Technically, the term “comorbidity” could be applied any time a person has two medical conditions at the same time. A person with both heart disease and diabetes would have comorbid conditions, for example, as these two diseases cause different symptoms and must be treated in completely different ways. In addiction medicine, the term has a slightly more exclusive meaning.
In the field of addiction, comorbidity is often used to describe a mental illness that is in place alongside the addiction process. The two conditions, mental illness and addiction, wind around one another and they must be untangled in order for true healing to take place. In short, people with addiction comorbidity need a tailored form of treatment that can help them gain control over both conditions at the same time.
Growing Stronger Together
Comorbidity in addiction is remarkably common. In fact, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), about four million adults in the United States had addiction comorbidity in 2002. It’s difficult to know which condition came first, and the answer to that question might differ from person to person. One person, for example, might struggle with depression for years and then turn to marijuana to help ease symptoms. The addiction in this person develops as a result of the depression. Another person might become addicted to methamphetamine, and as a result of that drug use, the person develops paranoid delusions and now meets the diagnosis of schizophrenia. In this person, the addiction caused the mental illness.
According to the National Institute on Drug Abuse (NIDA), addiction and mental illness can share some of the same genetic pathways and markers. For example, some people with mental illnesses have disruptions in the ways in which their bodies process the chemical dopamine. This can be a hereditary issue. When these people take drugs that also act upon dopamine, they may feel a greater response from the drugs, and since the response is greater, the urge to take the drugs again is also greater. This one genetic marker can influence both the mental illness and the addiction. It’s possible that many of these genetic issues lie underneath many substance abuse comorbidities.
While almost any mental illness can happen alongside a substance abuse disorder, these mental illnesses were commonly found in a study published in the Journal of the Pakistan Medical Association:
- Personality disorders
- Anxiety disorders
- Panic disorders
Treating Two Issues
In the past, doctors spent a significant amount of time trying to determine which issue developed first. This so-called “primary condition” was then treated, and it was assumed that the other condition would either disappear, or become much easier to treat, once the first condition was addressed. This approach had some unintended consequences. For example, according to an article published on Netscape, some people who had post-traumatic stress disorder and addiction were asked to obtain drug abstinence before they were given treatment for their mental illness. Unfortunately, the mental illness made abstinence all but impossible for some people. In short, they simply couldn’t deal with one issue and not the other. Now, doctors know that this isn’t the best way to treat a comorbid addiction issue, and they work to integrate treatment of both conditions to provide the best care.
The goal of a rehabilitation program for comorbidity is to help the person gain control over both issues and develop a toolkit he/she can use to stay healthy. It’s important to note that the goal of the program doesn’t include the word “cure.” Many mental illnesses such as schizophrenia, bipolar disorder and obsessive-compulsive disorder can’t truly be cured. Other mental illnesses such as depression and panic disorder may come and go, but they also can’t really be cured. And people with addictions will likely always have a tendency toward addiction for the rest of their lives, so they also can’t be considered cured at any point. Instead, through treatment, people learn to move past a crisis and then manage the disease throughout the rest of life.
In a traditional rehabilitation program for drug addiction, medications can play a role in reducing withdrawal symptoms and helping the person feel comfortable and relaxed enough to participate in therapy. But in people with comorbid conditions, this medication use can be a bit problematic. According to an article published in the journal Addictive Behaviors, people with anxiety disorders who were given antidepressants as part of their rehabilitation programs for addiction didn’t respond well to these medications. Other medications were used to better effect. Sometimes, the physical and chemical changes in people with mental illness and addiction drive different medication choices.
Similarly, in a traditional addiction recovery program, the addict is provided with several therapy options that can help the addict to learn more about the addiction and how he/she can control that addiction. Sometimes, these sessions are slightly confrontational and they’re designed to move at a rapid pace, so the addict can quickly get back to living life. People with comorbid conditions have much more to learn in therapy, as they have two conditions they must learn to control. A rapid pace and a confrontational technique may turn these patients off completely. Instead, some therapists use more supportive techniques that allow the patient/doctor trust to grow long before the addict is asked to make any huge life changes.
In addition, people with comorbid conditions sometimes benefit from therapy models that pull from their families, their friends and their communities. Their therapy allows them to build up a network of helpers that can assist them as they learn and grow. Some programs include the addict’s family, and the entire group learns how to communicate effectively and build up a safe environment for the addict. Other programs ask the addict to participate in sessions that include many other people who also have comorbid conditions. And still other programs connect the addict with programs in the community that can assist with:
- Parenting skills
All of this may sound ideal, but unfortunately, many people who have addiction comorbidity are not getting the help they need. According to SAMHSA, more than half of people with comorbid disorders received neither mental health nor substance abuse treatment. Of those who did get treatment, only 12 percent received treatment for both conditions.
Just because addiction professionals commonly restrict the use of the term “comorbidity” to discussions of mental health and addiction doesn’t mean that physical concerns don’t come into play when treating an addiction. In fact, many people do have physical conditions that must be treated in order for their addictions to heal. For example, using needles to inject drugs like heroin can place the user at a high risk of developing a chronic illness like hepatitis C. Some people who develop this medical condition also have an addiction, and they also have a mental illness. According to an article published in the Journal of Urban Health, treatments used to treat hepatitis can sometimes make psychiatric symptoms worse. Treating these patients with multiple issues all at the same time could be challenging.
People with comorbid conditions can also develop health issues that can be addressed such as:
- Dental problems
- Breathing problems
By alleviating these conditions, doctors can help patients feel more comfortable and relaxed, which may allow them to participate more fully in their rehabilitation programs. It’s hard to learn while in pain, so alleviating discomfort and improving physical health can be an important part of any recovery program.
People with mental illnesses and addiction need specialized programs developed just for them. They may be called “dual diagnosis programs” or “comorbid addiction programs,” but by any name, they’re designed to help the person address both issues at the same time. We provide a program like this at Axis, and we’d love to talk with you about the benefits of our program. Please call us to find out more about our program and what we can do.