Co-Occurring Disorders With Alcohol Abuse

Alcohol & mental health. They really go hand-in-hand, and can cause a “chicken or the egg” type scenario. Is my alcohol use affecting my mental health? Or is my mental health spurring alcohol abuse? The answer is individualized based on specific circumstances, while understanding the relationship between alcohol abuse or an alcohol use disorder (AUD) and co-occurring psychiatric disorders is critical to receiving effective treatment services.

What does “Co-occuring” mean?

In medical terms it’s known as “comorbidity”. It means two or more illnesses happening in the same person, at the same time. In the world of addiction treatment, co-occurring is used to describe someone experiencing both a substance use disorder and a mental health diagnosis. Co-occurring disorders are serious, and have strong implications for treatment needed. The good news is that the world of addiction medicine has been studying these correlations for decades, and identifying the most needed interventions for those who experience co-occurring disorders.

The National Institute of Drug Abuse has studied likely reasoning for the prevalence of co-occurring disorders. These include risk factors that make individuals vulnerable to both mental health and substance use concerns, and the interplay of substances & mental health’s cause and effect on each other. According to the Journal of the American Medical Association, 37% of those who struggle with alcohol abuse have at least one serious mental illness.

Common Co-Occurring Disorders with Alcohol Abuse
Depression

The National Institute of Alcohol Abuse and Alcoholism estimates that 30% to 40% of those with an alcohol use disorder experience a co-occurring depressive disorder. There is data to suggest these diagnoses pre-date alcohol use, and may be a primary driver for someone using alcohol in an abusive way. It’s important for treatment professionals to distinguish between sadness, grief and major depressive disorder in order to guide treatment approaches. While this disorder plays a role in both ongoing alcohol abuse and using alcohol as a coping skill for depression, effective addiction treatment will use necessary therapeutic modalities to address underlying or emerging depressive symptoms.

Bipolar Disorder

Bipolar disorder, categorized for its manic and depressive states, is well known as co-occurring in those with an alcohol use disorder. Specifically when experiencing mania, those with Bipolar disorders are prone to excessive substance use due to decreased inhibition, including alcohol and other drugs. That being said, Bipolar disorder can be especially hard to diagnose in those presenting with a primary substance use disorder, due to the chronic mood disruptions of a person in the throes of alcohol dependency. Most treating clinicians will rely on substance use stabilization and a period of sobriety before formally diagnosing a person with Bipolar disorder.

Anxiety

It’s important to note that alcohol induced anxiety and Generalized Anxiety Disorder are two different things. Acute withdrawal or Post Acute Withdrawal Syndrome symptoms can have high rates of anxiety that have you crawling out of your skin. Independent anxiety disorders will typically predate drinking escalation, rather than occurring after the cessation of Alcohol. Anxiety such as social phobia and panic disorders due have a higher prevalence of co-occurring with alcohol abuse, and aren’t uncommon motivators for the continuance of drinking. Anxiety and alcohol’s interplay is common, and will require good clinical evaluation in a treatment setting to determine the best course of treatment.

PTSD/C-PTSD

Post Traumatic Stress Disorder (PTSD) and Complex Post Traumatic Stress Disorder (C-PTSD) symptomatology lends itself to problem drinking. Symptoms such as nightmares, flashbacks, panic attacks, and depression can be a catalyst for using alcohol to self-soothe. On the flip side, using alcohol abusively is a risk factor for being in situations that result in a traumatic event. One works to inform the other, while symptoms of both alcohol use and trauma intermingle to develop debilitating functioning. For most, addressing the root of traumatic incidents and events will work to restore equilibrium and alternative coping skills outside of alcohol use.

Antisocial Personality Disorder

Antisocial Personality Disorder (ASPD) has the highest correlation of all disorders with alcohol abuse, and comorbid factors can complicate diagnosis. To truly identify the existence of both disorders at the same time, it’s important to get a comprehensive history in treatment about onset of ASPD and alcohol abuse behaviors such as failure to conform to social norms, deceitfulness, lack of remorse and impulsivity, as both disorders have overlap in symptoms. Both begin in early life, so retrospective reporting for client to clinician is needed to make an accurate co-occurring diagnosis.

How are co-occurring disorders treated?

Every person is different, which means an individualized approach to treatment is necessary based on the prevalence and type of disorder. An interdisciplinary approach involving therapy, medication management and support services will yield best outcomes. Specific treatment modalities such as cognitive behavioral therapy, dialectical behavioral therapy, and group therapy exposure all work towards addressing co-occurring mental health and addiction disorders.

If you’re wondering if your alcohol abuse is a result of a co-occurring mental health disorder, reach out for help today from a treatment agency. There is hope, there is recovery, and there is help waiting for you.