The Origins of Co-Occurring Disorders

This blog post is contributed by Izzie Karohl, NREMT, Policy Research Intern

SAMHSA’s 2020 National Survey of Drug Use and Health estimates that 45% of adults with a substance use disorder also have a co-occurring mental health condition. Because people with mental health conditions make up such a large portion of folks who seek substance use disorder treatment, it’s important to understand the complex relationship between the two co-occurring disorders.

This is the first blog post in a series that discusses current approaches to treating co-occurring disorders. But before we talk about treatment, we should start with one, deceptively simple question: why is the rate of co-occurring disorders so high in the first place? This blog post addresses the three most popular theories–the self-medication theory, the gene variants theory, and the kindling effect theory.

Self-Medication 

Drinking to cope with the distress of an underlying mental health disorder is self-medication. Sometimes, people develop a substance use disorder because the effects of drugs and alcohol alleviate symptoms of PTSD, bipolar disorder, depression, and/or anxiety, just to name a few. Part of recovery is learning how to cope with distress, and this can include symptoms of mental illness. However, it’s important that clinicians identify mental illness as an independent disorder so that the client receives appropriate psychiatric care. 

woman with co-occurring disorders

Gene Variants 

Numerous studies have demonstrated that substance use disorders and mental health disorders run in biological families. The gene variants theory proposes that specific genes linked to substance use disorders are also linked to mental health disorders. For example, you may have heard that people with untreated ADHD are more likely to develop a substance use disorder. The gene variants theory hypothesizes that genetic mutations which result in more hyperactive, impulsive, and reward-driven brains (ADHD) are also mutations that make brains more vulnerable to substance use disorders. Currently, scientists are identifying these specific mutations to create a “genetic risk factor” score that may be able to predict who is more likely to develop co-occurring disorders based on their DNA sequence. 

Kindling Effect 

When trying to start a fire, having one plank of wood only goes so far. But if you add lighter fluid and small sticks around the plank, the likelihood of a blazing flame skyrockets. That’s the basis of the kindling theory. Having an initial mental disorder, whether psychiatric or substance use, changes the neural pathways in the brain: strengthening some, lessening others, and making some more sensitive. These changes add kindling, making it more likely that a future stressor or behavior results in a secondary disorder. Unlike the gene theory that locates risk within one’s DNA, the kindling effect states that the progression of one disease and its changes to the brain are what make it more vulnerable to a second disorder. The kindling effect points to the importance of early intervention to prevent secondary disorder development.

None of these theories are ultimately “right” or “wrong.” Rather, each of them help to explain the various ways co-occurring disorders may develop. It could be that a person is (a) genetically predisposed to both disorders, (b) develops a psychiatric disorder early on and progresses, which increases the vulnerability to developing a substance use disorder and (c) copes with the first disorder by self-medicating. But no matter how a person’s co-occurring disorder came to be, there is effective treatment for both. People can and do recover from co-occurring disorders.

Read more about co-occurring disorders here.

The Importance of Compassion and Connection in the Referral Process

This blog post is contributed by a counselor with The Council’s Outreach, Screening and Referrals department, which provides free screenings and referrals to detox services, inpatient and outpatient treatment facilities, and other recovery options.

A while ago, a client was referred to me from the Harris County Psychiatric Center. During the screening, the client revealed that his meth and cocaine use had destroyed his family and had caused trouble with the law. The client described some of the horrible things that he did to keep his drug habit going. I could see the pain in the client’s eyes as he began to go through the screening process, which made me want to do more for the client.

The only way I could help this client was to disclose a part of my own addiction, to help him know that there is hope, and that he does not have to continue using drugs. The client could not believe that I was homeless for 30 years, living on the streets and going in and out of hospitals and treatment centers. After my disclosure, I saw that the client was motivated to change. Because I went through the recovery process, I was able to help the client develop a plan of action to change his life. I stressed the importance of completing treatment for the next steps to take place.

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The client went on to an inpatient treatment facility, completed the 30-day program, and contacted me as soon as he was finished. I was able to get the client into sober living where he landed a job and had a place to stay. The client remembered that I told him I was going to connect him with an organization that was going to pay for his education. I gave the client the contact information, and he is now enrolled in barber school, working on his certification.

The client calls me from time to time to let me know that he is staying on course. He tells me he now has a support system, which includes his family, and that he did not know that he was capable of making the necessary changes in his life. He says that he will forever be grateful for the help that he received from The Council and wants to come back and share his story with our clients to provide them motivation as well!

