Manual on Treating Substance Abuse & Mental Health Disorders
When a person is dealing with a substance abuse disorder, mental illness, or combination of disorders, it can be challenging to find the right kind of help to recover from and manage the individual’s mental health. Even knowing how to recognize substance abuse or mental health disorders can be confusing and challenging. When people or their loved ones recognize severe changes in behavior, it can be hard to know what the cause is, let alone what signs to look for to help determine what to do about it.
A substance abuse disorder involves use of illicit drugs or misuse of legal prescription or other substances that results in drug-seeking behavior that can be damaging to the person’s physical, mental and social health, relationships, and behaviors. On the other hand, a mental health disorder can be caused by internal or external factors that result in a change in the person’s personality or behavior. When the two are experienced together, the result can be a complex combination of behaviors and symptoms that may be hard to distinguish.
Understanding how to recognize substance abuse and mental health disorders, and knowing when and how they can be treated, is among the first steps to getting help for the affected individuals and their loved ones.
How to Know if Treatment Is Needed
It can be scary when a person’s behavior or physical health changes unexpectedly. However, with some understanding of what to look for, people and their loved ones can recognize the signs and symptoms of mental illness or addiction – or of co-occurring substance abuse and mental health disorders.
Symptoms and signs for both drug abuse or addiction can vary depending on the type of drug being taken. Similarly, different mental illnesses cause different behaviors. Nevertheless, there are some general physical and behavioral signs and symptoms that may indicate a substance abuse or mental health disorder is present.
Physical Signs and Symptoms
When it comes to behavioral or psychological conditions such as substance abuse and mental illness, physical evidence may be rare. However, these conditions can have an effect on the body that manifests as physical symptoms. The following are the most common general, physical signs and symptoms of substance abuse:
- Red eyes, dark circles under the eyes, or pupils that are larger or smaller than typical
- Tremors or shakiness
- Increased heart rate or blood pressure
- Sudden weight loss or gain
- Slurred speech or delayed response
- Unusual sweating
- Unexplained bruising or other skin damage
- Regular headache or body aches
- A need to increase the amount of drug taken to achieve the same effect as before
Some of the symptoms of substance abuse are withdrawal symptoms when the person tries to stop taking the drug. Some of these withdrawal symptoms can be dangerous or even, as sometimes the case with alcohol and benzodiazepines (benzos or prescription anxiety medications), fatal.
In contrast, the following are general, physical signs of mental illness:
- Heightened sensitivity to sights, sounds, or other sensory input
- Physical tics, shakiness, or restless movement
- Unexplained aches and pains
- Multiple unexplained cuts or bruises
- Change in personal grooming
- Sudden or extreme weight loss or gain
It can be noted that some of the physical symptoms of substance abuse are similar to those for mental health disorders. Also, on their own, many of these signs may point to certain physical illnesses. However, if several of these symptoms occur together and in combination with some of the behavioral changes described below, it can help to determine whether substance abuse and/or mental illness are present.
Behavioral Signs and Symptoms
It may sometimes be harder to recognize the behavioral symptoms of substance abuse and mental illness, but these symptoms are often more prevalent than the physical symptoms, so it can be helpful to know what to look for in behavior. In the case of substance abuse, the following general behavioral symptoms may appear:
- Loss of interest in activities that were formerly enjoyed in favor of substance use
- Trouble with relationships, the law, and/or finances
- Inability to keep up with work, school, or household responsibilities
- Secretive behavior, especially regarding the substance of abuse
- Increase in depression, anxiety, or paranoia
- Inability to stop taking the substance, even in light of negative consequences
Similarly, the following general behavioral symptoms may indicate a mental health disorder:
- Noticeable change in personality
- Extended depression, ambivalence, or apathy
- Hostility or violent outbursts
- Extreme mood swings
- Paranoia or continual hypervigilance
- Extreme changes in eating or sleeping habits
- Major mood swings
If multiple of the above physical and behavioral signs exist, or if the person’s behavior has changed drastically in other ways, a doctor or psychologist should be consulted.
