The term “concurrent disorders” describes cases where a person has both a mental health disorder and a substance abuse issue. People dealing with a mental health disorder are substantially more likely to develop a substance abuse disorder, and the inverse is also true.
Mental Health Disorders and Addiction
The relationship between a mental health disorder and concurrent substance abuse issue will usually be complex and can be difficult to properly identify, both for the person in question and those around them. It will also be different for every person dealing with concurrent disorders. As the Centre for Addiction and Mental Health (CAMH) suggest, it is best to think of the conditions involved in concurrent disorders as “independent problems that interact with each other.” Concurrent disorders can begin at any stage of life. A person who has always had a mental health disorder may develop a concurrent substance abuse disorder. A substance abuse issue can also make someone more likely to develop a mental health disorder.
Causes of Concurrent Disorders
As the Ministry of Health and Long Term Care (MOHLTC) note, “There is no single cause of concurrent disorders; each person’s situation is unique.” In some cases, both a mental health disorder and a substance abuse disorder may arise from the same source. This is often the case with people dealing with trauma, who may develop a dependence on substances after turning to them to cope with their symptoms. A person may turn to substances to cope with preexisting mental health disorders, or with certain impacts they have on that person’s life. A substance abuse disorder may also have an impact on a person’s life which results in them developing a mental health disorder. Symptoms of one issue may also disguise or distract from symptoms of the concurrent issue.
Causes and Effects of Concurrent Disorders
The cause and effect relationship between concurrent disorders is generally complex and can be difficult to define. A holistic, evidence-based approach is essential to treat concurrent disorders and help a person towards recovery. Client-centred treatment strategies are necessary to establish methods to deal with the different issues involved. CAMH state that, “The treatment plan needs to be designed to fit each person’s particular needs” and that “clients have the best success when both problems are addressed at the same time, in a coordinated way.” Rather than viewing a person’s concurrent disorders in isolation, the underlying causes must be identified and properly treated.
The links between the disorders must also be addressed, as a relapse for a substance abuser may make a concurrent mental health disorder re-emerge. Alternatively, a recurrence of a mental health disorder may make someone with a history of substance use more likely to relapse. Certain incidents or patterns may also serve as triggers for multiple concurrent disorders. In recent years in Canada, there has been an increased focus on this sort of treatment. Service providers are now better prepared to deal with concurrent disorders than in previous eras, although there is still much progress to be made.
Prevalence of Concurrent Disorders
There is a strong established link between mental health problems and addiction issues. As the Canadian Mental Health Association state, “people with mental illness have much higher rates of addiction than people in the general population. Similarly, individuals with an addiction have much higher rates of mental illness than people in the general population.” They reference a study carried out in Edmonton, Alberta in which a third of mentally ill individuals included also had problems with substance abuse.
Health Canada corroborate this, stating that “Between 40-60% of individuals with severe mental illness will develop a substance use disorder at some point during their lives” and that “almost 2% of Canadians (or 435,000 adults) have both a mental disorder and a substance use disorder.” The Canadian Centre on Substance Abuse (CCSA) have also reported that “more than 50% of those engaged in treatment for substance use are also struggling with mental illness and 15-20% of those engaged in treatment for mental illness are struggling with addictions.” The strength of the connection between substance abuse and mental health disorders means that a dual approach capable of addressing both is crucial. However, this type of approach has only come to prominence relatively recently. Trafalgar Addiction Treatment Centres’ clinical staff are highly qualified and experienced in providing holistic treatment, and our program is designed specifically to address all of the issues affecting a person’s well-being.
When Treating Concurrent Disorders
The close relationship between mental health disorders and substance abuse means it is essential to keep both in mind when considering treatment for either one. While a mental health disorder may complicate addiction treatment, and vice versa, maintaining a focus on both is proven to be beneficial. This more holistic approach to treatment can address underlying, interrelated issues related to an addiction or mental health disorder. This should be considered at the beginning of a treatment process. As CAMH note, “If someone has signs and symptoms of a mental disorder, substance use should also be considered. Likewise, if someone has signs and symptoms of a substance use disorder, mental health concerns should also be explored.” A dual approach featuring substance abuse and mental health treatment methods can provide breakthroughs for people for whom more narrowly focused approaches have proven ineffective.
Relationship Between Concurrent Disorders
While the connection between mental health disorders and substance abuse has been well established, the relationship is deeply complex. A mental health disorder may have a range of influences on a substance abuse problem, and the inverse is equally true. As the MOHLTC describe, “substance use can exacerbate mental health problems.” People suffering will mental health disorders will often turn to substances to temporarily relieve symptoms. Substance abuse may also lead to mental health disorders. For example, people struggling struggling with alcohol addiction may develop depression.
