By RICH JONES
People with mental health issues are at high risk for substance use disorder (SUD), says a leading virtual support program designed to help individuals struggling with stress, substance use and suicidal thoughts.
A 2019 national survey from the Substance Abuse and Mental Health Services Administration (SAMHSA) estimates nearly 50 percent of individuals with a severe mental illness reported engaging in drug or alcohol use. The diagnosis is called co-occurrence or comorbidity. Additionally, we know with certainty that COVID-19 has impacted that number and that the number of individuals struggling have skyrocketed because of it.
“Self-medicating mental illness with drugs and alcohol is prevalent,” said Heritage CARES EVP and Executive Director Rich Jones, MA, MBA, LCAS, SAP. “Most of us in recovery also have some type of co-occurring diagnosis. For example, alcohol does a great job of taking the edge off anxiety and stress. Likewise, cocaine can motivate people who are depressed. The problem is that substance use makes the underlying problem worse.”
CARES is an acronym for Comprehensive Addiction Recovery Education and Support. The virtual program provides participants and their families convenient access to support from trained engagement coaches on any mobile device at any time. This significantly increases the potential for long-term recovery success for patients who have been through SUD treatment programs.
Jones explains that it’s very subjective as to who will develop a co-occurring disease. He says it’s a matter of access, opportunity and exposure – and how a person is wired. For some, substance use will have a positive effect, but for others, a negative impact.
At Heritage CARES, the most common co-occurring disorder combinations our participants’ experience are:
- Alcohol and depression
- Alcohol and anxiety
- Alcohol and bipolar disorder
- Post-traumatic stress disorder (PTSD) and opioids
Which comes first: SUD or mental illness
“As we say in the industry, the first diagnosis depends on which door you enter,” says Jones. “That’s to say if you show up to a drug and alcohol facility, the SUD will be the primary condition diagnosed. If you seek care at a mental health facility, that condition will be the primary diagnosis.”
For example, a man in his 30s has low-lying depression and a drinking issue, but neither has been formally diagnosed. He goes to a football game one night, drinks too much and drives home. Two potential scenarios might play out.
In situation A, he gets a DUI on his way home from the game, which will force an SUD diagnosis. In situation B, the same man makes it home from the game, only to face his wife, who is fed up with his drinking and decides to leave him. As a result, his depression worsens, and he seeks help at a mental health facility for suicidal thoughts. Depression will then be his diagnosis.
“The important thing to remember is that there are no wrong doors,” Jones says. “Either way, patients receive a full psychological assessment, and both conditions will be treated. The treatment will most likely involve integrated or parallel care – integrated care involves one doctor treating both conditions, and parallel involves concurrent treatment for both, just not from the same person. Parallel treatment is the most common, but either works well.”
Our clinicl treatment would handle a co-occurring disorder diagnosis with parallel treatment. For example, our ACE (Assertive Community Engagement) coaches are trained to keep a person on an SUD recovery track but would need to send that person to a licensed therapist for mental health issues.
Other co-occurring disorders caused by substance misuse
SUD puts individuals at risk for a whole host of other medical issues. For example, in July 2021, The Lancet published a study that found in 2020, alcohol use was a factor in 741,300 new cancer diagnoses – 6.3 million individuals died in 2020 from cancers of the esophagus, throat, larynx, colon, rectum, liver and breast.
While the researchers suggest that lessening alcohol use can be a cancer-prevention strategy, the study found that “fewer than one in three Americans recognize alcohol as a cause of cancer.”
HIV, AIDS and hepatitis are other comorbidity concerns – especially among people who use injection drugs. In 2017, the CDC reported nearly 10 percent of all new HIV infections occur among injection drug users.
Also, chronic pain often leads to SUD. Research indicates an estimated 10% of chronic pain patients misuse prescription opioids. In addition, experts believe chronic pain and associated emotional distress rewire the brain’s stress and reward circuitry, increasing the risk for opioid use disorder.
Other illnesses linked to SUD include heart disease, diabetes, liver disease and other lifestyle diseases.
“Often, it’s challenging to separate the medical and psychological conditions from the SUD,” says Jones. “But many times, the SUD is something you can positively affect through recovery efforts. Find a coach, get a plan and stay on the path. For some illnesses, you’ll see immediate effects without the drugs or alcohol. Others take much longer. We can all only go one step at a time. But sometimes a small, positive step in the right direction is the beginning of a big journey.”
Heritage CARES involves the entire family on the recovery journey with resources and coaching designed especially for family members directly affected by SUD.
Rich Jones is EVP and Executive Director of Heritage CARES a virtual support program available for companies, rehabilitation centers and first responders. Heritage CARES (Comprehensive Addiction Recovery Education and Support) is a comprehensive program providing support tools for substance use disorders (SUD), stress management and suicide prevention and intervention to participants and their immediate family members. The platform also includes tools for wellness and mental health, and anxiety issues and is available for use 24 hours a day, seven days a week. There are three components to the program: peer coaching, education and care management. For more information on Heritage CARES, visit Heritage CARES.
