Co-Occurring Disorder Treatment

The presence of a psychiatric disorder along with substance abuse — known as “co-occurring disorders” — poses unique challenges to a treatment team. Individuals diagnosed with depression, social phobia, post-traumatic stress disorder, bipolar disorder, borderline personality disorder, or other serious psychiatric conditions have a higher rate of substance abuse than the general population. In fact, the National Institutes of Health (NIH) estimates that substance abuse is twice as prevalent among people with a serious psychiatric disorder. The total number of American adults with co-occurring disorders is estimated at nearly 8.5 million, reports the NIH.

Why is substance abuse so common among people living with mental illness? There are several possible explanations:

• Imbalances in brain chemistry predispose certain individuals to both psychiatric disorders and substance abuse.
• Mental illness and substance abuse may run in the family, increasing the risk of acquiring both disorders through heredity.
• Drugs or alcohol may be used to self-medicate, or to manage symptoms if those symptoms aren’t properly treated,
• Drug or alcohol abuse may aggravate the symptoms of a psychiatric disorder or trigger the onset of a latent psychiatric illness.

Facilities in the ARS network offer specialized treatment for clients living with co-occurring disorders. We understand that these patients require an intensive, highly personal approach to care. That’s why we tailor each treatment plan for co-occurring disorders to the client’s diagnosis, medical history, psychological needs, and emotional condition.

Treatment for co-occurring disorders must begin with a complete neuropsychological evaluation to determine the client’s needs, identify their personal strengths, and find potential barriers to recovery. Using this information, the treatment team can develop a specialized plan of care that addresses the client’s substance abuse and mental illness concurrently.

Some clients may already be aware of having a psychiatric diagnosis when they are admitted to an ARS treatment facility. Others are receiving a diagnosis and effective mental health care for the first time. The National Alliance on Mental Illness reports that 60 percent of adults with a psychiatric disorder received no therapeutic help at all within the past 12 months. For these individuals, a treatment program for co-occurring disorders represents a new source of hope.

In order to treat both conditions successfully, a facility’s mental health and recovery services must be integrated. Unless both issues are addressed at the same time, the outcomes of treatment probably will not be positive. A client with a serious mental illness who is treated only for addiction is likely to either drop out of treatment early or to experience a relapse of either psychiatric symptoms or substance abuse.

At ARS, we make it a priority to treat co-occurring disorders within the same program, using the following methods:

• Intensive individual therapy with a psychiatrist or therapist to address the symptoms and challenges of the psychiatric disorder
• Behavioral modification therapies (cognitive behavioral therapy or dialectical behavior therapy) to teach coping skills and increase self-awareness
• Medication therapy to help manage psychiatric symptoms or to reduce the cravings for drugs or alcohol
• Group therapy with peers who are also faced with the challenges of a dual diagnosis
• Family education and counseling to help loved ones understand the scope, nature and outcomes of co-occurring disorders
• Introduction to 12-step principles to initiate the process of spiritual recovery
• Experiential and holistic therapies — meditation, yoga, creative therapies, and recreational therapies — to encourage self-expression

Therapists treating clients with co-occurring disorders must empower and encourage these individuals at all steps of the process. Mental illness can pose specific obstacles to treatment, such as low motivation, fear of sharing with others, difficulty with concentration, and emotional volatility. The treatment team must take a collaborative approach, working closely with the client to motivate and assist them through the steps of recovery.

While co-occurring disorders are common, integrated treatment programs are much more rare. According to Psychiatric News, up to 50 percent of psychiatric patients being treated for mental illness also have a substance use disorder, yet relatively few of them receive treatment for both disorders at the same time. Integrated treatment works most effectively in the following conditions:

• Therapeutic services for both mental illness and substance abuse are offered at the same facility
• Psychiatrists, physicians, and therapists are cross-trained in providing mental health services and substance abuse treatment
• The treatment team takes a positive attitude toward the use of psychiatric medication
• A full range of recovery services are provided to facilitate the transition from one level of care to the next

To produce the best outcomes from treatment, the treatment team must be trained and educated in both mental health care and recovery services. Our ARS team is led by psychiatrists and physicians who have experience and education in both of these important areas. Cross-trained therapists, nurses, holistic therapists, and nutritionists contribute their knowledge and experience to the treatment of co-occurring disorders.

Most importantly, in order to ensure consistency in treatment, the team must collaborate actively with each other and with the client’s personal physician or psychiatrist. Otherwise, there may be conflicts in therapeutic goals, prescribed medications, and other crucial aspects of the treatment plan. At ARS, we work hand in hand with referring health care providers to achieve true continuity of care for our clients.

Integrated programs for co-occurring disorders are provided at The Recovery Village. Together with Central Florida Detox, our medical detox center in Orlando, our facilities cover a full continuum of care, from detoxification to residential treatment, outpatient care, aftercare, and sober living programs. Our case managers and discharge planners help take care of our clients’ psychosocial needs, such as family responsibilities and financial obligations, so they can concentrate on recovery.

The expected course of treatment for co-occurring disorders begins with detoxification. Our medication-assisted, progressive approach to detox makes this process much smoother and more comfortable for our clients. Once the body is stronger and the mind is clear, our clients are ready to begin the deeper explorations of therapy. In residential treatment, they can focus completely on recovery activities while living in a stable, structured environment.

After finishing a residential program, patients may graduate to a less intensive level of care. Our continuum of services includes outpatient care, partial hospitalization programs, and transitional living or sober housing. In the advanced stages of recovery, clients can practice their new coping strategies in the safe, supportive environment of a sober living home. With access to therapists, groups, meetings, and classes, clients have a strong network of professional and personal support for as long as they need it.

The length of stay for a client with co-occurring disorders is based on the individual’s needs, goals and personal development. ARS facilities do not impose an arbitrary deadline on our substance abuse programs, especially in the case of clients with complicated psychiatric needs. These individuals often require more extensive treatment, so their symptoms and concerns can be fully addressed.

Recovery is a lifelong process of growth and self-discovery. At ARS, we continue to support our rehab graduates through alumni services, transitional accommodations, and sober activities. In particular, clients with co-occurring disorders may require ongoing therapeutic support. If you’re ready to reach out for help for yourself or someone else, our network of facilities is ready to welcome you into our continuum of care. Call the toll-free number at any of our treatment centers for information on our advanced, evidence-based programs.