Living With a Co-occurring Disorder in Recovery

Each person’s recovery journey is unique. For some, recovery includes the extra challenge of managing one or more co-occurring mental health disorders in addition to addiction recovery. While this can create additional challenges, many of the treatments are actually similar or even the same. Living with a co-occurring disorder does not have to be a curse; both disorders can be managed disorders successfully.

What Are Co-occurring Mental Health Disorders?

Some people grow up with a mental health disorder, often undiagnosed. Not knowing what to do about it, they might turn to substances to self-medicate. This may lead to both an addiction and a co-occurring mental health disorder. Others may start using substances for other reasons and develop a co-occurring mental health disorder as a result of excessive or long-term substance abuse. Once again, they now have two disorders instead of just one.

Finding treatment for both disorders is the most important action to take. Continued substance use could worsen the mental health disorder or lead to the development of additional mental health disorders. Untreated mental health disorders can exacerbate substance use. The longer that both go untreated, the worse they can both get, and the harder they can become to treat.

Which Disorders Are Most Commonly Co-occurring?

The number and types of co-occurring disorders can widely vary, but there are a few specific mental health disorders that are quite common with substance use disorders. These disorders include:

• Depression
• Anxiety disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Bipolar disorder
• Post-traumatic stress disorder (PTSD)

Many of these can also occur together. Despite the fact that each disorder has specific treatments, many treatments overlap, including addiction treatment. Taking care of oneself and one’s recovery means that progress is being made toward treating the co-occurring disorder.

What Depression Looks Like for Men

Depression affects both men and women, but it can look different depending on a person’s gender. According to the National Institute of Mental Health (NIMA), six percent of men in the general population had a major depressive episode during the year 2020. Men are often less likely to recognize or talk about their feelings, which can make it more difficult for them to understand what is happening to them and also more difficult for others to notice symptoms of depression. Depression in men is also more likely to be characterized by irritability, aggression, or anger, which is less commonly associated with depressive symptoms.

Other symptoms can include:

• Feelings of restlessness or anxiousness
• Loss of interest in preferred activities
• Feeling hopeless, empty, flat, or sad
• Changes in sexual function or interest
• Problems with memory or concentration
• Sleep disturbances, including sleeping too much
• Changes in appetite, including eating too much or too little
• Isolating or withdrawing socially
• Self-medicating by increased use of drugs or alcohol
• Unexplained physical aches or pains, such as headaches or digestive issues
• Inability to function in day-to-day activities
• Engaging in high-risk behaviors
• Suicidal ideation or attempts

Characteristics of Anxiety as a Co-occurring Disorder

Men may feel anxious about taking a test, a job interview, a social situation, or finances. These common situations can cause episodes of anxiety that should dissipate when the situation resolves. However, some men experience anxiety that is disproportionate to what is happening around them. These men likely suffer from one or more anxiety disorders. According to NIMH, 14.3% of males in the general population experienced an anxiety disorder within a year of their survey. Anxiety disorders are common with addiction and can increase with heavy or extended substance use.

There are many different anxiety disorders. The most common umbrella diagnosis for anxiety is known as a generalized anxiety disorder (GAD). Symptoms of GAD can include:

• Feeling anxious, restless, or on edge
• Difficulty concentrating
• Irritability
• Being easily fatigued
• Feelings of worry that are difficult to control
• Difficulty falling asleep or staying asleep
• Unexplained muscle aches, headaches, stomachaches, or other pains

Other anxiety disorders include:

• Panic disorder is characterized by frequent, sudden, and unexpected panic attacks involving intense fear, pounding heart, sweating, trembling, chest pain, feelings of impending doom, or being out of control, despite there often being no clear danger or trigger. Panic attacks can occur without having a panic disorder.
• Social anxiety disorder involves intense and persistent fears of being watched or judged by others, including a pounding heart, sweating, trembling, blushing, stomachaches, difficulty making eye contact, a rigid body posture, speaking too softly, or feeling overly self-conscious. This disorder often interferes with social activities and can cause self-isolation.
• Phobia-related disorders are characterized by a disproportionate or irrational fear of objects or situations. Those with phobia disorders experience immediate and intense anxiety when encountering their feared object or situation and will take active steps to avoid those circumstances. There are specific types of phobia-related disorders, such as agoraphobia and separation anxiety disorder. There are also specific or simple phobias, including fears of:
  • Heights
  • Flying
  • Specific animals like spiders or snakes
  • Needles or injections
  • Enclosed spaces
  • Germs

Why Is It Called ADHD?

