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.

Combatting the Stigma of Addiction

We have understood addiction to be a disease for nearly a century, yet shame and stigma continue to keep people from seeking treatment and support. This has always been the case, but skyrocketing overdose deaths, substance abuse, and suicide rates both locally and nationwide renew a sense of urgency in our mission to combat false narratives, beliefs and assumptions around this chronic disease. This is the first in a blog series exploring the many facets of stigma that perpetuate addiction. Before we dive in, it is important to start with the basics:

Addiction is a disease.

Contrary to the belief that addiction is an individual moral failing, addiction is a complex, chronic disease that changes the chemical balance of the reward center of the brain. It is caused by a combination of biological, environmental, and developmental factors, and according to the American Psychological Association, about half the risk for addiction is genetic. Long-term substance use can also change the parts of the brain that affect learning, judgement, decision making, self-control and memory.

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Addiction is treatable. Recovery is possible.

There is not a cure to addiction, but it can be treated and managed. In fact, a study published by the Centers for Disease Control and Prevention and the National Institute on Drug Abuse found that 3 out of 4 people who experienced addiction went on to recover.

Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives and strive to reach their full potential. Recovery from substance use disorders looks different for each individual and can consist of pharmacological, social and psychological treatment. Regardless of the route taken, we want people struggling with substances to know that a life in recovery can be joyous, fulfilling and whole.

Everyone is worthy of recovery.

We believe everyone is deserving of a chance to live a life of recovery, regardless of the path that brought them to our doorstep. Anyone who comes to us for help is welcomed with the respect and compassion they need to feel safe enough to begin this vulnerable process of healing and renewal.

If you, a loved one, or a patient is struggling with substance use, contact us today to inquire about treatment options.

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.

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.

Now is the Time to Address Co-Occurring Disorders

As Houston’s leading nonprofit provider of prevention, education, and outpatient treatment services for addiction and co-occurring mental health disorders, The Council on Recovery has helped thousands of people enter recovery and families heal. As a leader though, it is our obligation to do more than serve. We need to look to the future, embrace behavioral health innovations that are grounded in evidence, and inspire others in times of uncertainty.

Over the past year, The Council has led just such a charge, through the formation of The Center for Co-Occurring Disorders. The Center is a groundbreaking initiative designed to address co-occurring mental health disorders concurrently. When we launched The Center, we knew there was an urgent need for these services; we also knew that if we wanted this effort to succeed – and to last – we had much more to learn.

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Our history in the behavioral health field told us that our efforts had to be disruptive. There have been far too many efforts to treat co-occurring disorders that have fallen short because those involved held on to the status quo; others could not conceive of how to reconfigure the existing frameworks; still others sought a one-size-fits-all solution; and others focused solely on direct services without modifying the systems in which they operate.

We knew The Center had to be different.

Our first year was a time to envision, generate ideas, and challenge existing systems. Through this process, we recognized that the approach to treating co-occurring mental health disorders needs to be multi-dimensional and uniquely catered to the individual patient. Here’s what we accomplished in the first year of this initiative:

  • We assessed the readiness of The Council’s own treatment programs to address co-occurring disorders in our clients.
  • We formed an advisory board comprised of leaders from the health, psychiatry, addiction and IDD (intellectual and developmental disability) fields.
  • We launched a 6-part workshop series that trained medical professionals in Houston to understand and address co-occurring mental health disorders, free of charge.

And these are just the first steps. Moving forward we intend to incubate, test and adapt the best models of assessment, treatment and payment. We will continue to educate the medical community on various aspects of co-occurring disorders, including their connection to trauma and suicide. We will continue to empower and equip healthcare providers with the skills and tools necessary to effectively and compassionately help those in need.

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.