run worsens the symptoms it was meant to alleviate.

Alcohol and/or substance abuse can increase an underlying risk for mental health issues. Mental health disorders develop within a complex interplay of genetics, the environment, and other outside factors. For an individual at risk for mental health issues, alcohol and/or substance abuse may expose that risk.

Alcohol and/or substance abuse can exacerbate the symptoms of a mental health issue. Use/abuse of alcohol and/or substances can dramatically escalate the symptoms of a mental health issue, or even trigger new symptoms. Alcohol and substance abuse also interact with medications such as antidepressants, anti-anxiety medication, and mood stabilizers, making them less effective.

With mental health issues and alcohol and/or substance abuse so closely linked it can be difficult to distinguish the primary issue. This may take time and patience, and it will be helpful to remember that the impact of these issues on one’s life will decrease with recognition and treatment

Consider family history. There is a greater probability of developing mental health or alcohol/substance-related issues if other family members also struggle with these.

Consider sensitivity to alcohol or substances. Take note of the relationship between your alcohol/substance use and your mental health.

Look at symptoms when you’re sober. While some depression or anxiety is usual after you’ve stopped using alcohol or substances, if the symptoms persist with extended sobriety, there may be a mental health issue.

Review your treatment history. Has there been separate treatment for a mental health issue or a substance abuse issue? Was treatment for an alcohol and/or substance abuse issue unsuccessful because the mental health issue was not addressed, or vice versa?

Stay Tuned for Part II of this blog: Co-Occuring Disorders: Treatment

The Adolescent Substance Abuse Treatment (ASAT) program at Adolescent Counseling Services addresses both alcohol/substance abuse and mental health issues, includes clients in the decision-making process and expects clients to be actively involved in setting goals and developing strategies for change, provides basic education about the areas of concern and their related issues, and focuses treatment on learning healthy coping skills and strategies to eliminate substance use, manage emotions, and strengthen relationships. The ASAT team of clinicians holds a deep understanding that continued recovery depends on achieving and maintaining mental wellness, learning and practicing healthy coping skills, and making positive and appropriate decisions when confronted with life challenges.