Co-Occurring Mental Disorders

When at least one mental disorder exists in addition to and independent of an SUD, we call it co-occurring mental disorder. According to a US study, around 42.8 percent of adults with an SUD also have a mental disorder. 17.6 percent of adults with a mental disorder also have an SUD. Depression, Schizophrenia and other psychiatric disorders are common among SUDs.

1. Depression:
   Depression affects about 350 million people and is among the leading causes of disability worldwide.
   Causes of Depression can be a combination of both genetic factors and environmental factors. Childhood trauma such as abuse, neglect, or insecure attachment or a significant personal loss early in life could lead to depression.
   Depression is quite common among alcohol dependents. In early recovery, negative feelings and depressed mood are common.  When depression is not recognized, clients may be at risk for suicide during early recovery.
   Suicidality:

• • Alcohol abuse is associated with 25‒50% of suicides
  • 10% of individuals with substance dependence commit suicide, often while experiencing a substance-induced mood disorder
  • Substance use can worsen depressive disorder symptoms and increase the risk of worsened depression, suicidal ideation, and suicide attempts
    Bipolar Disorders:
    Bipolar Disorders are characterized by huge mood swings of “mania and depression” that are out of proportion to anything in normal life. People in a manic episode rarely recognize their symptoms as a problem and resist efforts at intervention with a strong denial mode.
    Depression and mania cycles are not equal; cycles vary from minutes to weeks

3. Anxiety Disorder:
   Worldwide, anxiety disorders affect an estimated 3.6% of the global population.
   Some common types of anxiety disorder are

• • Panic disorder (Recurrent and unexpected panic attacks with intense fear)
  • Social phobia or social anxiety disorder (Situations “normal” to most, but anxiety-provoking for someone with social anxiety)
  • Generalized anxiety disorder (Excessive anxiety and worry, difficult to control)
  • Post Traumatic Stress Disorder (PTSD):
    Feeling intense psychological or physical distress cause by some trauma happened early. It can be triggered at any stage of life, but people with SUD has more likelihood of repeated PTSD episodes.
    Persons with PTSD normally develop detachment from others, inability to recall the event, sleep disturbances, difficulty in concentration, anger, a sense of doom about the future, etc.

5. Psychotic Disorders:
   Symptoms center on problems of thinking and perceiving. Most common among them are:
   Schizophrenia:  Most common type of psychotic disorder is schizophrenia, which is defined as  a chronic, severe, and disabling brain disorder characterized by the disintegration of thought processes and emotional responsiveness  Delusions, hallucinations, disorganized speech and abnormal motor behavior,  lack of desire or motivation to accomplish goals, lack of desire to form relationships and poor social skills are some of the visible symptoms of schizophrenia. 47% of those with schizophrenia also have an SUD. Anxiety and depressive disorders are also common.

6. Personality Disorders:
   World Health Organization lists personality disorders as one of the top health issues in the world
   Personality Disorders are classified into Cluster A, B & C.
   In Cluster A, persons exhibit

• • Paranoid—Pattern of distrust and suspicion of others
  • Schizoid—Detachment from social relationships
  • Schizotypal—Pattern of acute discomfort in close relationships, cognitive or perceptual distortions,
    In Cluster B, persons exhibit

• • Antisocial—Pattern of disregard for and violation of the rights of others
  • Borderline—Impulsivity and instability in interpersonal relationships, self-image, affect
  • Histrionic—Excessive emotionality and attention-seeking
  • Narcissistic—Grandiosity, need for admiration, and lack of empathy In Cluster C, persons exhibit
  • Avoidant—Pattern of social inhibition, feelings of inadequacy, hypersensitivity
  • Dependent—Submissive and clinging behavior
  • Obsessive‒compulsive—Preoccupation with orderliness, perfection, and control
    Borderline Personality Disorder:
    Essential feature of borderline personality disorder is a pervasive pattern of instability in:

• • Interpersonal relationships
  • Self-image
  • Emotional responses
    Persons with Borderline Personality Disorder are highly susceptible to peer influence and may use the same drugs of choice, route of administration, and frequency as peers.

8. Attention-deficit / hyperactivity disorder (ADHD):
   ADHD affects large numbers of children and adults. Some studies show almost 11 percent of American children are affected by ADHD. The situation is same with other countries too.
   Children with ADHD have an increased risk of later developing personality disorders including Anti-social Personality Disorder leading to increased risk of alcohol and Drug Use Disorder.  Approximately 1/3 of adults with ADHD have histories of alcohol abuse or dependence.
   There are other mental disorders also. However, the above mentioned mental disorders have more closer connections with SUD