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April 2011

What are Co-Occurring Disorders?

Image previewPlease note: This is the first in a series of blog posts that will address the relationship between addiction and associated mental health problems. I'm starting with a general overview here and will add posts that will be more specific, focusing more on specific mental health issues as they relate to children and the family.

Comments, suggestions, and questions are always welcome and will help me develop and tailor the blog to your interests/needs.

Addiction doesn't happen in a vacuum.

Sometimes we take for granted what our brains are for. We are not robots--our brain controls everything that we do, from monitoring breathing and heart rate to deciding whether to eat a cheesesteak with or without fried onions or reaching for a salad instead.

We know that drug, alcohol, and other addictions are complex problems that involve the interaction among many variables:

  • Biological, such as heredity or genetic makeup
  • Environmental, such as family, school pressures.
  • Social, or interactions and relationships with others
  • Emotional, or feelings such as anxiety, depression, anger.

It's the emotional variables that underly and contribute to the symptoms we most often associate with co-occurring disorders and compromise our mental health. I've previously written here before about the interaction between addiction and mental health, but what I want to focus on now is what happens when an addicted person's emotional issues become prominent and seem to take on a life of their own.

'Co-occurring disorder' is a fancy term for mental health problems that occur alongside the addiction, when a person's ability to manage their emotional world becomes a problem in itself. The main types of co-occurring disorders are:

The first of the two listed above sometimes start prior to the addiction, when the person turns to drugs (marijuana, cocaine, opiates, etc.), alcohol, or other compulsive behaviors (overeating, gambling, shopping, video gaming, etc.) to help manage their difficult emotions better. Choosing drugs, alcohol or compulsive behaviors helps to escape the painful and/or scary feelings by numbing, avoiding, or disconnecting from feelings altogether. Our emotions are often warning signs that something is wrong. Just like ignoring warning light on your car's dashboard can become a serious mechanical problem, not paying attention to our emotions can lead to coping-with-life problems.

ADHD, on the other hand is related to addiction and emotional well-being in a different way than the emotions described so far. ADHD is a neurobiological, or brain-based disorder, that contributes to increased impulsivity in behavior and emotional expression. Impulsivity often contributes to low frustration tolerance and anger management problems.

Sometimes, when a person becomes sober and lets go of their longstanding coping mechanisms, anxiety, depression, and ADHD problems become revealed and will need specific attention in addition to traditional addiction counseling and relapse prevention approaches.

It's estimated that 60% of people with a drug and alcohol problem also have a co-occurring mental illness. Symptoms of addiction--mood and personality changes, sleep and appetite disturbance, irritability and impatience--often mimic co-occurring disorders. Symptoms of depression are often expressed differently in children and adolescents, so that can complicate things even more.

Research suggests that the best treatment approach is one where both addiction and mental health issues are addressed at the same time. Finding a therapist skilled in treating both addictions and mental illness is crucial if there is any uncertainty of mental health problems.

Don't be afraid to ask a potential therapist if she/he has experience with co-occurring disorders, if you're at all unsure about your child or family member's situation. It will greatly increase the likelihood of getting the comprehensive treatment that's needed.

College is a Part of Life; It's Not Apart From Life

by Barry Lessin

April 5th, 2011

Getting a college degree is an impressive accomplishment that any person can be proud of.

Unfortunately, the faulty expectations that are part of the "mystique" of college life--"These will be the best years of your life!"--undermine the success of many kids' adjustment to college, leaving behind a long line of depressed, anxious, alcohol- and drug-abusing kids.

Many kids hit a wall when they get to college, mostly because they're not prepared for what are the normal challenges of this phase of life that college presents. Yes, it's normal-- no, there's nothing wrong with you!--if you struggle with establishing a life separate from your parents, family, lifelong friends and supports.

Confronting brand new academic, financial, and social pressures that the college experience brings is hard enough for any child, let alone with those with acknowledged learning and/or emotional problems. "Changes of scenery" and "getting away from mom and dad" are not part of a good plan for kids already struggling to manage their anxiety, depression, and/ADHD.

A recent Huffington Post article by Meg Schneider points out that, yes, going away to college offers the possibility of growth and positive change, but it's naive to believe that old challenges can just be erased.

Meg offers many excellent realistic suggestions for embracing the opportunities offered in college that will improve the chances of a successful college experience. Her main message is one of normalizing the college experience, and I love how she describes it: "College is a part of life. It's not apart from life". Perfectly stated.

If your child is unhappy at college, it's crucial to have him/her ask for help. It doesn't mean that there's something wrong with him or her. Getting that diploma may involve a few detours or pit stops along the way, including a few at a counselor's office. It's a normal part of the journey to that impressive graduation milestone. 

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