Addiction and Co-Occurring Disorders

Dr. Saurabh Bhardwaj

Dr. Bhardwaj, Medical Director is a Board-Certified Addiction Psychiatrist (ABPN) and currently the Medical Director of Defining Wellness Center in Brandon MS. He is also an Associate Professor of Psychiatry and Medical Director of Center for Innovation & Discovery in Addictions (CIDA) at the University of Mississippi Medical Center. He has been in Mississippi since 2018, building Addiction services for the state's only medical center and joined Defining Wellness Center in 2022 to provide specialized dual diagnostic services. He is a recipient of Ruth Fox scholarship from AAAP and trailblazer teaching award from UMMC. He is also a Fellow of the American Society of Addiction Medicine.

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It is not uncommon for some health conditions to come in pairs. For example, allergies often occur hand in hand with asthma just like heart disease is often correlated with a diabetes diagnosis. The same correlation is also common with substance abuse disorder and underlying mental health disorders. In fact, this entanglement is referred to as dual diagnosis or co-occurring disorders. Dual diagnosis refers to an individual diagnosed with a substance use disorder (SUD) and a co-occurring mental health disorder. According to the National Survey on Drug Use and Health (NSDUH), 45 percent of people with addiction have a co-occurring mental health disorder. [1] More often than not, these disorders are diagnosed as two completely separate issues. In order to encourage long-term recovery, it is important that these co-occurring disorders are treated simultaneously in a dual diagnosis treatment center.

Mental Health Issues and Addiction

The symptoms of one disorder may precede the other. However, the conditions typically exacerbate one another, making it seemingly impossible to determine the symptoms caused by one disorder from the other. For instance, individuals who attempt to escape feelings of depression may turn to painkillers or heroin for relief, but quickly discover the relief is only effective the first few times.

In most cases, there are a ton of contributing factors that play a role in the development of addiction and/or mental health disorders such as:

  • Biology – Some individuals are predisposed to being deeply attracted to the high achieved by drugs and alcohol. This may be due to factors such as prenatal exposure, genetics, early childhood exposure, childhood trauma, accident, injury, and a number of other situations and experiences that play a part in altering brain chemistry, even in the slightest way.
  • Genetics – Having a close relative who has suffered from mental illness and/or addiction may increase the likelihood and genetic predisposition of an individual suffering from the same disorder.
  • Trauma – Physical abuse, sexual abuse, wartime experiences, and even witnessing a traumatic event can drastically increase an individual’s likelihood of suffering from a mental health disorder and/or substance abuse disorder. Exposure to trauma may result in many mental health disorders such as PTSD, depression, anxiety, and other issues. Individuals may turn to drugs and alcohol to self medicate – putting them at greater risk of developing an addiction.
  • Environment – Exposure to a chaotic, drug-ridden, or traumatic environment may play a key role in the development of mental health or addiction disorders.

Common Co-Occurring Disorders

There are a few common mental health and behavioral disorders that coincide with co-occurring substance use disorders. Oftentimes, these underlying mental health conditions play a major role in the development of addiction. It is vital for an individual to treat any underlying mental health disorders appropriately in order to maintain long-term sobriety.

  • Attention Deficit Hyperactive Disorder (ADHD) – Individuals who suffer from ADHD may find themselves coping with drugs and alcohol to mitigate the symptoms of their mental health disorder. Many people are prescribed stimulants to treat the symptoms of ADHD, which can be addictive in itself – ultimately leading to a toxic pattern of substance abuse.
  • Bipolar Disorder – Approximately 50% of individuals who suffer from bipolar disorder also struggle with substance abuse. The constant influx of “highs” and “lows” associated with bipolar disorder may lead individuals to cope with drugs and alcohol. Drugs and alcohol may temporarily create relief from the depressive and manic episodes associated with this disorder.
  • Depression – An estimated 1 in 10 adults in the U.S are reported to struggle with depression. [2] Many individuals self medicate with drugs and alcohol, only exasperating the symptoms and making the problem much worse. The crash after the high of abusing other substances can be counterproductive and devastating for individuals suffering from pre-existing mental health disorders such as depression.
  • Eating Disorders – Eating disorders are often a direct result of feelings of inferiority and looking to re-establish a form of control. Drugs and alcohol that suppress appetite are most common amongst individuals suffering from eating disorders.
  • Generalized Anxiety Disorder (GAD) – One of the most common mental health disorders in the U.S. is generalized anxiety disorder. [3] People who suffer from GAD may abuse drugs and alcohol to deal with the symptoms of their disorder. Benzodiazepines are a highly addictive class of drugs typically prescribed to individuals who suffer from GAD – increasing the risk of abuse.
  • Obsessive-Compulsive Disorder (OCD) – Obsessive-compulsive disorder causes a variety of unwanted obsessions and compulsions such as paralyzing fear of germs and the compulsion to clean. Individuals with OCD often suffer from anxiety and depression as well and may turn to drugs and alcohol to mitigate the symptoms.
  • Post-Traumatic Stress Disorder (PTSD) – Post-traumatic stress disorder is caused by exposure to trauma such as sexual, physical, and emotional abuse, accidents, natural disaster, wartime exposure, and many other traumatic events. When an individual suffers from PTSD the brain of that individual produces fewer endorphins than a healthy brain. This chemical imbalance often leads to depression and the likelihood of an individual self-medicating to deal with the overwhelming feelings of depression and anxiety.

