Like a Storm
Substance use starts out as a light mist, a gentle drizzle, occasionally drinking or using in a seemingly harmless fashion. However, with even a casual glance, one can see ominous storm clouds building and feel the accelerated gusts of wind. For some, the fury of the storm breaks wide open as substance use becomes a substance use disorder. The pouring rain of substance use and the damaging winds of a mental health disorder unleash their collective destruction. The co-occurring mental health disorder and substance use disorder combine with a devastating fury that can leave its victims dysregulated, distressed, and dislocated. Yet, rebuilding is possible, and protection against future storms becomes a necessity.
The Co-Occurring Difficulties
A co-occurring disorder diagnosis is indicated when a person has an alcohol or drug-related
disorder along with one or more mental health disorders. The substance use disorder and the mental health disorder interact with each other and commonly increase the severity of both. The term co-occurring disorder does not imply that one disorder causes the other one, however, there is good indication that substance use will make mental health problems more severe, and mental health issues increase the likelihood and the severity of substance use behaviors. Drug or alcohol abuse can frequently launch a major mental health episode which may have been dormant or previously had very mild symptoms.
Mental Health Issues
There are several categories or classifications of common mental health issues that are associated with co-occurring disorders. The problematic symptoms of a mental health disorder may lead the client to self-medicate with drugs or alcohol. As an example, severe depression may lead a person to abuse alcohol or smoke methamphetamine. There is no standard pairing of any one drug with a particular mental health disorder.
Illnesses that frequently co-occur with addiction include the following:
• Attention Deficit Hyperactivity Disorder (ADHD)
• Bipolar illness
• Conduct disorder
• Personality disorders
• Anxiety disorders
• Thought disorders, including schizophrenia
• Post-Traumatic Stress Disorder (PTSD)
Chronic drug and alcohol use can create complexing physiological and neurological damage. Co-occurring disorders can compromise intellectual functioning and reduce judgment, insight, reasoning, and processing ability. Memory may be impaired and mental processing speed is lowered. Withdrawal effects, sleep deprivation, chemical imbalance, detoxification complications and a host of mental health problems all compromise abstract reasoning abilities.
These syndromes, symptoms, and effects lead to significant cognitive impairments. Therefore, concrete and practical psychoeducational materials are almost always required.
Rebuilding after the Storm
Co-occurring disorder treatment must address the unique symptoms experienced by the client, and treatment must address both the substance abuse and the underlying mental disorder in practical, simple, and relevant ways. In co-occurring disorders, treatment is designed to achieve abstinence from drugs and alcohol, reduce the symptoms of the mental health disorders, and prevent relapse for both.
Psychoeducation – the How and Why
Psychoeducation combines psychotherapy with education to identify and manage symptoms, design and implement treatment strategies, and prevent relapse of mental health and substance use disorders. Combining education with therapeutic interventions reduces healthcare costs, decreases legal problems, and increases social and occupational effectiveness. Using quality resources, we help people understand the effects of discouragement, and lead people in a process that builds confidence, self-assurance, and hope. These materials are designed to revitalize commitment and gain a hopeful mindset.
Psychoeducation with a Purpose
As co-occurring disorder counselors, it is important to educate the client in key areas and provide specific topics and services for their benefit. It is essential to:
1. Provide education on substance use disorders including risks, signs, symptoms, and long-term consequences. This includes information about the effectiveness, funding, length, and likely outcomes of various treatments.
2. Teach about mental health disorders, common warning signs, and symptoms for various diagnostic categories.
3. Educate the client about risks and effects of co-occurring substance use disorders and mental health problems including prevalence, complexities, and available integrated treatment strategies. Remember, psychoeducation interventions combine education with treatment to maximize impact.
4. Provide information on the therapeutic nature of psychotropic medication and increase medication compliance. Medication and counseling work better together than either one alone.
5. Reinforce socially acceptable and legally compliant lifestyle changes to reduce legal problems.
6. Destigmatize mental health conditions for clients and their families.
7. Teach emotional regulation skills such as stress management, frustration tolerance, mindfulness, and thought challenging.
8. Encourage lifestyle changes including increasing self-control and altering destructive habit patterns.
9. Address social issues, reduce codependent behavior, rebuild trust, and strengthen personal relationships. Assist clients in creating long-term recovery support. Help clients identify educational concerns, spiritual matters, housing difficulties, and occupational interests.
10. Provide relapse prevention planning that offers encouragement, sustains motivation, and inspires hope.
Specialized and Simplified
The previously mentioned cognitive impairments as well as increased stress levels further compromise a client’s reasoning abilities. This is not a harsh judgment, but rather a compassionate understanding of intervention requirements. Yet we’re asking someone with compromised cognitive abilities to change the way they think. For that to be possible, adjustments in treatment need to be made. My suggestion for working with the complications of COD is not to make the interventions more complex, but rather make the interventions simpler. The materials we’ve developed and used in our treatment programs are fundamentally different from other curriculums. Because the treatment of co-occurring disorders is exceedingly multifaceted, specialized psychoeducational resources are required.
The content should be simple to understand and easy to use. Additionally, using resources that are engaging, attractive, and appealing improves retention and increases practical application. If the amount of time and focus increases, the material that was designed to get to the heart of substance use and mental health disorders will have greater impact. Increased engagement and mastery of the material will improve motivation levels and inspire further growth.
Good Resources are Necessary for Good Treatment
As instructors, it’s not what you know, it’s what you can teach that matters most. Our clients often resist when they feel commanded, demanded upon, or forced to comply. Quality psychoeducation offers inspiration, encouragement, and opportunities to relate to the material, in a way that is appealing and doesn’t carry a boring, instructional tone. Great strides forward in recovery are most often attained by leading and inspiring, rather than compelling and criticizing.
Being Different Makes a Difference
Damage from the storm often brings the physical pain of addiction and is worsened with emotional suffering comprised of sorrow, sadness, discouragement, and regret. Co-occurring disorders psychoeducation must build knowledge, yet also provide emotional safety, bring comfort, and extend compassion. Because thinking processes are temporarily reduced or compromised, we’ve created program materials that are easier to comprehend, more concrete, more practical, more relevant, and generate more discussion, all to bring doable mastery in this post-storm rebuilding process. Targeting specific problems with the right resources, always yields the strongest recovery.
Dr. Hal Baumchen is the Executive Director of Northland Counseling Services and the Clinical Director of NorthStar Regional. He is the author of Journeys, a co-occurring disorders resource manual, Destinations, a practical guide for overcoming addictions and improving your mental health, the Destinations Companion Workbook, and he co-authored Finding Hope Again: Overcoming Depression with Dr. Neil T. Anderson.