Dual diagnosis, dual disorders, co-occurring disorders, co-morbidity . . . What does it all mean?

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Editor’s Note: Ted Thorndike, M.A., AAP, is a clinical counselor at the JSC Wellness Center.


The world of mental health and substance abuse diagnosing and treatment can sometimes seem like an ambiguous, vague and confusing abyss. To add to this abyss for some patients is what’s known as co-occurring disorders. I used a few other terms in my title as this concept is many times referenced with different words. For this article we will stick with co-occurring disorders as it is most commonly provided in the press, literature and by medical professionals. An individual diagnosed with co-occurring disorders basically means they have a mental health and substance abuse diagnosis simultaneously. As one digs deeper with these multiple diagnoses, a “which came first: the chicken or the egg?” confusion can arise. Am I anxious because of my excessive binge drinking patterns or did I have generalized anxiety disorder from the start? Or both? Was I initially depressed and then started abusing marijuana to alleviate my symptoms or am I depressed because of excessive use? Or both?


An important concept to explore when talking about co-occurring disorders is which substances can trigger or go hand in hand with different mental health diagnoses. There is no golden rule to this connection to say individuals diagnosed with generalized anxiety disorder strictly abuse alcohol to reduce symptoms and feel more comfortable socializing or that individuals diagnosed with bipolar disorder abuse marijuana to calm down when experiencing mania. However, a common theme for individuals diagnosed with co-occurring disorders is an inability to manage their current feelings, emotions and experiences. Post-Traumatic Stress Disorder is a common diagnosis that leads to substance abuse. In the beginning, alcohol, marijuana, ecstasy, opioids and cocaine can seem like a great alternative to deal with the pain and memories of the past and current symptoms of anxiety and/or depression. The unfortunate reality is that over time, as tolerance and abuse increase, anxiety and depression will worsen significantly. What initially started as a post-traumatic stress disorder now is coupled with an alcohol use disorder diagnosis, for example.


This is important to be aware of if you have a sole mental health or substance abuse diagnosis. It is crucial to seek treatment before you potentially have another condition to treat, increasing the financial, mental, emotional and physical burden. Abusing substances to manage one’s mental health is also referred to as self-medication. For example, if an individual is suffering from depression they may abuse Adderall, which is an amphetamine and can provide a euphoric feeling if not prescribed properly. Instead of seeking professional help and engaging in counseling, exercise, a healthier diet, meditation and potentially an antidepressant prescription, to name a few interventions, they now have two problems instead of weaning one problem down to none. On the flip side, someone may have no baseline anxiety but after years of marijuana abuse has morphed into generalized and social anxiety diagnosis. Initially, they smoked to have a good time and socialize with their friends but now have an anxiety and cannabis diagnosis to treat.


Wading through these various mental health and substance abuse diagnoses can be murky at best. Measuring the efficacy of potentially beneficial medications is difficult when one has substances clouding their mental, emotional and physical states. A good starting point when one is addressing co-occurring disorders is to remove any alcohol or drugs from the body. This removal process is recommended under the supervision of a healthcare professional in the event of severe withdrawal symptoms. The type of drug, quantity and frequency of use, and an individual’s physiological make up, will dictate withdrawal symptoms. Once the substances are out of the system, it can help the patient and professional assess the immediate mental health concerns with increased clarity.


I would also like to put a plug in for continued treatment of one’s substance abuse in the long term, even if they have reduced consumption significantly or achieved abstinence. As one achieves stability in addressing their co-occurring disorders, it can be tempting to fall back into past patterns as they may feel they have out grown or fixed past abusive patterns. Using support groups, counseling, exercise, meditation and journaling can be great strategies to manage one’s feelings and emotions. As I referenced earlier, numbing difficult feelings and emotions can be a big motivator to use and abuse substances.


Achieving mental health stability takes work and, depending on the severity of the issues, can feel like a puzzle. Throwing substance use into the mix can make it difficult to decipher what the core issues are that need to be addressed. Having clarity about who you are and what you need is an important foundation in achieving peace and stability. Seeking help and treatment as issues arise is important, but doing the preventative work to take care of yourself can minimize the impact. I’m a big believer in the “an ounce of prevention is worth a pound of cure” mantra.


To contact the Wellness Center, visit their location in the basement of Senators Hall or call them at (802) 635-1265.

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