Health Risks Associated with Drug Addiction/Abuse
Drug or alcohol abuse issues can result in some risks to physical, mental, and social health, such as:
- Increased risk of diseases like cancer, heart disease, and forms of hepatitis
- Damage to major organs, such as the brain, heart, liver, or lungs
- Digestive issues
- Injury caused by risky behaviors, such as driving under the influence
- Injury or death due to overdose
- Negative effect on or triggering of mental health disorders
- Increased depression, anxiety, mood swings, and paranoia
- Thoughts of or attempts at suicide
- Violent outbursts or aggression causing injury to self or others
- Loss of relationships, social network, and support
- Job loss or major financial issues
- Problems with the law
The effects of drug or alcohol abuse or addiction can be deadly. In fact, drug overdose is a leading cause of preventable death in the US.
How Living with an Untreated Mental Health Disorder Affects Daily Life
Mental health disorders make it more difficult to manage some of the basic elements of living, such as building or maintaining relationships, focusing or learning in school, getting or keeping a job, or even taking care of oneself. For example, a person with major depression may find it nearly impossible to be motivated to go to work, spend time with friends, or perform basic hygiene tasks.
When mental illness goes untreated, these issues may spiral until other problems arise, such as:
- Spending time in jail
- Being violent toward others
- Being victimized by others
- Causing repeated self-harm to the point of endangering one’s life
- Thinking of or attempting suicide
Getting treatment early on for substance abuse or mental health disorders can help avoid these risks and dangers down the road. These disorders are not curable, but they can be treated, helping people maintain a good quality of life while managing their disorders.
Determine an Approach to Recovery
Once it has been determined that help is needed for a substance abuse or mental health disorder, it’s important to figure out the best path of treatment for the specific individual. Because each person is different, and each person’s experiences and development of mental illness or addiction is unique, there is no one-size-fits-all course of treatment. When a person reaches out for help under these circumstances, there are several steps that can determine the specific treatment approach for that individual, based on a variety of factors.
Diagnosing an Addiction or Mental Health Problem
One of the first things that will happen when a person enters treatment is the level of addiction and the type of mental health issue will be assessed. This will be done through a variety of tests and assessments of the person’s history of use and mental health, and the degrees to which the behaviors described above are occurring. These tests and assessments include:
- Blood or urine tests to detect the presence of substances
- Self-assessments that can be analyzed by professionals
- Assessment of withdrawal symptoms
- Surveys and questionnaires to measure behaviors
- Comparison to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
DSM-5 is a manual that contains the most current standards for measuring substance abuse and other mental health issues. Through comparing the tests and assessments with the models in DSM-5, a professional can determine what the diagnosis is and use that determination to begin to lay out the plan for treatment.
Addressing the Needs of the Individual and the Family
As stated above, one of the most important elements of both substance abuse treatment and therapy for mental illness is customization to meet a specific individual’s needs. By taking into account the person’s particular history of substance abuse or mental illness, the specialist in treating addiction, mental illness, and co-occurring disorders can begin to create a plan to manage all elements of the person’s mental state. A program that can successfully integrate various program elements to customize treatment is more likely to result in positive outcomes.
By doing this, the professional can make sure that these elements are all taken into account during treatment, thereby increasing the chances that the entangled factors involved in substance abuse and mental health disorders do not continue to affect one another. This, in turn, makes it more likely that triggers of all conditions can be recognized and interrupted before relapse can occur.
In addition, the substance abuse and mental health expert can look at the person’s relationship history, including complicated family dynamics that may play into the substance abuse and/or mental health issues. There are several ways that the family can play into the mental health issues or substance abuse that can be helpful in customizing the individual’s treatment program. These include:
- Family history of addiction or mental illness: A person whose family members have a history of mental illness or substance abuse is more likely to have similar problems.
- Abuse, neglect, and other trauma: If the person’s substance abuse or mental health disorder is caused by trauma experienced within the family, it is important to include this factor in the person’s treatment. Without changing the situation for the person, recovery from and maintenance of the substance abuse or mental health disorder is likely to be short-lived.
- Enabling or codependent behavior: Sometimes family members either unconsciously or consciously play into the person’s initial reason for or continual need to abuse substances. Also, family relationships or dynamics can contribute to various aspects of mental illness.
The unique situations through which a person has come to develop a substance abuse disorder, a mental illness, or co-occurring disorders must be taken into account in the treatment program if recovery and maintenance of sobriety and mental health management are to be sustained.