Addiction & The Family: Unwritten Roles & Unspoken Rules

This blog post is the second in a series contributed by Rachel Evans, LMSW, of the Center for Recovering Families at The Council on Recovery and Ashley Taylor, MSW, LMSW, of Heights Family Counseling. Read the first post here.

When someone has a substance use disorder, the people within their close circle – whether it be family, friends or a combination of both – adapt to the associated behaviors. Many roles that these people embody contribute to the functionality of the system itself. There are a few adaptations of these roles, but the most common are the hero, the scapegoat, the addict, the mascot, the caretaker, and the lost child.

(For a breakdown of these roles and their impact on the system, read our blog post.)

While someone in the family unit might outwardly display particular character traits, there are also feelings that exist beneath the surface that are harder to recognize. Not every family system will reflect these roles, but oftentimes, these roles are displayed in some form or fashion. By taking on these roles, people within the system are able to assert some control over the outcome of their situation and maintain a sense of normalcy in a situation where one can feel a loss of control.

Addiction and family

In families that deal with substance use disorders, there are also unwritten rules that members abide by in order to prevent disruption within the system. These rules are: Don’t talk, don’t trust, and don’t feel. People within the system follow these rules to maintain the status quo. “Everyone in the system often begins to believe that their needs no longer matter,” says Rachel Evans, Family Therapist at the Center for Recovering Families. These rules are adaptations made beyond the roles that people within the family unit follow that help protect their goal, which is to manage life with someone struggling with a substance use disorder.

Family members can come to understand it like this: We don’t talk about the addiction. Secrecy allows the addiction to thrive. We cannot trust the person with a substance use disorder. Addiction often comes with inconsistent behaviors, so family members often learn not to trust their loved one, and often suppress their emotional experiences of the addiction. Because of these learned rules, recovery often begins with talking openly about the addiction safely, rebuilding trust, and identifying emotions in every family member.

If you or a loved one is struggling with a substance use disorder, or if you recognize any of these roles and rules in your own life, contact us today to inquire about counseling and treatment options.

The Impact of Addiction on The Family System

This blog post is contributed by Ashley Taylor, MSW, LMSW, of Heights Family Counseling and Rachel Evans, LMSW, of the Center for Recovering Families

When someone we love deals with addiction, wishful thinking tends to surround their recovery. We think to ourselves, “If this person just gets better, then everything else will fall into place.” No matter how desirable that outcome, substance use disorder is a systems disease that requires a systems solution. Substance use disorders not only affect the person suffering, but also the people closest to them.

“By the time people get treatment, the family system has often regulated around the addiction to maintain the status quo,” says Rachel Evans, family therapist at the Center for Recovering Families. “The addiction has become the locus of control.”

Everyone who is involved in the system has adapted in ways they might not even recognize in order to maintain a sense of normalcy and peace, while watching someone they love battle a difficult disease. Because of this, many families are exhausted by the time their loved one enters treatment. Regardless of the ways in which the support system has regulated itself around the addiction, the relationship between the person dealing with substance use disorder and their families can be an important one.

impact of addiction on family system

“The collaborative effort of treatment is very beneficial,” says Rachel. When appropriate, having family members present for treatment improves success rates, and treatment benefits both the person struggling with substance use disorder, as well as the family members. When it comes to recovery, it is crucial that everyone is willing to do things differently in order to set family recovery at the core of the system. Through family recovery, everyone is able to gather and understand different strategies for coping with the new way of life for this person, as well as unlearning potentially harmful practices that had been in use prior to the recovery process.

This help can take the form of family treatment, support groups such as Al-Anon and Nar-Anon, and even individual therapy. When an entire system is affected, addressing the entire system is the most effective treatment. This takes the responsibility off one individual and makes the process a collaborative one. In this way, the person going through recovery can feel more supported in their journey, and feel the love and encouragement from those closest to them.

The process of addiction recovery is rarely linear, nor does it only impact the person working to overcome substance use disorder. When addiction is viewed as a systems disease, it can be addressed throughout the whole system. By viewing this process in a more collaborative light, we are able to better support and understand the journey of our loved ones.

If you or a loved one is struggling with substance use disorder, call us today at 713.914.0556, or contact us through our website.

A Message to Those Affected by the Opioid Crisis

This blog post is authored by Mary H. Beck, LMSW, CAI, President & CEO of The Council on Recovery

Most of us are well aware of the opioid crisis facing our communities. We read the grave statistics about addiction and overdose deaths experienced by so many. Impassioned advocates call us to action, treatment specialists inform us on the most cutting-edge practices, legislators pass laws and allocate financial resources to combat this public health emergency. All of this is vitally important.

Yet we are facing a parallel crisis, which is tearing apart families and leaving people in severe distress – a crisis to which our communities are often blind: the trauma and grief experienced by family and friends of those struggling with addiction or who are trying to live in the wake of an overdose death.

