Managing Co-Occurring, Mood, and Mental Wellness in Early Recovery

Successful recovery and sobriety demands that people identify and treat any co-occurring mental health issues.

Maintaining and managing our mental health is part of a comprehensive recovery program. Without a plan for managing mental health, people in recovery are vulnerable to the symptoms of depression, anxiety, trauma, or other mental health disorders. The presence and lived experience of an informed mental health program will allow you to live lives guarded against relapse to substances, problematic unhealthy coping or process addiction. Being actively engaged with specialized professionals (therapists and psychiatrists) can help to maintain your mental health and mood stability during the life’s inevitable stress and life events. 

What Do Other Experts Say About Co-Occurring Disorders?

The National Institute of Drug Addiction (known as NIDA) states that:  “Integrated treatment for comorbid drug use disorder and mental illness has been found to be consistently superior compared with separate treatment of each diagnosis.”

Patients with comorbid disorders:

• Have decreased treatment adherence
• Demonstrate higher rates of treatment dropout
• Realize negative outcomes associated with treatment objectives.  

The Substance Abuse and Mental Health Association (SAMHSA) states that:

“The presence of two or more disorders can complicate diagnosis and treatment. Integrating both screening and treatment for mental and substance use disorders leads to a better quality of care and health outcomes for those living with co-occurring disorders by treating the whole person.”

What Are Co-Occurring Disorders, Anyway?

If you read the blog post or  watched my video on theories of the development of a substance use disorder, you may recall that having a co-occurring disorder is one of the theories as to how a person develops a substance use disorder. 

For the purposes of this video and also your holistic health, I want you to consider the following as possible co-occurring disorders: 

• mood disorders
• depression
• eating disorders
• generalized anxiety and other anxiety disorders
• attention and executive function disorders
• bipolar
• PTSD and other trauma
• grief
• anger

When a person has both a substance use disorder and a co-occurring issue, the symptoms of each “get in the way” of recovery, impacting roles (partner, employee, parent, community) and responsibilities. When under-treated, any of the issues are vulnerable to worsening, which is then likely to exacerbate the other problems of substance use or mental health issues.

Give Me The Facts, Doc

Co-occurring mental health and SUD is a common presentation. According to the Journal of the American Medical Association:

• Approximately 50% of persons with a severe mental health disorder have problems with substance abuse
• 37% of alcohol use disorder  and 53% of those with other substance use issues  have a diagnosable mental illness as well as the substance use issue
• 29% of persons diagnosed with a mental health disorder misuse alcohol and other drugs 

Individuals with drug use disorder:

• 44% have personality disorders
• 28% have mood disorders
• 24% have anxiety disorders 

Individuals with alcohol use disorder:

• 25% have personality disorders
• 16% have mood disorders
• 16% have anxiety disorders

 Individuals with both drug and alcohol use disorders:

• 51% have personality disorders
• 35% have mood disorders
• 27% have anxiety disorders
• 46% have post-traumatic stress disorder

So, What Can Be Done For and About the Risk of Co-Occurring Mental Health and Substance Use Disorder?

The Need for Integrated Treatment

Utilizing a well developed relapse prevention plan, integrated treatment can help people in recovery develop lives in which both the mental health and substance use disorder are managed.

Other Positive Impacts include: 

• Reduced or discontinued substance use
• Improvement in psychiatric symptoms and functioning
• Increased chance for successful treatment and recovery for both disorders
• Improved quality of life
• Decreased hospitalization
• Reduced medication interactions
• Increased housing stability
• Fewer legal problems
• Fewer negative employment and job consequences

Treatment Solutions for C0-Occurring Mental Health and Substance Use Disorder:

Here are the steps to managing a co-occurring disorder:

1. Get a correct diagnosis from a specialized provider
2. Evaluate current severity of mental health disorders
3. Develop a routine to monitor symptoms
4. With your specialized provider, develop your treatment plan to include treating the co-occurring
5. Emphasize and prioritize developing habits that are multidimensional in terms of benefit. Many positive habits help with treating both substance use disorder and co-occurring.
6. Do a timeline history with your provider to develop an accurate understanding of how your co-occurring disorder interacts with your substance use disorder and severity.
7. Develop a team; if prescriptions are necessary for your co-occurring disorder, try to find a prescriber who is addiction informed and willing to work with your psychotherapist.
8. Consider peer support for your mental health such as NAMI or DBSA.
9. Learn about your co-occurring disorder(s). 
10. Make sure your support network is mental health informed.

Get Specialized Support and Information

For more information, content, support, and tools on how to manage executive stress and enjoy life without drugs, alcohol, or over-relying on unhealthy coping, subscribe and check out my link to a free workbook on managing stress to help stop drinking.

NIDA. 2021, April 13. What are the treatments for comorbid substance use disorder and mental health conditions?. Retrieved from https://nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/what-are-treatments-comorbid-substance-use-disorder-mental-health-conditions on 2024, August 12

**Person-centered language note: As a leading clinician in substance use disorder assessment, treatment, and recovery, I am committed to elevating the language around mental health and substance use disorder. This means I will use “alcohol use disorder” rather than “alcoholic.” It means I will use “person with a substance use disorder” rather than “addict.” I minimize my use of the term addiction because it carries stigma, often people have their own relationship with the word accompanied with misinformation. I use the term recurrence or return to use rather than relapse. However, it’s important that people searching for help get connected with services that benefit them. In this regard, people are not searching “am I a person with a substance use disorder?” They are searching “am I an addict?” They do not search, “can a high functioning person have an alcohol use disorder?” They search “am I a high functioning alcoholic.” They don’t search “treatment for people who have a recurrence” but do search “how do I stop being a chronic relapser?” As such, I want to affirm people with substance use disorders with my care, which includes language but I also need to structure my business in a way that google searches find my material.