Drug Use And Co-occurring Disorders: How Are They Linked?

Last Updated: January 15, 2021

Authored by Roger Weiss, MD

Not to be mistaken with COD, dual diagnosis is a case where the patient is going through two conditions simultaneously. These two diagnoses do not have to be tied to a substance abuse problem or addiction. A person that is suffering from diabetes and heart disease at the same time is an example of this.

Mental Co-occurring Disorders

Approximately 7.9 million American adults had co-occurring disorders in 2014. The American Psychological Association (APA) says more than 8.9 million people have COD.

Addiction itself is a mental illness. As a result, it can lead to several other psychiatric problems. They range from mood disorders such as anxiety and depression to severe mental health problems, including psychosis. Drugs can alter the chemistry of the brain. Some of them cause excitation, while some cause inhibition of brain activity. Over a prolonged period, drug abuse and polysubstance use can cause permanent changes in brain chemistry. The type of mental illness an individual may suffer after chronic drug use depends on the specific brain chemical. Furthermore, they also depend on the brain area affected.

Male Patient With Co-Occurring disorder In A Clinic.

Addiction can bring about mental illness in people who are prone to mental illness, environmentally or genetically. Some examples of mental disorders that are directly caused by substance abuse and addiction are:

  • Hallucinogen persisting perceptual disorder
  • Substance-induced persisting amnestic disorder
  • Substance-induced delirium
  • Persisting dementia
  • Substance-induced sexual dysfunction
  • Substance-induced sleep disorder
  • Psychosis

Other mental illnesses that may occur concurrently (but not necessarily as a result of) with substance abuse include:

  • Depression
  • Anxiety Disorders
  • Schizophrenia
  • Antisocial Personality Disorder (APD)
  • Wernicke-Korsakoff syndrome

Symptoms of Co-Occurring Disorders

The most common symptoms of mental co-occurring disorders can be classified into physical and mental categories.

For the Physical Category, these Symptoms May be Present:

  • Nausea
  • Vomiting
  • Hyperactivity
  • Sweaty palms
  • Shaky hands
  • Decreased appetite
  • Irregular heartbeat

Mental symptoms of mental COD may include:

  • Euphoria
  • Depression
  • Sleep deprivation
  • Personality changes
  • Moodiness
  • Paranoia
  • Forgetfulness
  • Social withdrawal
  • Fear and anxiety
  • Anger-related issues
  • Suicidal thoughts
  • Delusions/Hallucinations

Co-occurring Physical Comorbidities

Physical co-occurring disorders fall under a vast spectrum of diseases and infections that can be further categorized into smaller units, such as:

  • Gastrointestinal
  • Cardiovascular
  • Hematologic
  • Neurologic System
  • Infectious
  • Pulmonary (Other Than Infectious)
  • Other Conditions

Gastrointestinal Disorders

These are common with cocaine users, and examples include appendicitis, ruptured spleen, abscess of the pancreas/liver, obstructed bowel, perforated peptic ulcer, ischemic bowel disease, etc.

Cardiovascular Disorders

Ischemic heart disease, cardiomyopathy, hypertension, arrhythmias are examples of this, and the most likely substance-related causes are alcohol and cocaine use.

Asian woman having heart attack.

Neurologic System

People that use heroin and alcohol have the highest risk of suffering this. Examples include Wernicke-Korsakoff’s Syndrome, alcohol and sedative withdrawal seizures, cerebrovascular accidents, Hepatic encephalopathy, and polyneuropathy.

Infectious Diseases

At least 76 percent of patients who have used injection drugs for under 7 years have hepatitis C, while 25% of patients with alcohol-related disorders and those who do not inject drugs show serologic evidence of infection. Other infections that have ties to substance abuse include HIV, Bacterial Pneumonia, Tuberculosis, and sexually transmitted diseases.

Pulmonary Disorders (Other Than Infectious)

Asthma, Chronic obstructive pulmonary disease, and aspiration pneumonia are examples. Common with patients that abuse substances that contain nicotine.

Other Conditions

Cancer, Diabetes, Acute Trauma/Fractures are examples of other possible co-occurring physical conditions.

What are Treatment Approaches for Drug Use and COD?

Treating COD is essentially a tougher task for healthcare professionals. This is due to the complexity of the condition. Therefore, an optimum treatment program should address both conditions at the same time.

On that note, studies have shown that a person is more likely to seek or be willing to accept treatment for a co-occurring disorder than for substance abuse alone.

Typically, treatment cannot be recommended or started without an appropriate diagnosis – as should be expected. The process of diagnosis for co-occurring disorders is called “Screening.” This screening process determines if some signs and symptoms seal the existence (or otherwise) of COD in a person.

