co-occurring & dual diagnosis


What is withdrawal?Withdrawal is the first step towards addiction recovery, but it’s an often misunderstood part of the process.

Why Withdrawal Occurs

The term withdrawal refers to the symptoms someone with a substance abuse problem experiences after suddenly stopping the use of drugs or alcohol. Withdrawal typically begins within a few hours of when the abused substance leaves the bloodstream.

Withdrawal occurs because drugs and alcohol make changes to how your brain processes emotions and regulates mood. These changes flood the body with neurotransmitters, like dopamine and serotonin, to create an artificial high. When the body doesn’t get its fix of the addictive substance, it takes time for the brain, nervous system, and vital organs to return to functioning normally. Since addiction is a disease, willpower alone can’t stave off the symptoms of withdrawal.

Symptoms of Withdrawal

In addition to an intense craving for the abused substance, common symptoms of withdrawal include:

  • Nausea
  • Vomiting
  • Abdominal pain
  • Shakiness
  • Sweating
  • Chills
  • High blood pressure
  • Anxiety
  • Difficulty sleeping
  • Muscle aches or cramps
  • Confusion
  • Hallucinations

The mood changes associated with withdrawal depend on the type of substance being abused. Generally speaking, someone who has been using depressants such as alcohol or opiates will experience a period of overstimulation during the withdrawal process. At the opposite end of the addiction spectrum, someone who has been abusing stimulants such as methamphetamine or cocaine will experience depressive symptoms. In rare cases, the depressive symptoms associated with withdrawal from stimulants can lead to attempts at self-harm.

Delirium Tremens

Although most withdrawal symptoms are merely uncomfortable and not physically dangerous, severe alcohol abuse can result in a potentially deadly condition called Delirium Tremens (DTs). Approximately 3-5% of alcohol abusers are at risk for DTs during the withdrawal process, with the highest risk being among those who have been struggling with alcoholism for 10 years or more.

The symptoms of DTs are similar to other types of withdrawal, with added hand tremors, irregular heart rate, dehydration, and fever. Without treatment, loss of consciousness and potentially fatal seizures can result.

It’s important to keep in mind that the serious symptoms of DTs don’t begin immediately. Sufferers experience mild withdrawal symptoms first, with the risk for seizures peaking 12 to 48 hours after the last drink.

Someone who is suffered from DTs can be treated with intravenous fluids, vitamins, correction of salt and water imbalances in the bloodstream, and sedative medications.

Severe cases of withdrawal from benzodiazepines can also produce a condition similar to DTs.

Length of Withdrawal

The length of time someone will experience withdrawal varies depending upon the length of substance abuse and the type of substance being abused. Common timelines include:

  • Alcohol: 3 days to several weeks
  • Benzodiazepines: several weeks to several months
  • Cocaine: 7 to 10 days
  • Heroin or prescription painkillers: 24 to 48 hours

The intensity of withdrawal symptoms tends to peak in the first 24 to 48 hours, which is when a substance abuser is most at risk of relapse. After this point, discomfort is reduced to a milder level and more easily managed with exercise, rest, and proper nutrition.

Post-acute withdrawal is a term used to refer to the ongoing symptoms someone experiences while in recovery. These symptoms are primarily emotional in nature and can include cravings, anxiety, irritability, fatigue, and trouble concentrating. Episodes of mood disturbances will come and go, but can appear as long as two years after the initial withdrawal experience. In people who don’t seek professional addiction treatment, post-acute withdrawal episodes are well known as a risk factor for relapse.

Effect of Co-Occurring Conditions

People who suffer from drug or alcohol addiction and a co-occurring mental health disorder such as depression or anxiety can have more intense mood changes during the withdrawal process. Physical conditions such as high blood pressure or diabetes can also affect the severity of the withdrawal process. For treatment to be effective, co-occurring disorders must be addressed simultaneously.