What a Day at a Treatment Facility Is Like
When a person checks into inpatient or residential treatment, it can be intimidating. Knowing what to expect from inpatient treatment can help a person transition into treatment with confidence and with a minimum of concern about what will happen.
Treatment after detox generally involves undergoing individual, group, and family counseling, along with building relapse resistance skills and practices to help avoid triggers and control cravings. Sometimes, treatment may also involve other activities to help the person achieve a normal routine that will assist with the transition from rehab back to normal life. This can include exercise, recreation, and chores that are all part of the treatment process and skill-building efforts.
A particular day might include:
- Morning wakeup, cleanup, breakfast, and grooming
- An individual counseling session or behavioral therapy
- Skill-building workshop or group therapy
- Evening recreation and social time
- Family therapy
- Preparation for bed and personal time
The order and content of these sessions and activities vary depending on the individual’s needs and specific treatment plan. Specifics will also depend on the facility; this is why it is important to assess what the facility offers and how the program is prepared. Talking to the facility’s staff members and specialists about the program can help make clients more comfortable with what to expect during treatment.
Statistics, Facts, and Data
- About 5 million people in the US had a substance abuse disorder in 2014. Of these, only about 4.1 million got any kind of help, and of those 2.6 million received treatment at a facility that specialized in substance abuse treatment.
- Also in 2014, about 14.8 percent (35.5 million) of US adults received treatment for mental health issues within the previous 12 months. That is compared to 43.6 million adults who are estimated to have any mental illness, and 9.8 million who have serious mental illness.
- Only 5 percent of those with serious mental illnesses received treatment, and fewer than half of those with any mental illness received treatment.
- Approximately 7 million adults have co-occurring substance abuse and other mental disorders – over 3 percent of adults. For about 1 percent of adults, the co-occurring mental disorder is serious.
- Between 50 and 75 percent of people in substance abuse treatment have a co-occurring mental disorder.
- About 4 percent of adolescents (12 to 17) have had a major depressive episode co-occur with a substance abuse disorder.
- Mental illnesses that co-occur most often with substance abuse disorders include mood disorders, in up to 42 percent of patients, and anxiety disorders and post-traumatic stress disorder in up to 27 percent each. In addition, severe mental illnesses occurs in 16-21 percent of people who abuse substances; antisocial personality disorder can be found in up to 20 percent; and borderline personality disorder occurs in up to 18 percent.
- Of the more than 3 percent of people who have schizophrenia or bipolar disorder, between 40 and 51 percent of these people are not treated for their mental illness.
- Co-occurrence of major depressive disorder with an alcohol use disorder is common for adults, with 11 percent of young adults and 7 percent of adults having this dual diagnosis.
- Only 4 percent of individuals with co-occurring substance abuse and mental health disorders receive treatment for the multiple conditions, and 55.8 percent of people with co-occurring disorders receive no treatment.
Frequently Asked Questions
The following are some of the most commonly asked questions about mental health and substance abuse disorders.
What are the chances of an individual with an addiction also having a mental health disorder?
It is very likely that a person who is dealing with substance abuse also has a mental health disorder. In fact, looking at people who are already in substance abuse treatment programs, between 50 and 75 percent have a co-occurring mental health disorder. This does not mean that the mental health disorders are severe or that they necessarily have negatively affected the person’s everyday life. However, it is an indication that mental illness and substance abuse often go hand in hand.
There are several factors that contribute to this co-occurrence of drug abuse or addiction and mental illness. First of all, there is the concept of self-medication, in which people often try to manage psychological issues like post-traumatic stress disorder or anxiety by taking drugs or alcohol to numb themselves, or to manage the symptoms of the mental health disorder. The problem comes in when the person begins to develop a tolerance to the substance and needs more and more of it to have the same effect that was originally achieved with less. This can happen either with prescription drugs, such as benzos like diazepam (Valium) or alprazolam (Xanax), or with legal or illicit substances like alcohol or heroin.
The other problem comes in when a pre-existing addiction makes changes to brain chemistry that result in damage to mental processes, which can either trigger a potential mental illness or worsen the symptoms of a mental health disorder that already exists.