The Screening Procedure Usually Helps the Healthcare Provider to Determine Some Important Information, Such As:

  • The patient’s safety and self-control. This will include the possibility of suicidal tendencies, aggression, or violence towards others and the ability of the person to provide self-care
  • Details of previous diagnosis, hospitalization, or treatment for a previous mental disorder. During this stage, questions will be asked about any substance abuse instances while the person was dealing with these mental disorders (if applicable). It will help to determine if COD is a result of substance abuse or independent.
  • Trauma history. Examples are previous instances of sexual, physical, or emotional abuse; PTSD resulting from horrific experiences such as the death of a loved one, a war, or similar situations. While asking questions related to this, the healthcare provider must be careful to keep the session short to avoid these events’ deep memories.
  • The current co-occurring disorder symptomatology of a person, based on DSM-IV-TR criteria. This will include questions about any psychotropic medications prescribed in the past or being used.
  • History of mental disorder-related symptoms and any related diagnosis, treatment, and hospitalizations for these.
  • Any indications of some sort of cognitive impairment in patients. The presence of this will require a mental status examination to be carried out.

The screening results will be either negative or positive and will determine the next course of action. In a situation where the result is positive, it is still necessary for a qualified and licensed mental health clinician (such as a psychologist, psychiatrist, or clinical social worker) to confirm the diagnosis before the actual treatment is allowed to begin.

On that note, it is difficult to treat a co-occurring disorder with a singular approach. While the patient is receiving treatment for the mental disorder, the treatment also has to be done for the substance abuse disorder. Hence, while psychotherapy is a crucial part of the rehabilitation process, a combination of various therapeutic techniques prove to be the most efficient treatment approach.

Further research also suggests that skill-building, cultural sensitivity, illness management, and support to patients for the pursuit of practical goals are effective in the treatment of co-occurring disorders.

Find Treatment Today

Drug use and COD are more complicated and require extra efforts to control and cure. Co-occurring disorders are more common than previously thought. Hence, one needs to follow the proper diagnosis and treatment guidelines. Integral treatments for drug use and co-occurring disorders include a combination of behavioral therapy, medications, and support groups. They recognize increasing age, poor financial condition, and living in cities as risk factors for drug use and COD.

If any questions or queries about drug use and co-occurring disorders are left, talk to the experts to get accurate information. For more on drug abuse, addiction, available treatments, and additional suggestions, call our helpline.

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Page Sources

  1. National Center for Biotechnology Information. Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. 2005. https://www.ncbi.nlm.nih.gov/books/NBK64163/
  2. National Center for Biotechnology Information. 5 Co-Occurring Medical and Psychiatric Conditions. 2006. https://www.ncbi.nlm.nih.gov/books/NBK64105/
  3. Pamela L. Owens, Ph.D., Kevin C. Heslin, Ph.D., Kathryn R. Fingar, Ph.D., M.P.H., and Audrey J. Weiss, Ph.D. Co-occurrence of Physical Health Conditions and Mental Health and Substance Use Conditions Among Adult Inpatient Stays, 2010 Versus 2014. 2018. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb240-Co-occurring-Physical-Mental-Substance-Conditions-Hospital-Stays.jsp
  4. Narender Kumar. The relationship between physical & mental health: co-occurring mental & physical disorders. 2004. https://pubmed.ncbi.nlm.nih.gov/15591625/
  5. A. G. Crocker A. Prokić D. Morin A. Reyes. Intellectual disability and co‐occurring mental health and physical disorders in aggressive behavior. 2013. https://onlinelibrary.wiley.com/doi/abs/10.1111/jir.12080
  6. Erica N. Peters, Robert P. Schwartz, Shuai Wang, Kevin E. O'Grady, Carlos Blanco. Psychiatric, psychosocial, and physical health correlates of co-occurring cannabis use disorders and nicotine dependence. 2014. https://www.sciencedirect.com/science/article/abs/pii/S0376871613004146
  7. Katherine E. Watkins, M.D., M.S.H.S., Audrey Burnam, Ph.D., Fuan-Yue Kung, M.S., and Susan Paddock, Ph.D. A National Survey of Care for Persons With Co-occurring Mental and Substance Use Disorders. 2001. https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.52.8.1062
  8. Mel Pohl, Logan Smith, Chronic Pain and Addiction: Challenging Co-occurring Disorders. 2012. https://www.tandfonline.com/doi/abs/10.1080/02791072.2012.684621
  9. Youth.gov. Co-occurring Disorders. https://youth.gov/youth-topics/youth-mental-health/co-occurring
  10. Substance Abuse and Mental Health Services Administration. Mental Health and Substance Use Disorders. 2020. https://www.samhsa.gov/find-help/disorders

Published on: April 5th, 2017

Updated on: January 15th, 2021

About Author

Roger Weiss, MD

Dr. Roger Weiss is a practicing mental health specialist at the hospital. Dr. Weiss combines his clinical practice and medical writing career since 2009. Apart from these activities, Dr. Weiss also delivers lectures for youth, former addicts, and everyone interested in topics such as substance abuse and treatment.