When Addiction and Mental Health Disorders Coexist

Often, when women walk through the doors of The Next Door, they are not only dealing with addiction.  Many have what therapists term a “co-occurring disorder,” otherwise known as a dual diagnosis.

Having a co-occurring disorder means a woman is struggling with a mental health disorder along with a substance use disorder. Some of the most common co-occurring disorders are social anxiety, general anxiety, depression, PTSD, bipolar disorder, personality disorders, and schizophrenia.


Which Comes First – Addiction or a Mental Health Issue?

“What comes first is not such a cut and dry issue,”says Adrienne Hlavati, the medical director of Emergency Psychiatric Services at Nashville’s Mental Health Cooperative. “Sometimes you have to see a person for a while and look at periods of sobriety. Some people can identify the trauma that began their illness and led to addiction. Others’ lives fall apart after they start using substances.”

Receiving a mental health diagnosis can be initially scary for a woman already dealing with addiction.  However, at The Next Door, women are assured the diagnosis can help with their treatment.

“I think one of the benefits of a diagnosis while in a supportive environment like The Next Door is that you have a team around you,” says Jolene Underwood, a therapist at The Next Door. “I had one client that said ‘well I have PTSD – a whole other thing to deal with.’  I told her that she had been dealing with that all along. The diagnosis is actually a gift because it calls attention to some things that we really need to help and support.”

Dr. Finlayson adds the focus on Adverse Childhood Experiences (ACE), or trauma people experience in childhood, has shed some light on co-occurring disorders.  In fact, research says every ACE experienced increases the likelihood of prescription drug abuse by 62%.

“A lot of people who have gone through trauma in childhood use the substance to anesthetize them,” says Finlayson. “They get a sense of relief that they can use the substance to cope.”


To Medicate or Not Medicate

One of the difficult decisions professionals face when treating co-occurring disorders is whether to put someone in early recovery on a new medication when they worked so hard to stop using alcohol or illegal substances.

“Some medications can be extremely helpful when people are trying to detox and stabilize,” says Dr. Finlayson, “However, certain medications can definitely be overused. Some are not very helpful because they are very similar to the drugs people have abused.”

Often, when people self-medicate, the substances end up exacerbating the symptoms they were trying to treat. This may cause them to further self-medicate, eventually leading to a crisis point.  Hlavati says changing a person’s mindset about medications is important.

“Teaching them that self-medication makes things so much worse while prescribed medication can help them feel better,” says Hlavati. “Often a person needs to get through withdrawal and have a period of sobriety for the new medication to help. We are aiming for true health and healing.”


The Next Door’s Approach

In many cases, people with co-occurring disorders are left with the option of either a treatment center for their mental illness or a treatment center for their addiction.

“Too many places consider them separate problems,” says Dr. Finlayson. “People bounce from one treatment center to another, never getting a chance to move ahead.”

Thanks to an expert team consisting of medical professionals, social workers, and trauma informed therapists, The Next Door is uniquely positioned to properly treat women who present with both substance use and mental health disorders – especially those that are struggling with self-injury, eating disorders, intense anxiety, or clinical depression.

“One of the great things is that at The Next Door, when clients present with concerning behaviors, our interdisciplinary team can work together to keep these clients safe and help them change their behaviors.  We can meet them where they are – helping them truly heal,” says Underwood.

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