In either case, the addiction and the mental illness then co-exist and are practically inextricable from one another. Because of this, it is important to make sure that those who have co-occurring mental health disorders and addictions get treatment for both or all conditions, in order to make sure that all contributing factors are addressed.
What mental health problems have the highest rate of a co-occurring substance abuse issue?
Depression and anxiety are challenging mental health issues that are most often treated alongside substance abuse. Benzos are prescription drugs normally used to treat these conditions, but when misused, they can quickly become addictive.
Benzos are some of the most commonly prescribed drugs in the US, treating anxiety, insomnia, and depression. However, even small doses, taken long-term, can change brain chemistry to a degree that can result in tolerance and addiction. In addition, misuse of these drugs can quickly lead to dependence.
People often also self-medicate anxiety, depression, and similar mood disorders with alcohol use. Occurrence of alcohol use disorder in young people can predict major depression disorders in early adulthood, while occurrence of major depression in young adults often predicts the occurrence of major depressive disorders later in adulthood.
What is self-medicating behavior, and when does it become a concern?
Self-medicating behavior occurs when a person attempts to manage the symptoms of a mental health disorder or other emotional issue through taking drugs or drinking alcohol.
Self-medication tends to happen most often in response to trauma. Substances of abuse often feel initially soothing for those who are dealing with trauma, depression, and anxiety. As a result, people with these types of histories tend to overuse or misuse drugs and alcohol more often in an attempt to overcome the feelings that come with these mental health issues.
Self-medication is a concern whenever it happens, because it’s a sign that a larger mental health issue may be occurring. It can be helpful to approach this issue as soon as it is realized that this is what is happening. Managing mental health issues as severe as trauma, post-traumatic stress, major depression, and anxiety is difficult to do alone, and going without treatment can lead to more severe mental illness and the psychosocial and financial consequences of the illness. If it is suspected that a person is self-medicating by abusing drugs or alcohol, an intervention may be appropriate.
Is an outpatient program for addiction treatment enough, or is inpatient care the right solution?
According to research, the element of drug treatment that seems to result in the most long-term, positive outcomes is making sure that an adequate amount of time is spent in treatment. Because of the nature of addiction, this means sufficient time in treatment helps prevent relapse, or a return to substance-abusing behaviors.
People who are abusing drugs can get help through outpatient programs; however, outpatient programs often carry a higher risk of relapse. This is because the person in treatment is still exposed to the same temptations and triggers of their everyday life. Because inpatient treatment allows for isolation from the substance of abuse and the triggers of cravings for the substance, a person in an inpatient program has a greater chance of learning how to avoid triggers and cravings before venturing back out to the outside world. As a result, this person is less likely to relapse in the sensitive first year after treatment.
Because of the dangers and discomfort of detox, the higher chance of recovery with a customized program, and the post-treatment support and aftercare provided, a research-based, well-rounded inpatient or residential rehab program is most often recommended for the best chance of achieving and maintaining recovery after treatment. The specific choice of which is best – inpatient or outpatient care – is determined on a case-by-case basis depending on the specifics of each individual’s situation.
What are the best ways to cope with withdrawal symptoms and get through the detox process?
Withdrawal is a challenging process for most people. Withdrawal often includes uncomfortable symptoms like:
- Digestive discomfort
- Aches and pains, sometimes severe
- Mood swings
- Anxiety and depression
- Increased heart rate
While it may seem that managing these symptoms alone or with the help of friends might suffice, people often underestimate how uncomfortable these symptoms can be. They don’t expect that these symptoms often lead to relapse and a return to addiction when managed without professional help. In fact, people who receive help are the ones more likely to stay in recovery for the long-term.
In addition, some withdrawal symptoms – including those from alcohol or benzos – can be risky and may even result in death if not handled by medical professionals. These withdrawal symptoms can include seizures and, specifically with alcohol detox, a condition called delirium tremens (DTs). These withdrawal syndromes are dangerous and require medical supervision. For addictions to opiates, alcohol, and benzodiazepines, medical detox is always required.
What accommodations are offered at a residential treatment center?
Residential treatment centers vary, depending on whether they are privately or publicly owned. Clients stay on site, and room and board is included in the costs, while individuals undergo treatment for addiction or mental health treatment.
