Back To CourseGuide to Becoming a Substance Abuse Counselor
7 chapters | 59 lessons
Jennie is a therapist and licensed clinical social worker with a master's degree in social work.
Have you ever had the misfortune to have two illnesses at the same time? Maybe you had bronchitis and then came down with the flu. Or maybe you have a family member with both diabetes and high blood pressure. You can see where one illness may complicate or worsen the other. That's similar to what happens with co-occurring disorders. Co-occurring disorders happen when someone has both a substance abuse diagnosis and another mental health issue like depression. This may also be referred to as a dual diagnosis.
These diagnoses can have tricky relationships with each other. For example, someone may develop a substance abuse disorder first, such as an addiction to opioids (like pain pills or heroin). Because of the mental and physical effects on the body and brain over time, plus all of the life complications of an addiction, that person may then start to develop depression and anxiety disorders as well.
Likewise, someone may have post-traumatic stress disorder that was never diagnosed or treated properly, and then start depending on alcohol to control the symptoms. This is understandable, and may even be effective in the short-term. But over time this almost always makes things worse since it then leaves the person with yet another struggle to deal with.
People who have a mental illness are also more vulnerable to developing a substance abuse problem. Sometimes this is referred to as self-medicating. Among the most common disorders to occur in substance abuse treatment are major depressive disorder, general anxiety disorder, and post-traumatic stress disorder.
The most common signs of depression are decreased interest in daily activities, a change in sleep and eating patterns, self-isolation, and thoughts of shame and self-blame. A short standard screening test called the PHQ-9 (or patient health questionnaire-9) can be used as a beginning screen for depression.
Major signs of general anxiety include nervousness, worrying about different things, and a feeling of doom -- like something horrible could happen at any moment. Another scale called the GAD-7 (or General Anxiety Disorder-7) can be used to check for this condition.
General anxiety is often confused with a different anxiety disorder called post-traumatic stress disorder (known as PTSD). Signs of this can include both depression and anxiety symptoms, along with exposure to a traumatic event that the client likely tries to avoid thinking about. Anxiety symptoms can be even more severe with PTSD, and the client might have flashbacks, nightmares, and intrusive memories of the traumatic event. One commonly used screen for PTSD is the PCL-5 (or PTSD Checklist for DSM-5).
As you can see, these conditions can make it very difficult to manage everyday life and may easily complicate or worsen a substance abuse disorder. It's generally recommended that substance abuse and mental health issues be treated together because of their complicated relationship. Fortunately, there are several standard treatments that are helpful for multiple conditions.
Variations of cognitive behavioral therapy, or CBT, have been shown to help with a variety of mental illnesses as well as substance abuse issues. CBT is particularly effective for depression and anxiety disorders. Therapy can be delivered in individual, family, or group sessions. A few types of CBT therapies are specific for PTSD as well, such as prolonged exposure and cognitive processing therapy.
Motivational interviewing is a technique to help clients identify their goals and take steps to achieve them, without feeling overwhelmed or too pressured. It's often used for substance abuse and other mental health conditions. It can be combined with a variety of other treatments as well.
Medication is sometimes recommended for more severe mental health disorders, especially for those who have a strong biological cause such as schizophrenia or bipolar disorders. Counselors typically work in conjunction with a physician when clients need medication, usually working alongside a psychiatrist who specializes in mental health medications.
Medications are also sometimes used to compliment counseling in substance abuse treatment. For example, there are pills that can decrease the urge to drink, or help clients gradually wean themselves off pills. Most doctors require clients to also participate in counseling while taking these medications. Sometimes supervised detox is necessary for a few days to help clients quit highly addictive substances in a safe environment.
Traditionally, counselors and legal systems have suggested or even required clients to participate in 12-step groups such as Alcoholics Anonymous while they get mental health treatment. Others feel this takes away from the voluntary nature of these groups and don't believe clients should be pressured to join them. However, 12-step groups are often abundant and free when mental health treatment may be more difficult to access.
It's helpful for therapists to have training in and a basic understanding of a variety of mental health conditions, as well as an understanding of the differences in substances. Clients struggling with benzodiazepines will have a very different experience than those quitting meth, for example.
Substance abuse clients are often referred by the legal system, and laws vary by state. In some areas marijuana is considered a helpful medication, while in other areas it remains illegal.
Fortunately, relief from symptoms of one disorder can help ameliorate symptoms of another. Clients who quit drinking may notice their mood fluctuations even out over time and they may no longer meet criteria for major depression. Paranoid symptoms may sometimes go away once a client stops using methamphetamines. Learning relaxation techniques to naturally manage anxiety may make it a easier to quit substances.
Therapists should always work within their areas of training and experience. Some counselors are trained specifically in the area of substance abuse treatment but don't have a license for treating mental health. In this case, a referral to a licensed mental health therapist may be needed. Even licensed therapists may also find themselves outside their areas of expertise due to the wide variety of issues that may co-occur. While it may sometimes be ideal to refer clients to a specialist, in some areas there may be limited availability of clinicians due to recent rises in substance abuse cases. This is where ongoing training in proven therapies along with consultation with more experienced therapists is key.
As you can see, dealing with both a substance abuse problem and a mental illness can be tricky for both clients and those who help them. When someone has both of these issues, it is called a co-occurring disorder (previously called a dual diagnosis). Common diagnoses that co-occur with substance abuse include major depression disorder, general anxiety disorder, and post-traumatic stress disorder. However, any mental illness could co-occur with substance abuse problems. It is generally recommended that rather than treating issues separately, therapists should treat them together. Fortunately, common interventions like cognitive-behavioral therapy, motivational interviewing, and meditation can be helpful for multiple conditions. Therapists should seek training in a variety of mental health conditions and evidence-based treatments, and should ask for support and consultation when needed, or refer to qualified professionals if necessary.
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Back To CourseGuide to Becoming a Substance Abuse Counselor
7 chapters | 59 lessons