Importance of Integrated Treatment

Living with an untreated mental health disorder and/or a co-occurring substance use disorder can be a deadly combination. The lack of resources, delusional thinking, and unhealthy behaviors often result in detrimental consequences and even death. Common life-threatening health disorders that may result in untreated co-occurring disorders include:

  • Heart disease
  • Increased risk of stroke/heart attack
  • Diabetes
  • Smoking
  • Overdose
  • Asthma
  • Suicidal ideations
  • Obesity/Malnutrition

Due to the potential nature of untreated co-occurring disorders, it is imperative that each disorder is properly diagnosed and treated simultaneously. Integrated treatment offers a range of treatment services specific to the dual diagnosis. Individualized treatment services will specifically and effectively treat the disorders amongst the client – promoting healing on all levels.

Each client will have a unique treatment plan, customized to fit his/her individual needs. However, an integrated treatment plan will generally include the options of:

Medical Detox –  The first step in integrative treatment is for the individual to be properly and safely detoxed. Medical detox services provide clients with medical support and monitoring if needed to help them stabilize in treatment.

Evaluation – To ensure that all current mental health symptoms are accurately diagnosed, an evaluation is the next step in integrated treatment. Additionally, all other underlying issues and triggers are identified.

Diagnosis – Based upon the professional evaluation results, diagnoses are made to help the client better understand and frame past experiences and compose an effective treatment plan going forward.

Treatment plan – A customized treatment plan is created for each client that integrates a range of therapeutic and medical interventions with the goal of empowering the client to heal from addiction, learn how to manage mental health symptoms, and address any underlying issues that may present an obstacle in his/her recovery.

Individual Therapy – One-on-one therapy is the foundation of recovery, providing the client with a safe and private atmosphere to discuss past experiences, traumatic events, current issues, and goals for the future. As treatment goals are executed, the client can work together with the therapist to create new therapy goals and adjust the treatment plan accordingly.

Group Therapy – There are many different types of group therapies that may be a beneficial component of integrated treatment, such as:

  • 12-Step groups
  • Addiction specific support groups
  • Mental Health specific support groups
  • Support groups that help participants deal with a commonly shared life issue (e.g., parenting, legal problems, job seeking, etc.)

Behavioral Therapy – Behavioral therapy is the most common form of therapy utilized in research-based dual diagnosis treatment centers. Treatment will often include group and individual therapy in order to help individuals understand the motivations behind their behaviors while identifying triggers for alcoholism. When an individual is able to identify and understand his/her triggers for unhealthy behaviors, the individual is able to learn and develop healthy coping skills when dealing with co-occurring disorders.

Family Therapy – Addiction is said to be a family disease. Family dynamics and
relationships may contribute to the way an individual responds to integrated treatment. Throughout the treatment process, family members learn how to become a healthy system of support for their loved ones long-term recovery journey. The goal of family therapy is to provide a source of strength, support, and self-esteem.

Aftercare –  Before leaving treatment, clients are encouraged to work with a therapist to create an individualized aftercare plan. Much like the treatment plan, this should include a unique combination of treatment services and aftercare support that will serve the treatment goals and needs of the client on an outpatient basis. The goal is to equip the client transition into independent living in recovery successfully.

  1. Substance Abuse and Mental Health Services Administration The National Survey on Drug Use and Health:2017
  2. Harvard Health Publishing 1 in 10 Americans Depressed
  3. National Center for Biotechnology Information Generalized Anxiety Disorder (GAD)

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