Many people who have mental health diagnoses also have substance use disorders and vice versa. This is sometimes referred to as co-occurring disorders or having a dual diagnosis. At Cottonwood, in Tucson, Arizona, we have an internationally respected co-occurring disorders program.

The Chicken or the Egg?

Substance misuse is twice as common among adults with mental illness. This is often attributed to people with mental health disorders attempting to self-medicate their symptoms. Sometimes, this fact is used to argue that mental illness causes addiction. Unfortunately, alcohol and other drugs can also make mental health symptoms worse and lead to a person developing symptoms of mental illness that they did not previously display. This might seem to indicate that substance use causes mental illness, but saying one causes the other may be an oversimplification of a much more complex issue that we are still learning more about each day. It seems more likely that one can contribute to the other, but not be the sole cause of it.  

Shared Underlying Causes

If you have ever compared a list of things that contribute to mental illness against a list of things that contribute to substance use disorders, you may have noticed that the two lists overlap a lot:

• Inherited traits – People with mental illness tend to have family members with mental illness. People with substance use disorders tend to be related to people with substance use disorders.
• Environmental exposures – Maternal stress and substance use, and exposure to toxins have both been linked to mental illness and addiction. Trauma, particularly during childhood, has also been linked to a number of adverse outcomes later in life.
• Brain differences – Scientists have noted a difference in how brains are built and function in people with addictions and mental illness, versus the rest of the population. Brains that are prone to addiction and mental illness are also more likely to have lower than optimal levels of specific chemicals.

Diagnosis is More Complicated in Dual-Diagnosis Situations

Because the symptoms of mental illness and addiction can be similar, it can be tricky for clinicians to apply an accurate label. A thorough medical and psychiatric assessment, as well as a detailed physical examination, are important steps in this process.

Mental Disorders Commonly Found in People With Substance Use Disorders

Any mental illness can be part of a dual diagnosis, but there are some that are more commonly found alongside addictions:

• Anxiety and mood disorders
• Schizophrenia
• Bipolar disorder
• Major depression
• Conduct disorders
• Post-traumatic stress disorder (PTSD)
• Attention Deficit Hyperactivity Disorder (ADHD)

Substance Use Disorders Commonly Found in People with Mental Illness

Just as some mental disorders are seen more often in people with addiction, some drugs are more often misused among people with mental health disorders:

• Alcohol
• Tobacco
• Opioids
• Stimulants
• Marijuana
• Hallucinogens
• Prescription medications

Treatment Options

In the past, there was a common belief that patients needed to be treated for whichever problem was creating bigger issues and then get help for the second issue later. Today we recognize that when addiction and mental illness exist within the same person, they can each make the other worse, so it makes the most sense to treat them both simultaneously. Mental health disorders and addiction can benefit from similar treatments, so combining these treatments makes a lot of sense in many ways:

• Psychotherapy
  • Cognitive behavioral therapy (CBT)
  • Dialectical behavior therapy (DBT)
  • Assertive community treatment (ACT)
  • Therapeutic communities (TC)
  • Contingency management (CM)
• Medication
• Supportive housing
• Strong social supports like family and friends who understand their struggles, show compassion, and are ready to learn as much as possible about mental disorders and addiction 
• Support groups with other members sharing similar problems
• Nutritional education and support
• Exercise

How Treatment Helps

We offer a variety of support in our residential and outpatient treatment options. As they progress in their recovery journey, we hope that our patients will obtain:

• Increased understanding of their diagnoses
• Stronger life skills
• Strategies to recognize red flags for relapse 
• Enhanced communication skills
• Better relationship skills
• Improved anger management skills
• A stronger support system that has a better understanding of the patient’s struggles

At Cottonwood, we believe in holistic, individualized treatment for all of our patients, in a trauma-informed setting. Whether they are navigating a mental health diagnosis, recovering from a substance use disorder, or struggling with an eating disorder, or some combination of these, we create a tailored treatment strategy for everyone we serve.