Substance use can also “imitate or hide symptoms of mental health problems leaving the mental health issue undiagnosed/untreated.” For example, the symptoms of addiction can often appear similar to those of Attention Deficit Disorder, such as a person exhibiting a nervous energy or agitation, and a lack of ability to focus on certain stimuli. Substances can also affect medications prescribed for mental health disorders and make them less effective or dangerous to the user. Someone with a substance abuse issue may also be less likely to take prescribed medications as instructed or to follow a treatment plan.
Treatment for Concurrent Disorders
The MOHLTC state that, “From a service delivery perspective, the earlier concurrent disorders are recognized, assessed, diagnosed, and treated, the greater quality of life the individual will have.” Holistic, client-centred treatment for people with concurrent disorders has become more common in Canada in recent years. As the CCSA state, “Historically, substance abuse and mental health services have been developed separately; with Canada’s mental health and addiction systems being independent and compartmentalized […] few services existed which explicitly worked with clients with both substance use and mental health problems.” This approach of treating concurrent disorders in isolation has been proven to be less effective, and is gradually being outmoded, as we have “developed our knowledge base for evidence-based policy and practice.” This improvement in the knowledge base around concurrent disorders has allowed service providers to develop integrated methods that can identify and treat concurrent disorders in an evidence-based, effective way. As the CCSA describe, “Effective intervention for clients with concurrent disorders requires integration and collaboration between mental health and addictions staff.” This integrated service is the kind of treatment Trafalgar provides, with clinical staff with expertise in both mental health and substance abuse treatment. Trafalgar’s highly qualified clinical staff will also collaborate with clients’ mental health service providers when applicable.
Trafalgar’s Concurrent Disorders Treatment
Trafalgar uses treatment methods such as cognitive behavioural therapy, individual therapy and group counselling, which have proven effective in treating people with concurrent disorders. Cognitive behavioural therapy allows clients to focus on how their behaviour and thought patterns relate to their mental health and substance use issues. It helps them to identify ways to modify their behaviour to better cope with these problems. Individual therapy allows a person to identify the underlying causes of their problems and methods for dealing with them. Group counselling provides people with supportive, understanding environments in which they can discuss their issues and strategies for coping with them.
Relapse Risks and Aftercare for Concurrent Disorders
People in recovery with concurrent disorders may be at particular risk of relapse, due to the way in with the disorders interact with one another. As CAMH note, “when a person relapses with one disorder, it can trigger the symptoms of the other disorder.” Like addiction, mental health problems are also often lifelong, recurring issues. This means that a person in recovery must always maintain a focus on their treatment and ensure that they have the necessary supports in place. They must also be aware that a relapse is not a reason to give up on treatment: “When a person has a relapse, he or she may become discouraged and give up on a treatment plan. However, relapse should not be a reason to stop treatment. Relapse is common. It is more helpful to see it as another step in the recovery process.” Relapse can provide an opportunity to identify relapse triggers, recommit to current or previous treatment, or modify a treatment plan.
Aftercare for Concurrent Disorders
The lifelong nature of recovery means that sustained support and aftercare for those who have participated in treatment is crucial: “Relapses are common for severe mood disorders and alcohol or drug dependence, so longer term treatment and recovery monitoring is required, as is ongoing assessment.” Aftercare also allows for continual engagement with a treatment plan, so that any modifications necessary can be identified and implemented. Trafalgar’s treatment program incorporates this necessary, ongoing support. Our Aftercare and ContinUcare programs ensure that we are there to offer support to clients as they face the challenges of recovery. Aftercare functions through group counselling sessions specific to certain issues, providing long-term peer support and preventing a person from becoming isolated in their recovery process. It is available to Trafalgar clients on an ongoing basis after they have finished their initial treatment and is a crucial aspect of our commitment to our clients. ContinUcare keeps clients in touch with our clinical team through sets of questions that are provided periodically, allowing the client to monitor their own progress and helping our clinical team to identify any potential issues. These programs provide Trafalgar alumni with access to long-term supports that reduce the likelihood of relapse. They also provide reassurance for the client and those close to them that any problems that arise will be identified and proactively addressed. This means that a client can rely on Trafalgar’s support as they continue their journey towards a brighter tomorrow.
Future of Treatment for Concurrent Disorders
The progress that has been made in Canada in recent years in the treatment of concurrent disorders is greatly encouraging for mental health and addiction treatment service providers. It represents a move towards a more holistic, person-centric approach incorporating evidence-based methods. Treatment methods and strategies are being designed to treat the whole person, and not just their disorders. Integrated, evidence-based services of the kind Trafalgar Addiction Treatment Centres provide are a proven, effective way of treating those dealing with concurrent disorders.