At the public level, there may be little more than this offered. State and municipal treatment centers provide a place to sleep and meals while a person undergoes medically assisted detox and is introduced to what may be a limited number of treatment modalities.
However, just because a treatment center is privately owned doesn’t mean it will provide more than the minimum of treatment requirements. For this reason, it is important to ask questions about provisions before selecting a treatment facility. The main factors to look for include:
- Medical detox
- If needed, medical support for abstinence until other treatments take effect
- Various types of therapy, including behavioral therapy, family counseling, and self-help groups
- Post-treatment aftercare and motivational support to help maintain sobriety and avoid relapse
These are considered by experts to be some of the most important aspects of a program in order to achieve long-term recovery.
How long should one stay at a drug treatment facility?
Experts advise and research demonstrates that one of the strongest predictors of long-term recovery from addiction is the amount of time spent in the rehab program. For this reason, it is important that a person undergoing treatment for drug abuse or addiction remain in the recommended program for as long as possible in order to be most likely to achieve and maintain recovery.
Many residential rehab programs are 28-30 days long; however, this does not mean that this signifies a month-long treatment process. Research also demonstrates that aftercare, which can be provided from a few weeks to several years after inpatient treatment can help a person avoid relapse for longer periods of time, making it more likely that the person will maintain long-term recovery.
The longer that a person is able to stay abstinent after initial treatment, the more likely that the individual will be able to maintain sustained recovery. For this reason, a combination of long-term residential treatment coupled with sufficient aftercare is often the best choice.
Once someone leaves treatment, how can that person avoid relapse?
As stated above, aftercare and other post-treatment programs can help a person avoid relapse. These programs can consist of a variety of treatments, including 12-step programs, motivational therapy, and continued individual, group, and family therapy programs.
A person may relapse for one of many reasons, which include:
- Returning from rehab to a social network or group of friends that encourages continued drug use
- Undergoing outpatient rehab and relapsing during treatment
- Experiencing stressors or psychological symptoms that caused the substance abuse to begin with
- Being unmotivated to complete treatment or achieve recovery to begin with
Through a variety of counseling and motivational aftercare programs, these issues can be mitigated to enable the person to incorporate the treatment, training, and habits gained in rehab to ultimately achieve long-term recovery.
What should be done if there’s a relapse to drug or alcohol use?
It is important to remember that relapse is part of recovery, and it need not be seen as a failure on the part of the treatment program or the person undergoing treatment. Instead, relapse should be seen as an indication that the treatment provided has not been sufficient, and treatment adjustments should be made to try to work through the issues and return to recovery.
Drug and alcohol addiction is not a curable condition. Similar to asthma, diabetes, and high blood pressure, addiction is a condition that must be managed throughout a person’s life. However, with appropriate management techniques that meet the specific individual’s needs, treatment can be effective in helping a person avoid future relapse and gain control of the condition, making it possible to maintain abstinence and return to a future of remission from drug or alcohol abuse.
What’s the best way to confront someone about a drug or alcohol problem?
It can be challenging to approach someone about a substance abuse issue, especially if the person isn’t motivated to seek help. An intervention, in which family members or concerned loved ones approach the individual about the issue, is often the best course of action. It’s recommended that the help of a professional interventionist is sought.
Educating the intervention group about drug and alcohol abuse, and setting up the plan for the event, is important for ensuring a successful intervention. The ultimate goal is that the individual agrees to go to treatment directly following the intervention; however, this may not happen. Other possible outcomes include:
- The person not believing that there’s a problem
- The potential for an angry, aggressive, or violent response from the person
- People in the intervention becoming overly emotional or various members enabling the abuse
- The person storming out
Professional interventionists or family mediators can help the family and other loved ones to plan for these potential responses. These professionals provide valuable outside perspective with objectivity that can help to keep the proceedings under control.
It is also possible to get medical interventions through health screenings with a doctor. These can be beneficial in that they provide the objective opinion without an intervention from the family or loved ones.
However the issue is handled, it is important to approach the person with compassion and understanding. While it is possible for treatment to achieve positive outcomes when the person is unwilling to enter treatment, it is more likely that recovery will be achieved when the person is actively invested in the outcome.