Our loved ones die – it is a sad, painful truth. For years, many of us live in fear of this truth – knowing that when someone we love so deeply is suffering from a chronic illness, death may be the outcome. We cherish the moments of reprieve and hope for recovery. At other times, we are doing everything in our power to save them – we suffer in silence once they are gone.

This is true whether your loved one dies from cancer, heart failure, brain disease, and yes, addiction too. If you are feeling the pain of a loved one’s substance abuse or their death, you are not alone. Over 100,000 people have died of a drug overdose in the past year alone – leaving spouses, parents, siblings, and friends behind.

How did we get here?

Americans take 80 percent of all prescription painkillers in the world. New reports from the Centers for Disease Control and Prevention and the Houston High Intensity Drug Trafficking Area confirm that drug overdoses have surged since the onset of the COVID-19 pandemic, both in Houston and nationwide. The sharpest increases were deaths involving opioids, primarily illicitly manufactured fentanyl. In the last year, fentanyl related deaths in Houston increased by 40%.

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The extremity of this surge is a cause for grave concern for our team, but it only strengthens our resolve to partner with local leaders and community partners to tackle this issue comprehensively and systemically. This takes a multi-pronged approach – focused on education and awareness, providing intervention and treatment, opening doors to recovery, and when necessary supporting family and friends in their grief.

If you are one of the millions watching a loved one’s addiction spiral out of control, or if you have already lost a loved one due to an overdose, you deserve the same compassion and support others receive when they are grieving.  You need a place to turn, where your strength and courage are honored, while your grief and emotions are nurtured. The Council on Recovery is that place – a place to start when you don’t know where to turn and a place to heal.

If you, a loved one, or a client/patient is struggling with opioid use, contact us today, and we can get them the help they need. For more information on our opioid use services, download our flyer.

Recovery is for Everyone: A Recovery Month Message from our President & CEO

This blog post was contributed by Mary Beck, LMSW, CAI, President & CEO of The Council on Recovery

Friends,

This National Recovery Month, we celebrate and honor our friends, family members, coworkers and colleagues who are in recovery from addiction and other mental health disorders. Recovery is not a single finish line; it is a daily, lifelong commitment to better oneself and reach one’s full potential in the face of chronic substance abuse and mental health conditions. Such an effort can be difficult for anyone, but 75 years of service to our community has taught us this – with adequate resources and support, recovery is possible for everyone.

The theme of this year’s Recovery Month is “Recovery is for Everyone: Every Person, Every Family, Every Community.” In this year of growth and change for our organization, this theme reminds us of our commitment to welcome everyone to recovery by lowering barriers to recovery support, creating inclusive spaces and programs, and broadening our understanding of what recovery means for people with different needs and experiences.

Lowering barriers to recovery

To fulfill our vision for a community in which substance abuse is no longer a major problem, we must be willing to offer our services to all who need them. Serving the diverse community of Houston means understanding the various needs of people from differing backgrounds, as well as the unique barriers to recovery they may face.

Whether that means providing virtual services, combatting shame and stigma that still exist with substance use disorders and related mental health conditions, or offering an extensive range of treatment services to meet each person’s individual needs, our team is dedicated to helping all Houstonians who need us.

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Creating inclusive spaces and programs

Addiction is an equal opportunity destroyer, which means the opportunity of recovery can and should transcend race, gender, age, sexual orientation, creed, wealth, and any other label. Addiction and other mental health issues can affect anyone at any time, yet we know that those most affected often are afraid and uncertain or unable to access services necessary for recovery. Through our comprehensive service offerings, wellness opportunities, and compassionate, diverse team of addiction professionals, we strive to create an inclusive environment that celebrates our differences and unites us in a common goal of recovery for our entire community.

Broadening our understanding of recovery

Creating inclusive spaces for healing also requires understanding that recovery is not a single, defined process, neither is it limited to those with substance use disorders. The reason there is no universally agreed-upon definition for recovery is that the journey of recovery looks different for everyone. According to SAMHSA, recovery is “a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential.”

Our understanding of the effects of substance use, as well as its relation to other mental health conditions, has greatly improved in the past few decades, along with our approaches to treatment and recovery support. Through initiatives like our Center for Co-Occurring Disorders, we are working with trusted organizations across Houston to broaden our understanding of addiction and recovery to treat those who need our help more effectively.

If you or someone you love is struggling with substance use or another mental health condition, we welcome you to begin your own recovery journey today. Call us at (713) 914-0556, or contact us through our website, and our intake team can connect you with the help you need.