Co-Occurring Disorders

A co-occurring disorder is one that sees a combination of mental health issues occurring in the same person. It has also been referred to as a dual diagnosis or a dual disorder, although ‘dual’ implies there are two co-occurring disorders, and there may sometimes be more.


Diagnosing co-occurring disorders


It can be very difficult to identify whether the two (or more) issues are occurring separately to one another, whether they have become linked along the way, or whether one condition precipitated the other(s). For example, if someone exhibits signs of addiction, it does not always mean that this is the dominant issue they face.


It could be that one way they try to manage their depression or anxiety better, for example, is to drink alcohol or take drugs. In a circumstance like this, the addictive behaviour can, in fact, cause further confusion for the sufferer when they are trying to seek out appropriate treatment and support. It can even appear to have ‘replaced’ the underlying issue, at least temporarily.


Whilst people may not always want to look at the underlying reasons for their behaviour, then, it is often a crucial step in the process of both seeking help, and understanding their own issues more accurately.


How co-occurring disorders may play out


1) Co-occurring depression and substance abuse


If someone, for instance, begins to experience depressive episodes and is misusing substances at the same time, then that person would be suffering from co-occurring disorders. It would be worth considering what triggered the depressive episodes, as the trigger could well be the substance itself. Alcohol, for example, is a well-known depressant, meaning it can interfere with our brain’s neurotransmitters, and if consumed excessively or too regularly, can impact on the quality of our mood and consequently, our mental health.


What is perhaps less acknowledged is that alcohol has been found to increase levels of norepinephrine, a hormone that increases impulsivity, hence why people often feel dissatisfied with things they have done while under the influence of alcohol which they might not have done otherwise.


Individuals may become unhappy and even depressed when they are faced with the consequences of actions taken while under the influence of alcohol.


Handling the emotions experienced in the aftermath of mistakes made whilst under the influence of a substance may be so difficult that it becomes hard for the person to see that these issues are exacerbated by the substance, as opposed to helped by it.  


The other aspect to consider is the recovery from having taken any kind of substance, whether it is a type of drug or alcohol. Whether it is a “come-down” or simply exhaustion, it can take days for someone to feel rebalanced and back to themselves. These side-effects may create a cycle of dependency in themselves, where the individual feels they need the substance in order to avoid feeling the ‘come-down’ or depressive episode that can ensue when it wears off.


The individual may also become aware that social situations feel harder when they are “on their own”, so to speak, without the aid of the substance to assist them in feeling less self-conscious.


Anxiety can develop from this realisation, whereas in the past, the individual may have been able to hold their own socially. This is an example of why co-occurring disorders can be difficult to identify at times– because it is not always clear which issue existed independent of the other, or whether it did at all.


2) Co-occurring depression and eating disorders


The same issue can face sufferers of eating disorders and the professionals who treat them. Someone who is feeling extremely depressed, anxious and isolated may well experience a loss of appetite or a distinct lack of interest in nurturing themselves. This can include not seeing the point in getting out of bed, showering, brushing one’s teeth, eating, or a multitude of other seemingly small but important tasks.


If there is no motivation for the person to feed themselves, this can be mistaken for an eating disorder, as opposed to a manifestation of the severe pain they are feeling through their depression.


Having said that, it is not uncommon for someone suffering from an eating disorder to also experience other mental health issues alongside it. In the case of anorexia, long-term malnutrition can change the biochemical activity in a person’s brain, impacting on their behaviour and mood, and causing them to feel a variety of different emotions ranging from anger to acute anxiety and isolation. Some other side effects generally associated with eating disorders are insomnia, irritability, exhaustion, paranoia, and a feeling of nameless dread (whereby the sufferer experiences high anxiety that something awful is going to happen and it is not understood or contained).


Research suggests that over 50% of people who experience eating disorders also experience depression. Considering these symptoms and research, it would be difficult not to draw a parallel between the effects that anorexia can have on mood and the effects that depression can have on mood. This is why, at times, mental health issues can no longer be viewed in isolation, because they can often be enmeshed.


Challenges associated with recovery from a co-occurring disorder


Whilst treatment differs depending on the individual’s issue(s), a combination of support from professionals (such as the GP, inpatient treatment in a rehabilitation setting, or therapy) and support from loved ones (whether this is family, friends, or colleagues), is encouraged.


When someone is in treatment for a co-occurring disorder, their recovery may be more complicated in terms of them being able to see direct results. This can be for numerous reasons: one of them is that the person may hope that once they have their substance-use under control, their mental health will improve drastically.


If depression, for example, exists independently, it may require more motivation and patience on the part of the person going through treatment, as they work through their depression alongside their issue with substances. The same can be important to remember for any co-occurring disorder, as it can be tempting to feel discouraged when things do not immediately improve.


