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!

RECAP: Danny Trejo’s Story of Recovery & Redemption Inspires Hundreds at The Council’s 37th Annual Spring Luncheon

Actor, activist, author and restauranteur Danny Trejo inspired a crowd of more than 900 Houstonians with his story of recovery and redemption at The Council’s 37th Annual Spring Luncheon on Thursday, April 21, 2022. Presented by The Moody Endowment, the event raised more than $450,000 to help local individuals and families recover from the effects of addiction and co-occurring mental health disorders.

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Mistress of Ceremonies and Board of Trustees member Jerri Duddlesten Moore opened the luncheon, followed by an invocation by Reverend Michelle Manuel of St. Luke’s United Methodist Church. Board of Trustees Chair Joe Matula then announced that this year’s Lifetime Achievement Award is awarded to the late Kirby Attwell, a longtime friend and supporter of The Council, whose life and legacy have forever changed the landscape of addiction treatment in Houston.

President and CEO Mary Beck, LMSW, followed, giving an impassioned appeal for a community united against the growing shame and stigma around substance use disorders and co-occurring mental health conditions. “It is through this community that we find the antidote to shame,” she said. “Awareness, education, and connection are all powerful tools in the fight against stigma.”

Luncheon Co-Chairs Diane St. Yves Brewer and Patrick Keegan then shared their powerful stories of recovery, with Keegan recounting how his attendance of a previous Council luncheon inspired him to a life of recovery. “I saw hundreds of people: sober, happy, and successful and I thought to myself, ‘If these folks can do it, I can do it.’”

Board Trustee Joanie McLeod introduced keynote speaker Danny Trejo who told his harrowing, inspiring, and often humorous story of recovery and redemption. Trejo told the crowd about his substance use in his early childhood, how he found recovery with the help of a 12-step program, and how service to his community has been essential to his recovery. He also emphasized the importance of organizations like The Council to those struggling with substance use, saying, “The Council is like a lighthouse, they point the way when you’re lost.”

The event concluded with a surprise video from former Prima Ballerina for the Houston Ballet, Lauren Anderson, who announced she would serve as keynote speaker for The Council’s Fall Luncheon on October 21, 2022. Save the date!

Growing Our Own: The Council’s Fellowship Experience

At The Council on Recovery, we know we can’t solve addiction alone. That’s why training medical and behavioral health professionals is an essential part of our work – and has been since as early as 1955! For ten years, our Mary Bell Behavioral Health Clinical Fellowship has been a pillar in our efforts to train the next generation of behavioral health professionals. We sat down with Nina Tahija, LMSW, our current Mary Bell Behavioral Health Clinical Fellow at the Center for Recovering Families to discuss her experience:

Tell me about yourself and what you do at The Council.

I graduated from University of Houston Graduate College of Social Work in 2021. While I was there, I completed a clinical internship at Baylor Psychiatry Clinic, a trauma fellowship, and a specialization in health and behavioral health. I’m also a trauma-sensitive yoga facilitator. I have a strong passion for providing trauma-informed care for my clients.

I currently work as a Mary Bell Behavioral Health Clinical Fellow. In this role, I co-facilitate psychotherapy groups, lead a Dialectical Behavior therapy-informed skills group, conduct assessments and provide individual therapy.

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Nina Tahija, LMSW

Why did you want to become a fellow with us?

I was looking for a supportive and collaborative environment to continue honing my clinical skills. I had heard former interns and fellows speak highly of the tremendous growth they got as part of the clinical team, so I thought it would be a natural next step for me. The fellowship program at The Council offered the opportunity to work with individuals struggling with substance abuse and/or other mental health struggles, while receiving intensive training through weekly didactics, supervision, and treatment team meetings.

What are some major takeaways from your experience as a fellow with the Center for Recovering Families?

One of the biggest takeaways for me is the power of connection in one’s recovery. As a group facilitator, I have witnessed the profound impact this space provides for clients to share openly and vulnerably, ask for what they need, and support each other. I also learned the importance to meet clients where they are, understanding that each person has unique lived experiences and are in different parts of their healing journey.

