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What are Co-Occurring Disorders and Who is at Risk?

The simultaneous presence of both mental illness and a substance abuse disorder in a single individual, known as “co-occurring disorders” (CODs), has become the focus of attention for many behavioral health researchers, clinicians and policymakers in recent years due to emerging evidence of the serious and challenging nature of these disorders. Within the population of individuals with serious mental illness, for example, substance use has been shown to adversely affect the course and outcome of mental health treatment.

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) recently estimated that 7.2 million Americans between the ages of 18 and 54 have CODs. In Virginia, this equates to approximately 191,210 adults currently living with CODs in the Commonwealth. Persons at risk for developing a COD include individuals with a serious and debilitating mental illness and those with a history of abusing alcohol and/or other drugs.

Strong evidence indicates that the prevalence of substance abuse in people with severe mental illness is substantially greater than in the general population. Studies suggest that those with schizophrenia, for example, are four times more likely to have a substance use disorder during their lifetime than persons in the general population; those with bipolar disorder are more than five times more likely to have such a disorder.

Adolescents in particular are a vulnerable population and face unique risks from the use of mood-altering substances. The use of substances often compromises their mental and emotional development by interfering with how they approach and experience interpersonal relationships. In addition, adolescents who abuse substances are at serious risk for a number of direct and indirect consequences, including school-related problems, risky sexual practices, delinquent behavior, developmental problems, and a worsening of drug/alcohol abuse.

Both adults and adolescents with mental health disorders can be at increased risk of abusing alcohol and other drugs. Some people with mental illness use drugs or alcohol to self-medicate; the use of mood- or mind-altering substances helps them to deal with the symptoms of their mental illness; the side effects of medications they take as part of their treatment; feelings of depression and alienation; or the inability to relate to others around them.

Despite the reasons for the existence of CODs, however, research suggests that persons with untreated CODs are likely to experience a worsening of both their mental illness and substance abuse, leading to poorer functioning, higher rates of psychiatric hospitalization, decreased social functioning, and non-compliance with treatment. In addition, CODs are associated with an increased risk of contracting HIV and hepatitis, greater difficulty in accessing health care services, and an increased risk for violent behavior.

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