Seeking additional support during this particular stage of the recovery process is key so as to avoid feeling isolated and defeated within oneself. Working in an integrated way with a professional can ensure that a number of different issues can be addressed simultaneously, without any being discarded or thought of as insignificant. There are many factors that can contribute to co-occurring disorders and ultimately, it is important not to rule any out, but rather, to simply be mindful that they may be significant in their own right.




Natasha Klimt


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    Detoxification (detox) is the medical intervention required for someone who is physically dependent to drugs or alcohol. If required, medical detoxification would be the first step taken in residential rehab. Detox is used to prevent uncomfortable and dangerous (even fatal) withdrawals symptoms resulting in suddenly becoming abstinent from alcohol/certain drugs.

    The goal of a medical detox is to aid in the physical healing required following long term addiction and rid the body of all together of substance whilst providing a cushion for unpleasant symptoms of withdrawals. Detox is not considered the whole treatment for drug/alcohol addiction and it is always recommended that a comprehensive rehabilitation program is used along side to help maintain long term abstinence.

    Medication is often required for alcohol detox. If you are dependent on alcohol and experiencing withdrawal symptoms it is vitally important to seek medical advice prior to stopping. There is a long list of medications used when treating alcohol addiction and the exact medication given to an individual will depend on their needs/medical history. Some of these include;

    • Chlordiazepoxide (Librium)
    • Lorazepam (Ativan)
    • Diazapam (vailium)

    Librium and Valium are the most commonly used detox medication in the UK. All medication used to help with alcohol detox have been proven to help reduce the effects of withdrawal symptoms.

    There are also a number of drugs recombined by the NHS to help treat alcohol misuse. Some of these include:

    • Naltrexone
    • Disulfiram (Antabuse)
    • Nalmefene
    • Acamprosate (campral)

    Medication is always required for heroin detox. For someone suffering from heroin addiction, the thought of detoxification (detox) can be exceptionally daunting. Withdrawal symptoms from opiates, such as heroin, can be severe and include pain, vomiting, nausea and shaking.

    There are different ways that heroin detox can be carried out, most usually either ‘maintenance therapy’ or ‘full medical detox’.

    Attempting to switch from heroin to a heroin substitute, usually on a controlled prescription, is known as Maintenance therapy. Subsites used are most often methadone or buprenorphine.

    A full medical detox from heroin will always be carried out in a residential rehab setting and will allow the individual to switch form heroin to a substitute and slowly withdraw completing treatment free of all substances. Someone using a heroin substitute can choose to have a full medical detox at any time, however detoxing substances such a methadone can often add to the length of detox required. Drugs most commonly used to fully detox from heroin are, Subutex, Suboxone and Methadone. Much like alcohol, the exact drugs used will be dependent on the individuals needs/medical history.

    Once detoxed from heroin the risk of overdose is much higher following relapse due to tolerance following withdrawal.

    The length of treatment in a residential rehab depends on a number of elements. Some substances require longer periods of detox than others.

    Private paying patients will also often choose a length of stay that suites their therapeutic and financial needs. As a rule, a full treatment program in a rehab is considered to be 28 days (often referred to as a month), however, treatment is offered in several different ways and lengths starting at 7 days.

    Treating alcohol addiction will always require a minimum of 7-10 days, this would be considered the detoxification (detox) faze. The length required for treating drug addiction can vary drastically depending on the substance being used. Detox for Heroin addiction is generally around 14 days minimum, with more time required if substances such a methadone are being used. Treating prescription drug addiction can often take the longest. The time required for treating gambling addiction, eating disorders and sex addiction will be based on the individuals needs.

    Rehab programs can be as long as an individual requires but primary treatment is normally caped at 12 weeks, with the offering for further secondary and tertiary treatment thereafter.

    *based on average rehab stays, everyone will vary dependant on needs and medical requirement/history.

    There is no need for your employer to know that you are seeking help for trauma and addiction unless you choose to involve them with the process. All employers should have a policy that explains what you do if you cannot come to work due to illness – illness to include treating alcohol addiction/treating drug addiction.

    If your work absence extends over 7 days your employer is likely to require an official statement of fitness to work which would be obtained from your GP. This would need to supply evidence of your illness as well as any adjustments required for returning to work, fazed return or reduced hours, but does not need to specify in detail the reason why you have been absent.

    If you are absent from work for 7 days of less, for example entering rehab for a detoxification (detox) on a Saturday for 7-10 days taking a full week away from work, you can self-certify your illness by letting your employer work you will not be attending work for that period of time. Exactly how an individual would do this would be dependent on a specific companies’ policies on taking sick leave.