The Benefits of Medical Detox

It can be extremely uncomfortable and potentially dangerous for someone with a substance abuse problem to attempt to go through withdrawal alone. During withdrawal, substance abusers aren’t thinking clearly and can’t properly monitor their symptoms. For this reason, medically supervised detox is the first step of treatment in an inpatient residential rehab center.

In medical detox, a substance abuser’s symptoms and vital signs are closely monitored and managed with appropriate pharmaceutical interventions. Holistic therapies such as massage and acupuncture can also be used to provide the safest and most comfortable beginning to the recovery process.

By Dana Hinders

To learn more about our programs, please visit our website.

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co-occurring mental disordersCo-occurring disorders are mental illnesses, such as depression, anxiety, PTSD, or OCD, that occur in people who are also suffering from drug or alcohol addiction. This is sometimes referred to as a dual diagnosis.

The National Alliance on Mental Illness (NAMI) reports that most mentally ill people who struggle with drug or alcohol addiction are men between 18 and 44. However, women and older adults can also have a dual diagnosis.

How Mental Illness Creates a Vulnerability to Addiction

Mental illness makes people more vulnerable to drug and alcohol abuse because there is an impulse to self-medicate symptoms that can have a negative effect on one’s qualify of life. For example:

  • Someone who suffers from severe anxiety in social situations might turn to alcohol to relax and feel more comfortable in a group setting.
  • Stimulants like cocaine or methamphetamine are often abused by people who are suffering from depression because they temporarily increase focus, attention, and energy levels.
  • Benzodiazepines or prescription sleep aids may be abused by someone suffering from PTSD as a way to cope with the anxiety and insomnia associated with the condition.

Self-medicating may be done for several different reasons. Some people lack the resources necessary to obtain a proper diagnosis, while others are simply afraid to discuss their symptoms with a healthcare provider due to the societal stigma surrounding mental illness. In the case of severe illnesses such as schizophrenia, self-medicating can also be a response to unpleasant side effects associated with certain prescribed medications.

Self-medicating mental illness with drugs and alcohol is problematic because it’s only effective in the short term. Tolerance quickly develops, requiring higher doses of the abused substance to achieve the same effect. This leads to withdrawal symptoms when the substance is no longer being used and will eventually intensify the symptoms associated with the underlying mental illness.

Other factors that contribute to the high percentage of mental illness in people who suffer from drug or alcohol addiction include:

  • Effects of adolescence: The teen years are the time when signs of mental illness most often begin to appear. This is also the time when peer pressure and societal influences can lead vulnerable young people to experiment with drugs and alcohol. Since the brain is still developing during adolescence, substance abuse during this time can worsen the symptoms of mental illness.
  • Overlapping genetic risk factors: Research is still being done to understand how our genes affect addiction, but there appears to be a significant overlap in the genes linked to higher risks of addiction and those linked to a higher risk of mental illness.
  • Involvement of similar brain regions: Certain parts of the brain are affected by both substance abuse and mental illness. For example, depression, schizophrenia, and other psychiatric disorders are linked to abnormalities in the circuits of the brain that process the neurotransmitter dopamine. Addictive substances flood the brain with dopamine, creating a powerful motivation to continue using.

Mental Illnesses Caused by Addiction

While most people with co-occurring disorders exhibited symptoms of mental illness before developing drug or alcohol addiction, it’s possible for addiction to create symptoms of a mental illness. For example, long term abuse of ecstasy can create changes in the brain that lead to issues with depression and anxiety. There is also some evidence to suggest that substance abuse in the teen years increase the risk of developing a mental illness later on in life, since drugs and alcohol can affect the growth of brain.

Seeking Treatment

When seeking addiction treatment, it’s vital that you choose a program that addresses both substance abuse and the underlying mental illness. If you treat the substance abuse as an independent and unrelated problem, it’s difficult to maintain long-term sobriety because you’re not addressing the underlying issues that led to your addiction in the first place.

