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Co-occurring disorders (CODs), also known as dual diagnoses, are mental disorders that coexist with at least one substance use disorder (SUD) and can manifest as mood, anxiety, personality or psychotic disorders. Almost eight million adults in the U.S. had a COD in the year 2014, according to the 2014 National Survey on Drug Use and Health published by the Substance Abuse and Mental Health Services Administration. Within this demographic, substance abuse tends to be characterized by greater severity of addiction, including greater functional impairment and self-destructive behavior, according to research.
Similarly, the “comorbidity,” or frequent co-occurrence of these two conditions (CODs and SUDs), can pose a complication in treating affected individuals. For those with a drug or alcohol problem and another underlying disorder, integrated treatment that concurrently addresses the physical, mental and psychological symptoms of both disorders is considered the gold standard of addiction treatment, and is associated with better recovery outcomes.
Are certain CODs more commonly associated with drug or alcohol addiction? The answer is “yes.” In the words of the director of the National Institute on Drug Abuse, Dr. Nora Volkow, M.D., in a research report titled “Comorbidity: Addiction and Other Mental Illnesses,” “While we cannot always prove a connection or causality, we do know that certain mental disorders are established risk factors for subsequent drug abuse—and vice versa.” This article thus familiarizes readers with common CODs that often accompany drug or alcohol addiction.
Mood disorders are “the most common psychiatric comorbidities among people with SUDs,” according to the research. There is also a “high prevalence of substance abuse in those with mood disorders,” according to previous studies conducted in this area across more than two decades.
Mood disorders are a mental health category that encompasses all bipolar disorders and types of depression. When defined by their general contours, both bipolar disorder and depression are brain disorders that cause changes in mood, energy and a person’s ability to function.
There are numerous types of both bipolar disorder and depression, as enumerated by the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standard classification of mental disorders used by mental health professionals in the U.S. (For more on the various types of bipolar disorder and their symptoms, this short info guide from the Depression and Bipolar Support Alliance is helpful. For more on the different types of depression, the National Institute on Mental Health has compiled this introduction.)
Within the category of mood disorders, people with bipolar disorder evidence the greatest susceptibility to substance abuse:
- Approximately 60 percent of patients with bipolar disorder have a lifetime diagnosis of a SUD, according to a study in Current Psychiatry.
- Rates of lifetime substance abuse were high for both alcohol (48.5 percent) and drugs (43.9 percent) among patients hospitalized for a manic or mixed bipolar episode, according to another article.
- In the previous edition of the DSM-5 (DSM-IV) bipolar disorder had higher rates of comorbid SUDs than any other COD.
- “Substance abuse is present in most patients with bipolar disorder,” potentially on the basis of “increased impulsivity,” according to another study.
Anxiety disorders also commonly co-occur with SUDs, according to the research. In fact, among people with SUDs, they appear to be the next most common COD after mood disorders, according to the NIDA research report cited earlier.
Like mood disorders, anxiety disorders can take many forms, according to their classification by the DSM-5. Fear (defined as an emotional response to a real or perceived imminent threat) and anxiety (defined as anticipation of a future threat) are typically the two big general characteristics of anxiety disorders. Panic attacks, for example, are a manifestation of a fear response, whereas avoidance behaviors, heightened vigilance and muscle tension embody an anxiety response.
Specific anxiety disorders are reportedly more likely to be risk factors for substance abuse. People with generalized anxiety disorder or panic disorder are more likely to self-medicate with drugs or alcohol. Similarly, people with symptoms of social anxiety are more likely to drink.
And anxiety disorders are especially prevalent among people with alcoholism. This link has been thoroughly studied. Research suggests that people drink in order to cope with social fears and with stress, for example—hence the formation of the “tension reduction hypothesis,” which reportedly attributes higher rates of alcohol abuse in people with social anxiety disorder to the same dynamic.
When left untreated during childhood, Attention Deficit Hyperactivity Disorder is an established risk factor for substance abuse, according to numerous studies. The disorder is very common among children, reportedly occurring in an estimated 8.4 percent of children between the ages of 3 and 17, according to a 2011 U.S. national health survey.
ADHD is characterized by inattention, hyperactivity and impulsivity. For example, children with ADHD are often:
- Easily distracted
- Fidgeting, squirming or running about
- Quick to grow bored with a task
- Interrupting or intruding on others’ activities
- Making careless mistakes on homework
Just how common is ADHD among the SUD treatment population? One study found nearly one in four adult patients at an addiction treatment facility had ADHD. The same study reported the estimate that 15-25 percent of adults with a lifetime history of substance abuse may have ADHD.