The Unique Challenge in Treating Co-Occurring Disorders

What is a Co-Occurring Disorder?

Co-occurring disorders are multiple disorders that are known to occur in the same individual at the same time. There are many different diagnostic categories and diagnoses that can lead to someone dealing with symptoms of multiple disorders simultaneously.

We often see a combination of eating disorders, mood disorder diagnoses, often with a substance abuse diagnoses, whether it’s benzodiazepine, alcohol or possibly cannabis use or more. Additionally, we see anxiety disorder diagnoses as well as people who have a history of anorexia, major depression, and panic disorder.

How Common is it that People Have More Co-Occurring Disorders?

Statistically, you’ll find ranges between 25%, maybe 35% of Co-occurring disorders nationally. We often work with individuals who have more than one problem that they struggle with. They may come in with a primary diagnosis but have other issues that were not identified throughout their treatment. Those other pieces come to light as we treat the whole person holistically.

How Come Co-occurring Disorders Diagnoses Get Missed?

Frequently, addiction specialists end up addressing the only symptom that the person presents with and that leaves a lot of other things unexplored.

We have had many people who have been in treatment elsewhere for perhaps an eating disorder and during the eating disorder treatment, substance dependency flares up, and they are not equipped to deal with that.

The Role of Trauma

The common thread to a lot of co-occurring diagnoses is trauma. In our experience, people who have experienced trauma are often being treated for one diagnosis. And it turns out that they meet criteria for multiples.

We see people who have very substantial trauma, often childhood and often multiple wounds even into adulthood. It can be early childhood sexual abuse or physical abuse or harm and neglect. As you move into adolescence, we see domestic violence and relationships with sexual assault. For some people, it is their parent’s divorce or a significant move or a nonfatal car accident. It all depends on how the person that’s seeking help has received that event that makes all the difference.

The Role of Grief

Grief in and of itself can develop into a major depression if it isn’t resolved within a reasonable amount of time. If a loss was part of a traumatic situation, such as during mass shootings, domestic violence, and other tragic events where there was not only the loss of a friend or family member, but the environment in which it occurred was traumatic.

Sometimes just caring for a dying loved one ultimately turns into trauma. Sitting and watching someone pass, over a period of months while putting your own emotional needs on the back burner can lead to problems because after they die, the survivors panic and develop symptoms of depression and anxiety among other things.

An all too common narrative is that those suffering from trauma and grief can resort to substance use to try to manage those feelings.

Being Prepared to Anticipate Co-occurring Disorders

As mental health professionals caring for these individuals, we understand that it starts with being prepared to deal with and manage the different set of symptoms. Because we understand the common thread of trauma, we anticipate that someone who has substance abuse and trauma and depression is likely to deal with anxiety.

We are evaluating for disordered eating for instance, and so we can manage an individual who has an eating disorder that’s pretty severe, who engages in self-harm and deals with suicide in relation to the depression and anxiety. In addition, we then deal with any history with substances and how that plays into their symptoms.

What happens is that you get one segment of symptoms in control, meaning we are successfully addressing substance abuse stuff; they are not using, and their cravings are down, but suddenly the eating disorder behaviors will rise.

In our practice, we are prepared to anticipate that, manage all of these symptoms in the same setting and then perhaps work with them primarily one on one so if we can determine if the level of monitoring needs to ramp up or down.

The Importance of a Non-Linear Approach

Another important consideration in treating people with Co-occurring disorders is to guard against expecting linear change. Individuals can come in and stop not using substances, but then we see the eating disorder come up! Then when the eating issues stabilize, we see self-harm or mood dysregulation… almost like a whack-a-mole effect.

It is important that the client not feel as if you are looking at their healing linearly or looking to treat one set of symptoms at a time. You want to avoid having them feel as if they’re always falling backwards on one or more aspects of their recovery.

Daring to Go Back to the Source

One of the keys to facilitating this kind of healing is in following the symptoms back to their source or ideology. Someone who experiences anxiety or depression or nightmares can benefit from tracing those symptoms back and seeing connections between the past and the present. This approach brings diagnostic clarity and can reveal what is most important to address and treat. Understanding how symptoms trace back helps to build an effective plan of care. It can be painful initially, but it is what promotes long term healing.

The Value of Providing Tolerance

Another critical component in addressing Co-occurring disorders is the concept of tolerance. Having the ability to tolerate the client’s process and stay a positive presence for a wide range and variability of symptoms, creates an environment that is safe and fertile enough to bring change.

Holding Hope Makes the Difference

There is no “one size fits” all way of dealing with these issues. You have to look at the person as a unique individual with a unique set of circumstances and then build a treatment around that with what’s showing up in the moment, not with a pre-prescribed plan.

We believe that you have to be the ones to hold the hope that things will be different because usually when we’re dealing with individuals who are struggling with Co-occurring disorders, they often have had a variety of treatments, and some of those have not been successful or helpful. Being the place where we hold onto the hope for them when they are struggling is essential.
To hold that vision of hope in healing, you must work to keep yourself grounded. When a person comes in with all of these symptoms, it can feel terrifying and overwhelming. We have to be responsible for doing that work on our own because we have to be there to help guide them if things get scary and a little worse before they get better.

We see more and more movement in the direction of treating people more holistically, which helps to hold on to hope. When we’re addressing the whole person and not just one set of symptoms, it is easier to tackle. All of these behaviors are rooted on some level, in trying to survive and to function. It helps when you have a belief that people are doing the best they can. Our role is to convey that there are ways to make the process less painful for them over the long term.

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