What is some advice you have for people wanting to go into social work and behavioral health?

Know your why for going into this field. Be open to continually reflect on your own experiences, positionality, and biases so you are mindful of the lens that you are working with. Also know that you don’t have to go through this process alone. One of the highlights of my time in graduate school is finding a supportive community through my peers and mentors.

Finding Recovery at The Council’s Luncheons

The Council’s beloved Annual Speaker Series is more than a luncheon: time and time again, it has served as the starting point in a person’s recovery journey.

It’s a big claim – and to the outside observer, may seem far-fetched. How could a luncheon be the doorstep to recovery? The answer lies in community. As one attendee explained, “My view on recovery was very narrow. I felt like a complete low-life alcoholic doomed to a life of despair, but when I walked into my first Council luncheon and saw the massive crowd of happy and seemingly normal and successful people, my vision changed.”

This centuries-old misconception of addiction as a moral failing has long contributed to the feelings of shame that work to keep people trapped in their disease. The Council’s luncheon is a bold declaration that it is okay to have this disease; it sends a message that recovery is possible and worth our best efforts for every individual. The Council’s luncheon delivers a radical shift in perspective and opens the doorway to possibility. Said one individual, “The Council’s luncheon broke the stigma for me of what an alcoholic was and what a glorious life in recovery could look like.”

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Every spring and fall, up to 1,000 members of Houston’s recovery and behavioral healthcare communities attend The Council’s luncheons.

The sheer size of The Council’s luncheons further strengthens this powerful message. One attendee remarked, “I sat in this room with 1,000 people who were there to support recovery. I had never seen anything like it. For the first time in my life, I felt the stigma of addiction lift. Here was a place free from shame and judgment. A place to share the stories of addiction, but more importantly to share the promises of recovery and the resources available to every person in Houston through The Council.”

Because if addiction thrives in isolation, community is the antidote.

Through community we can nourish recovery. A community of recovery can change despair to possibility; it can give us permission to replace shame with self-compassion; it can provide a lifeline of hope.

Since its inception nearly 40 years ago, The Council’s Annual Speaker Series has raised millions of dollars to support local families impacted by addiction; it has shared a message of hope for recovery; and perhaps most importantly of all it has created a community of individuals who can find strength in recovery, together.

If you know someone who needs to hear lived experiences of the power of recovery, invite them to our upcoming luncheon. They might just walk away changed.

Announcing Danny Trejo as Keynote Speaker for our 37th Annual Spring Luncheon

The actor, activist, author and restauranteur Danny Trejo will tell his story of recovery and redemption on Thursday, April 21, 2022 at the Hilton Americas – Houston hotel.

The Council on Recovery is excited to welcome Danny Trejo as the keynote speaker for our 37th Annual Spring Luncheon on Thursday, April 21, 2022. Danny Trejo is an actor, activist, author and restauranteur, best known for his starring roles in the Spy Kids, From Dusk Till Dawn, and Machete film series, as well as recurring roles in the television series Breaking Bad, King of the Hill, and Sons of Anarchy. He most recently appeared in the popular Star Wars series, The Book of Boba Fett.

Danny Trejo headshot

Trejo struggled with addiction at as early as 12 years old, found sobriety through attending 12-step meetings while in prison, and has been sober for more than five decades. He chronicled his harrowing and inspiring story in his critically acclaimed 2021 memoir Trejo: My Life of Crime, Redemption, & Hollywood.

Since its inception 40 years ago, The Council’s speaker series has promoted a message of hope and healing, and helped to reduce the shame and stigma of substance use and related disorders in the Houston community and beyond. The Council provides treatment and recovery support to individuals affected by substance use and other co-occurring mental health conditions, regardless of their ability to pay. Funds raised through our annual luncheons ensure that no family in need is ever turned away.

To reserve your table today, visit our speaker series website. Individual tickets will be sold at a later date.