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Co-Occurring Disorders Co-Occurring Disorders: Substance Use Disorders and Mental Illnesses Co-Occurring Disorders Substance Use Disorders and Mental Illnesses A ADULTS 1919 University Ave. W., Suite 400 St. Paul, MN 55104 Phone: 651-645-2948 Toll Free: 1-888-626-4435 Fax: 651-645-7379 E-mail: [email protected] Web: www.namimn.org Phone: 1-651-645-2948 Toll Free: 1-888-NAMI-HELPS www.namimn.org NOTES NAMI Minnesota champions justice, dignity, and respect for all people affected by mental illnesses. Through education, support, and advocacy we strive to effect positive changes in the mental health system, and increase the public and professional understanding of mental illnesses. CO-OCCURRING DISORDERS Substance Use Disorders and Mental Illnesses INTRODUCTION 1 CO-OCCURRING SUBSTANCE USE DISORDERS AND MENTAL ILLNESSES 2 MOST COMMONLY MISUSED DRUGS 11 DIAGNOSING CO-OCCURRING DISORDERS 17 TREATMENT FOR CO-OCCURRING DISORDERS 22 TREATMENT PROVIDERS 45 FAMILY SUPPORT 47 RETURNING TO WORK AND SCHOOL 49 RELAPSE PREVENTION 55 INSURANCE AND TREATMENT COVERAGE 57 DIVERSE POPULATIONS AND CONSIDERATIONS 63 CRISIS PREVENTION 71 DATA PRIVACY AND DISCLOSURE 79 RESOURCES AND RECOMMENDED READING 82 INTRODUCTION Substance use disorders (SUD) negatively affect a person’s ability to work, go to school, and have good relationships with friends and family. While it impacts about 7.8 percent of the general population, (SAMSHA, 2018) it is even more common among people who have a mental illness. In fact, almost half of people living with a mental illness also have an addiction to drugs or alcohol. Among some groups, such as young people, the number of individuals with both a substance use disorder and mental illness is even higher. When someone is living with a substance use disorder and mental illness at the same time, these are called co-occurring disorders. Other terms include comorbidity and dual diagnosis. People experiencing co-occurring disorders have unique needs. Re- search and practice have shown that an “integrated” approach to care and treatment is best for individuals with co-occurring disorders. This means that the co-occurring disorders are treated at the same time instead of separately Unfortunately, fewer than 10 percent of adults with co-occurring disorders receive treatment for both conditions. Almost half receive no treatment at all for either condition (SAMHSA, 2018). Disparities due to discrimination and the lack of access to treatment contribute to higher rates of co-occurring disorders among diverse populations. Coping with mental illnesses by using substances is a common behavior, and careful culturally informed and responsive approaches to interventions should be taken (SAMHSA, TIP 59). Currently, there are limited resources available to help individuals and their families understand co-occurring disorders or learn about effective treatments. NAMI Minnesota often hears from families that they didn’t know the signs of substance use for their loved ones with a mental ill- ness. In addition, families want to know how to support their loved one in recovery and how to find the best treatment programs here in Minne- sota. For example, in a recent survey conducted by NAMI Minnesota, respondents reported that they had trouble finding the right type of care for a loved one with co-occurring disorders. In part, this is because there is a disconnect between substance use treatment systems and mental health systems. The systems can be difficult to navigate, chal- lenging to coordinate care, and often don’t speak the same language. NAMI CO-OCCURRING DISORDERS 1 This booklet is designed to help individuals and families navigate these and other barriers to find the best care. This booklet will help you: Ì Learn the terminology of substance use and co-occurring disorders Ì Identify common symptoms of substance use disorders Ì Understand the basics around treatment and recovery Ì Find and evaluate appropriate treatment options in Minnesota Ì Connect to additional resources Ultimately, we hope that this booklet will improve access to care for in- dividuals with co-occurring disorders by empowering families to better recognize the symptoms of substance use disorder in loved ones with a mental illness and advocate for effective treatment. CO-OCCURRING SUBSTANCE USE DISORDERS AND MENTAL ILLNESSES Defining Mental Illnesses and Substance Use Disorders Mental illnesses are generally thought of as changes in thinking, mood, and/or behaviors. In the DSM-5, which is the handbook that mental health professionals use to make diagnoses, a mental disorder is defined as “a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associ- ated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disor- der. