Using Integrated Treatment for Co-Occurring Disorders

Co-occurring disorders are a common problem in psychiatric circles – up to 45 percent of people diagnosed with a psychiatric condition have at least one co-morbid condition, with substance use disorder being by far the most common second condition, especially for anxiety disorders, depression, bipolar disorder, psychotic disorders, borderline personality disorder, and antisocial personality disorder. Treating these disorders requires different considerations than a single disorder, such as using integrated treatment for co-occurring disorders.

In simple terms, if you address a person’s depression but they remain addicted, they are less likely to succeed in making long-term progress with their self-doubt and depressive symptoms because their second condition remains a powerful contributor to the first. Cutting into that cycle by addressing both (or all) concurrent conditions is paramount yet difficult. That is what defines integrated treatment.

What is Integrated Treatment?

Integrated treatment refers to an individually prepared treatment plan that involves:

• A holistic view of the client’s health and history
• An interdisciplinary look at their diagnoses and symptoms
• A treatment plan that may involve, among others:
  • Social workers
  • Psychotherapists
  • Student counselors
  • Psychiatrists
  • Physicians
  • Case managers
• Day-to-day treatment by multiple experts involving multiple concurrent approaches, i.e., integrating therapy and medication into experiential treatments, solo and group therapy, family support, community outreach, etc.

In some cases, integrated treatment involves a biopsychosocial approach, which means it takes into consideration a client’s contributing biological factors, psychological factors, and social factors. “Holistic” and “interdisciplinary” are important terms in integrated treatment, referring to a top-down overview of a patient’s medical care and personal history, and involving the experience of multiple medical and social experts in the treatment process.

As an example, a client with a long-term history of severe depression, suicidal ideation, and substance use disorder may be referred to an inpatient residential treatment program for integrated treatment, where they will go through the early stages of a detox program and rehab plan while supported by a trusted and experienced therapist and integrated into group therapy sessions when the time is right.

Every individual treatment plan is paced as per the client’s own unique circumstances, and consideration, meaning things don’t move at a strict schedule. For patients who respond better to outpatient care or don’t need residential treatment, their outpatient plan may differ from that of a peer with a similar history but different circumstances.

What is a Co-Occurring Disorder?

A co-occurring disorder is any set of psychiatric conditions diagnosed together, but it generally refers to a mental health condition diagnosed alongside an addiction or a substance use disorder. Examples include anxiety and substance abuse or depression and substance abuse. 36 to 40 percent of people diagnosed with a psychiatric condition have a substance use disorder (SUD) and usually have a higher severity of substance use than people diagnosed with only a SUD.

The rates are even higher among teens – in adolescent clinical groups diagnosed with a psychiatric condition, more than 60 percent are diagnosed with co-morbid substance use and an additional non-SUD condition, with more than 50 percent having a conduct disorder and 15 percent having either depression or ADHD. Co-occurring disorders are sometimes also referred to as a dual diagnosis.

In all cases, treatment options must be carefully considered – one condition can’t be effectively treated without treating the other.

Why Are Co-Occurring Disorders Common?

Psychiatric conditions like depression and anxiety feed off of and contribute to the development of substance use disorder. The two are deeply intertwined, even more so than the way some conditions are heavily related to others, like schizotypal personality disorder and schizophrenia, or major depressive disorder and generalized anxiety.

This synergistic effect is heavily studied and can be traced back to the way substance use interferes with and affects the brain, which has a compounding effect on the development of other behavioral and psychological conditions. An effective treatment plan that tackles both problems has a similar synergistic effect – treating a client’s depression can help in the treatment of their substance use and vice versa.  

Most substance use disorders involve drugs that primarily affect the brain’s relationship with specific neurotransmitters, especially dopamine and serotonin. The manipulation of the effectiveness and abundance of these neurotransmitters in the brain leads to a knock-on effect on genetic predisposition, or pre-existing mental health conditions that may also have contributed to the development of a substance use disorder (through self-medication or maladaptive coping mechanisms, for example, e.g., drinking away depression).

Trying to treat one without the other produces a mental backlash that makes treating either more difficult. For example, withdrawal symptoms can heavily exacerbate feelings of depression and anxiety, and losing a powerful stress management mechanism through substance use can cause stressors to compound in a person who isn’t equipped to deal with them.

The ways in which both addiction and other non-SUD psychiatric conditions compound in the brain makes treating them together more important than any other pairing of two mental health conditions.

Seeking Integrated Treatment for Co-Occurring Disorders

Not all integrated treatment for co-occurring disorders involves rehab or residential treatment. Outpatient clinics or partial hospitalization can help individuals with substance use problems seek the help of multiple professionals at the same time to determine a treatment plan that tackles their conditions.

The process for starting integrated treatment may involve a thorough psychiatric evaluation and diagnosis of potential concurrent health issues, both mental and physical, before determining a treatment plan that may involve one-on-one psychotherapy (cognitive behavioral therapy or dialectical behavior therapy), vocational and coping skills training, experiential treatment, group therapy, and medication.

In the long-term, these inpatient and outpatient treatment plans are meant to be a stepping stone towards the development of anti-relapse measures, community or family support structures, stress management skills, and healthy coping mechanisms. Clients are encouraged to continue to seek care by regularly visiting a therapist or a group therapy setting and may need to continue taking medication to manage their symptoms.

In many cases, treatment facilities that focus on integrated treatment make a point of guiding their clients through the transition period into everyday living, prioritizing coping skills they can use to manage their daily stressors and help them keep relapses at bay.

Finding Treatment for Co-Occurring Disorders in Malibu

If you or someone you know has a co-occurring disorder, speak with us at Amend Treatment. Our professional team is here for you every step of the way.

For more information, send us a message or give us a call.