    Any time longer than 7 days it is likely an employer will require a note from the individuals GP certifying their sickness and a fit note on return. Most companies have a clearly outlined policy on sickness and receiving sick pay so the exact requirement can vary. A rehab will always be willing to advise on time off work.

    How much does rehab cost is a very frequently asked question. The cost of treatment can range from £1,000 per week upwards depending on the place, with luxury rehab being the most expensive.

    There are free options available on the NHS but the waitlist of those looking for free treatment is longer than that for privately paying patients. Some private health insurance policies will cover treatment in some rehabs around the country.

    Choosing the right rehab centre will often be based on priced but it is important to follow guidance on the most suitable treatment centre for an individual’s needs which our expert team of advisers are on hand to offer.

    There are certainly pro’s for both treatment near by and traveling for treatment with one of the most asked question being should I get rehab near me? There are rehabs all over the UK and around the world that all offer expert programs, let’s look at how to choose a rehab.

    Local treatment

    Being close to home gives certainly has benefits. Visitors are normally permitted in rehab following the first 7 days stay, therefore if an individual is in treatment for a length of time longer than that being local will make it easier for loved ones to visit.

    Most rehab centres will also provide a full aftercare plan for someone following treatment, this will include ongoing aftercare in the specific treatment centre. Living close by can make it easy to take full advantage of ongoing aftercare. There can also often be the option for ongoing care with an individual therapist, again being close by will allow that treatment to be carried out face to face.

    Some individuals wish to be local but are willing to look broader, for instance the greater city of residence (London, Manchester, Liverpool, etc)

    Treatment Away

    Getting treatment away from home can be very appealing to some. Being out of the local area makes it a lot harder to just walk out of treatment as resources locally are unknown. Some also take comfort in knowing that they are not near home and focus more on treatment.

    As the price for treatment can vary so much from one residential treatment centre to another, private paying patients often would rather travel to keep the cost down. Those using private health insurance may also have to travel to find a treatment centre covered in their policy.

    When opting for treatment away from home this can be anywhere in the UK and also abroad. Aftercare can still be carried out and very successful using tools such as The Online Rehab.

    There is no right or wrong when choosing where to go to residential rehab, but our expert advisors are always on hand to help provide information on all possible options.

    Whilst millions of people in the UK have taken recreational drugs (amphetamine, cannabis, cocaine, crack, crystal meth, GHB, heron, ketamine, methadone, and prescription drugs) and drank alcohol not all become ‘addicted’. Most recent reports show that 279,793 individuals were in contact with drug and alcohol misuse services in the last year with over half of that being from opiate addiction and a quarter for alcohol.

    There are several risk factors invoiced in addiction and those using drugs and alcohol socially, simply take the risk. These risks are as follows;

    Tolerance – basically, if a substance is used repeatedly an individual’s tolerance to it will build. This will result in more of the same substance being required to get the same effect. In the long run this can easily lead to addiction and physical dependencies.

    Environmental risks – these can include influences such a peer pressure and stress as well as physical or mental abuse of an individual (particularly as a child). Overall, those who live with frequent pressures and stress are more likely to reach for a substance to cope and are therefore at higher risk of becoming addicted.

    Drug type – it is very well known that certain drugs are simply more addictive than others. Using substances such as heroin increases the risk of becoming addicted for need to ‘chase’ a high as well as physical dependency.

    Drug administration – how a drug is administered can affect its addictive qualities. A drug injected rather than smoked or snorted will release a quicker and more intense high thus making it psychologically (and in many cases physically) more addictive.

    Biological factors – it is now widely reported that being an addict is not only psychological but also biological. This includes your genetic makeup, mental health, sex and age. It is also reported to be 8 times more likely for the child of an addict to become an addict themselves.

    Its believed that addiction is approximately half genetics and therefore some are 50% more likely to become addicted than others.

    How do you help a loved one trapped in addiction?

    The first step is to help and encourage the individual to become willing to accept help. They do not need to be shouting this off the rooftops, but they do need to be willing to go into treatment. There are ways to help someone become willing to get treatment for alcohol or treatment for drugs.

    Set boundaries – set boundaries and stick to them. Once you have laid them out follow through with whatever consequences you have set however hard it is.

    Stop finances – if you are financially supporting someone stopping these finances can be the quickest way for the addict needing to ask for help. With no money to acquire a substance an addict’s options become very limited.

    Intervention – getting together with other family members/friends/colleagues and staging an intervention is often very successful in the fist stage of acceptance and gaining an admission to residential rehab.

    You can’t make them quit, this can lead to dangerous withdrawal. Boundaries are very important in helping someone become willing to get help. Unfortunately you cannot do someone’s recovery for them and without self-motivation it is very hard to make it work.

    The next step is to call our highly trained advisers 0203 955 7700.

    There is a huge range of rehab options available and where to start can be completely over whelming so let us help.