A recovery plan for someone suffering from a mental illness and drug or alcohol addiction should include the following:

  • Medically-supervised detox to rid the body of the abused substance while minimizing withdrawal symptoms
  • A complete mental health evaluation and diagnosis
  • A personalized treatment plan to address both mental illness and substance abuse concerns
  • Individual therapy
  • Group therapy to encourage connections with others and learn from the experiences of people struggling with similar issues
  • Family therapy to promote a stronger support system
  • A detailed aftercare plan with referrals to resources necessary to maintain sobriety while addressing ongoing mental health concerns

Making the decision to seek addiction treatment can feel a bit overwhelming, but know that is the first step in regaining control of your life and planning for a brighter future.

By Dana Hinders

To learn more about our programs, please visit our website.

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Chicken or the EggIf only life was a true reflection of the fairy tales our mothers read to us as small children.  There was a problem, with courage and determination it was overcome, and everyone could then live happily ever after.  The illusion was that there was only one problem, and that if it was resolved, everything else would be perfect.  Unfortunately, the myth does not mirror reality, and it certainly does not describe recovery from addiction.

It is often appropriate to ask whether addiction is the problem, or the symptom of something else.  This question does not discount the fact that addiction is a chronic disease, but acknowledges how other issues are often the triggers for drinking and using.  If these “co-occurring conditions” are not recognized and addressed, recovery is hard to achieve.  It is for this reason that St. Joseph Institute believes that “treating” addiction without an equal or greater emphasis on addressing these other issues in a person’s life is poor healthcare practice.  It is like placing a Band-Aid on a wound that has not been cleaned and medicated.  In the end, the patient does not get better and the condition may get far worse.

Not every issue that triggers the desire to use drugs and alcohol is a mental health condition that can be diagnosed and classified.  That is not what is important.  What matters is that something is causing pain or distress – both of which become invitations to self-medicate.

Listed below are some of the common “companions” to addiction that need to find resolution, so that recovery can become easier, and the temptation to use again lose some of its power.

Depression. Escaping feelings of sadness are a common reason to drink and use. Ironically, drugs like alcohol only make depression worse.

Anxiety. Studies on university campuses show the strong link between the social anxiety that accompanies modern life and the use of drugs and alcohol.

Pain.  Human nature drives us to escape pain with all possible haste, rather than learn ways of reducing pain through lifestyle changes or natural means.  Our aversion to pain has made the United States the world’s largest consumer of opiate medications.

Relationships. Nothing creates more emotional distress than relationships that are not working well. Rather than learning to build better boundaries, communicate effectively, or resolve conflict, many people simply medicate their relationships.

Bipolar. Some mental health conditions cause distress and the best medications are still imperfect.  Millions of America’s use their drug of choice to self-medicate their mental health issues.

Stress. Managing the stress of daily living should never be an optional activity.  However, all too often we let it build to unhealthy levels, and allow stress to feed addiction.

Boredom. A surprising number of people use drugs and alcohol to cope with boredom, rather than find activities, hobbies and other outlets for their pent up energy and frustrations.

Sex. For many addicts and alcoholics, their drug of choice has been an integral part of their sex lives.  Concerns about the impact of sobriety on inhibitions, performance, and the quality of the experience need to be resolved.

Self-worth. Guilt, shame, a lack of validation, rejection, are issues that can drive addiction in the hope that using will fill the mental void.

Trauma.  The deep “psychic” pain that comes with abuse, PTSD, and other forms of trauma become fertile ground for addiction.  Without resolution, these hurts often become the “justification” for using drugs and alcohol.

We must realize that addiction does not live in a vacuum.  It is fed by the events in life.  If the issues that have a powerful impact on our lives are not addressed, they become the constant “siren’s call” to use again.  Attempting to treat addiction in isolation is often a futile exercise.  Is it the “problem” or the “symptom?”  I suggest the answer doesn’t matter.  To find wellness the addicted person must deal with both the chicken and the egg.