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Getting Help for Co-occurring Disorders

If you have co-occurring disorders, don't despair. There are effective ways to treat your mental health disorder while you heal from addiction. It is possible to abstain from mood-altering chemicals and manage your mental health symptoms. In fact, people recover more effectively when they receive health care that treats both disorders.

Diagnosis starts with questions

Co-occurring disorders are diagnosed by first assessing your chemical use and mental health separately. This helps the clinician determine whether your mental health disorder exists independent of chemical use.

You'll be asked questions about the history of both your chemical use and mental health. During the chemical use assessment, you may be asked:

  • How old were you when you first used alcohol or other drugs?
  • How often do you use alcohol or other drugs?
  • How much alcohol or other drugs do you use?
  • What have been some of the consequences of your chemical use?

During the mental health assessment, you may be asked:

  • What are your current mental health symptoms?
  • What is your family medical history?
  • How old were you when your mental health symptoms began?
  • Have you noticed any relationship between your mental health symptoms and your chemical use? For example, do you notice that you are more depressed when you are drinking?
  • Have you ever been treated for your mental health symptoms? Have you ever been to therapy, used medication, or been hospitalized?

Once an assessment has been completed, the course of treatment can be determined. Treatment is most effective when the substance use disorder and the mental health disorder are treated at the same time. In some cases, abstaining from all mood-altering chemicals while monitoring the mental health symptoms for signs of improvement might be all that is needed. In other cases, other interventions are needed.

It's important to remember that working on recovery means facing the consequences of your chemical use. This process might be painful and cause you to feel sad, guilty, ashamed or anxious. This is normal. These feelings are not signs of an additional mental health problem.

Treatment involves support, therapy, medications

A variety of options are available for treating co-occurring disorders. These include finding support, engaging in therapy, and taking appropriate prescription medications.

Finding support

First and foremost, if you are chemically dependent, you must abstain from mood-altering chemicals. The fellowship of Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Dual Recovery Anonymous (DRA), and other Twelve Step groups can be very helpful as you enter recovery. Being with others who understand the disease of chemical dependency and mental health problems can help lessen the shame and help put your life into perspective. (Find a group near you)

Choose Twelve Step meetings carefully. Ask yourself the following questions:

  • Does this group welcome people with co-occurring disorders?
  • Do I feel comfortable talking about my mental health in this group?
  • Will group members support my use of prescribed psychiatric medications?
  • Is my sponsor concerned about my mental health and my sobriety?

Your family can play an important role in helping you get on the road to recovery. Work with family members to learn about mental health disorders, addiction, and integrated treatment.

Family members can use different strategies to support your recovery. They can:

  • help you follow all treatment recommendations
  • encourage total abstinence from alcohol and other drugs
  • help you build good coping skills
  • reduce family friction and provide social support
  • encourage participation in peer support groups
  • help you create a sober peer network
  • know the signs of relapse
  • support your involvement in meaningful, structured activities

Engaging in therapy

Many types of therapy can help you live with co-occurring chemical dependency and mental health issues. These include cognitive behavioral therapy, motivational enhancement therapy, interpersonal psychotherapy, and desensitization treatment. Although each type of therapy approaches issues in a different way, the purpose of all therapy is to give you the tools to work through your problems.

It's important to find the right therapist for you. As you're looking for a therapist, temember that you are a consumer, much as you are when you're shopping for a car. As a consumer, you have the right to choose whether or not to use the services of a particular therapist. Take the time to interview several therapists and ask about their credentials and professional training. Most therapists offer a free or low-cost initial consultation.

Here are some questions you might ask:

  • What is your training and background?
  • What is your knowledge about chemical dependency and Twelve Step recovery?
  • What style or method of therapy do you use? Will future sessions be conducted in the same way as the first session?
  • How will the two of us handle goal-setting and what results can I hope for?
  • How long will therapy last, and how will I know when I am done with therapy?
  • What is the fee? Do you take my type of insurance? Do you have a sliding fee scale?
  • What is your view on treating mental health issues with medication?

A good relationship between you and your therapist is necessary for a successful outcome. Here are some essential ingredients to a good therapy relationship:

  • You should feel that the therapist is sincere and genuine.
  • The therapist should respond to your questions in a thoughtful and considerate manner.
  • You need to feel that you are treated with respect and taken seriously.
  • You need to have confidence in your therapist's skills and training.
  • You need to feel that you help determine your own program of therapy.
  • You need to feel at ease with your therapist, that your therapist is someone you can trust.

Taking appropriate prescription medication

In some cases, prescription medication is necessary to treat mental health disorders. If you are already using psychiatric medication and have been recently diagnosed with chemical dependency, talk to your doctor about whether it's safe for you to continue taking the medication. Some psychiatric medications have severe withdrawal effects that require medical monitoring. Do not stop taking a medication without consulting your doctor.

Some people in the recovery community do not believe in treating mental health symptoms with medication. They may tell you that you're not truly sober if you're taking medications. Ask yourself, "If I have a mood disorder and I start taking a medication that changes my mood, am I still in recovery?" The answer is yes! A medication to manage your mood is very different from a drug that alters your mood. Let's look at a few of the differences between a drug and a medication.



Has an immediate effect

May take weeks to be effective

Causes inconsistency in mood

Stabilizes mood

Requires the user to take more and more to achieve desired effect

Does not usually cause the user to increase dosage or take more than prescribed

Result is usually intoxication

Result is not usually intoxication

Sometimes people who are prescribed a medication for a mental health disorder are ashamed to tell anyone about it. Some may keep it a secret from AA or NA members, as if taking medication means they are cheating in their recovery. They may feel that taking a medication is a sign of weakness or a breach of staying clean and sober. This is not the case.

Taking an antidepressant for a depressive disorder is like taking insulin for diabetes. Without medication, you might not function very well. Please remember this example if you are feeling bad about needing to take a medication for a mental health disorder.

Don't despair -- there's hope

If you have a co-occurring substance use and mental health disorder, it is very important to seek integrated treatment for both. Talk to your doctor about your treatment options and be sure to follow his or her instructions.

Maintaining abstinence, attending therapy sessions and support meetings, and taking prescribed medications are all essential to your recovery. Taking a medication is not substance abuse.

Remember, symptoms of substance use and mental health disorders can mask or mimic one another. A thorough assessment of chemical use and a thorough mental health history are necessary to determine the course of treatment.

Above all, asking for and receiving help for both your mental health disorder and chemical dependency is the first step to recovery.

This information is an excerpt from A Guide for Adults with Co-occurring Disorders, by Susan M. Hoisington, Psy.D., L.P.

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