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunc- tion in the individual, as described above.” Substance use disorders are considered a mental illness. Like other mental illnesses, it is listed in the DSM-5. The definition of substance use disorders in the DSM-5 is very specific and is provided below. A diagnosis can also identify the specific substance that the individual is using, for example alcohol use disorder, but the criteria will be very similar. DEFINITION OF SUBSTANCE USE DISORDER: A problematic pattern of substance use leading to clinically significant impairment or distress as manifested by at least two of the following symptoms occurring in a 12-month period: 2 NAMI CO-OCCURRING DISORDERS Ì Substance is often taken in larger amounts or over a longer period of time than was intended Ì Persistent desire or unsuccessful efforts to cut down or control sub- stance use Ì Great deal of time is spent in activities necessary to obtain the sub- stance, or recover from its effects Ì Craving or strong desire to use the substance Ì Recurrent use resulting in failure to fulfill major role obligations at work, school, or home Ì Continues substance use despite having persistent or recurrent social or interpersonal problems Ì Important social, occupational, or recreational activities are given up or reduced because of substance use Ì Recurrent substance use in situations that are physically hazardous Ì Substance use is continued despite knowledge of a persistent physi- cal or psychological problem that is likely to have been caused or exacerbated by the substance Ì Tolerance, as defined by either of the following: • A need for markedly increased amounts of the substance to achieve intoxication or desired effect • A markedly diminished effect with continued use of the same amount of the substance Ì Withdrawal, as manifested by either of the following: • Characteristic withdrawal syndrome for the substance • Use of the substance or closely related substance is taken to relieve or avoid withdrawal These disorders have commonly been referred to as addiction, alcohol- ism, chemical dependency, and substance abuse. All of these disorders have different levels of severity. The National Institute on Drug Abuse defines addiction as “a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. These brain changes can be persistent, which is why drug addiction is considered a “relapsing” disease—people in recovery from drug use disorders are at increased risk for returning to drug use even after years of not taking the drug.” We don’t know all the reasons that people develop a mental illness and/or substance use disorder, but we do know that biology, genetics, environment (high stress, peer pressure, physical and sexual abuse, NAMI CO-OCCURRING DISORDERS 3 early exposure to drugs, poverty), and the stage of brain development play a significant role. The Relationship Between Mental Illnesses and Substance Use Disorders Almost half of people living with a mental illness have a co-occurring substance use disorder. That number is far higher than for the general population. Researchers are working to uncover the links between substance use disorder and mental illnesses. Understanding this link is an important key to developing more effective treatments for both substance use disorders and mental illnesses. Most research right now supports the idea that there is something shared in common between substance use disorders and mental illness- es that leads to the high levels of co-occurrence. This idea of something shared is known as a “common factor.” Here are two possibilities of the common factor: OVERLAPPING GENETIC VULNERABILITIES: Some people’s genes make them more vulnerable to both substance use disorders and mental ill- nesses or once one appears, they become more vulnerable to the next. For example, some people are born with genes that make them more likely to develop depression and those same genes might make them more likely to develop a substance use disorders. OVERLAPPING ENVIRONMENTAL TRIGGERS: Early exposure to adverse childhood experiences, stress, and trauma (for example, experiencing a natural disaster, witnessing domestic violence, experiencing abuse or neglect, or experiencing neighborhood violence) have been shown to contribute to the development of mental illnesses and substance use disorders. Some groups, like military veterans, may be at an increased risk for co-occurring disorders given high rates of trauma. It is a common belief that substance use disorders can develop when people “self-medicate” by using drugs or alcohol to mask an underly- ing mental health condition.
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