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Treatment for Co-Occurring Disorders

by James Heller 25. August 2009 07:31

By Ken Bachrach, Ph.D.
Clinical Director

It is very common for a person to have both a psychological disorder and an addictive disorder.  When this occurs, the term most often used is that the individual has a co-occurring disorder or COD.  Previously, the term frequently used was that the person was “dually diagnosed.”

People with both an addictive disorder for substance use or dependence and a psychological disorder such as depression need treatment for both disorders.  The best approach is to treat both disorders in an integrated fashion with a team of providers who understand both disorders.  

In the past, treatment was often sequential, meaning it was requested that the person got treatment for one disorder before being accepted for treatment for the other one.  This often resulted in disastrous outcomes, since a person could not stop their drinking or their drug use until their psychiatric condition was stabilized and vice versa.  

The next approach was to treat these disorders in a parallel fashion, but unfortunately the two treatment providers or teams frequently did not communicate with one another.  Many people in substance abuse treatment programs require psychological counseling and psychotropic medication for their COD.  Some of these individuals were self-medicating with alcohol, prescription medications, and illicit substances like methamphetamine as a way to cope with their psychological disorder.  

At Tarzana Treatment Centers in Los Angeles, we strive to provide integrated behavioral healthcare and have both mental health and addiction specialists on our alcohol and drug treatment teams.  The advantage of this integrated approach is that the entire person is being treated rather than only one specific disorder, and the team is communicating with one another.  With proper treatment for the COD, these individuals can focus on their recovery from alcohol dependence and drug addiction.

The likelihood of having a substance abuse problem is not evenly distributed among individuals with psychological disorders.  Our nation’s largest community-based mental health survey, titled the Epidemiological Catchment Area (ECA) Study, revealed that individuals with Bipolar Disorder have the greatest likelihood of having a substance use disorder some time in their life.  

The rates of substance abuse or dependence among those with Bipolar Disorder were over 60%.  People with Schizophrenia had a 50% chance of developing a substance abuse disorder, while those with depressive and anxiety disorders had rates ranging from 25% - 33%.

The effects of substance use and misuse can cause many psychological symptoms ranging from depression to anxiety to psychosis.  That is why it is often difficult to determine if a person is experiencing substance-induced psychological symptoms that will subside once the substance use has stopped or whether the person has an independent COD.   

The psychological symptoms from substance use can last for many weeks and months, so some period of abstinence is needed to make a definitive diagnosis.  Still, if symptoms are severe, persist for a reasonable period of time, or if there is a documented history of these symptoms during prior periods of abstinence, then psychological and psychiatric treatment should be initiated to address these symptoms.


If you or a loved one needs help for co-occurring substance abuse and mental health disorders, please call Tarzana Treatment Centers in Los Angeles now at 888-777-8565 or contact us here.

Southern California Locations for Alcohol and Drug Treatment
Tarzana Treatment Centers has locations all over Southern California in Los Angeles County. Other than our central location in Tarzana, we have facilities in Lancaster in the Antelope Valley, Long Beach, and in Northridge and Reseda in the San Fernando Valley.