ADHD can be a confusing or misleading name for many people. Hyperactivity often does occur in many adults with ADHD, causing them to quickly dismiss a potential diagnosis. However, the name is simply inclusive of a full array of possible symptoms that include inattention, hyperactivity, and impulsivity. Some people have primarily inattentive symptoms, others have hyperactive-impulsive symptoms, while still others have all three categories of symptoms.

While ADHD is a diagnosis commonly associated with children. However, according to NIMH, adult males are more likely to be diagnosed with ADHD, with over five percent of men ages 18 to 44 in the general population sharing this diagnosis. ADHD is common with substance abuse because many substances help to counteract some of the symptoms. Stimulants are used to treat ADHD, and many people will find themselves self-medicating. Symptoms are not always as obvious in adults. Those with ADHD often struggle with:

• Staying organized
• Maintaining relationships
• Getting up or getting ready in the morning
• Being on time
• Staying on task or completing tasks
• Trying to do multiple things at one time
• Remembering important dates, appointments, bills, etc.
• Paying attention to details or making careless mistakes
• Losing track of things like keys, wallet, etc.
• Poor time management
• Being easily distracted
• Interrupting or talking excessively
• Fidgeting or restlessness

Describing Bipolar Disorder and Its Relationship to Addiction

Formerly known as manic depression for its dual cycles of mania and depression, bipolar disorder is one of the most common co-occurring disorders. Research is ongoing, but one theory is that addiction and bipolar disorder share common neurobiological and genetic factors. Bipolar disorder occurs at roughly the same prevalence in men and women, with NIMH reporting nearly three percent of males within the general population experiencing a bipolar diagnosis in the prior year.

Bipolar disorder is a serious mood disorder that consists of episodes of mania or hypomania followed by episodes of depression. There are two main types of bipolar disorder:

• Bipolar I disorder is characterized by serious manic episodes lasting at least seven days and typically requiring hospitalization, followed by depressive episodes that last two weeks or longer. Some people also experience mixed episodes, where they experience both manic and depressive symptoms concurrently.
• Bipolar II disorder is characterized by depressive episodes that last at least two weeks or longer with hypomanic episodes that are less severe than full-blown manic episodes.

Bipolar depression symptoms are similar to those listed above for depression. Symptoms of hypomania include:

• Pressured or rapid speech
• Feeling very positive or overly enthusiastic
• Feeling Irritable or very sensitive
• Decreased need for sleep
• Loss of appetite
• Having racing thoughts
• Being very creative
• Spending money, including money they don’t have
• Engaging in risky behaviors, including gambling or unprotected sex

When someone is manic, they might have all of the above symptoms, but to a more extreme level. Additionally, they are likely to feel invincible or superhuman, have delusional thoughts, or experience hallucinations.

What Is PTSD and Why Is It So Common in Addiction Recovery?

PTSD can develop in some people after experiencing trauma. When trauma occurs, the fight or flight response activates, then the body accesses the rest and digest state to recover. For some people, the trauma is overwhelming and their brain is unable to process it properly, leaving the body stuck in a fight or flight state. This can make them feel like they are still in danger weeks, months, or even years after the traumatic event occurred.

Those who experience PTSD will experience a wide variety of symptoms that are broken down into four basic categories:

• Re-experiencing symptoms, such as flashbacks, recurring dreams or memories, or distressing thoughts.
• Avoidance symptoms include avoiding people, places, objects, or feelings related to the trauma
• Reactivity and arousal symptoms, such as being easily startled, tense, on edge, having difficulty concentrating, irritability, trouble sleeping, or engaging in risky or destructive behaviors
• Mood and cognition symptoms, such as distorted thoughts or trouble remembering key features of the traumatic events; negative thoughts about self or the world, or negative emotions like fear, guilt, shame, and anger. The person may feel socially isolated; lose interest in preferred activities; have difficulty feeling happiness or satisfaction.

While NIMH indicates that approximately two percent of males in the general population had PTSD in the year prior to their data, it is notable that up to 59% of young people with PTSD develop a substance use disorder. The links between those who have experienced trauma or PTSD and those who develop addiction are very strong.

The Importance of Treating Co-occurring Disorders Together

Treating only the substance use disorder may exacerbate the symptoms of the mental health disorder. Treating only the mental health disorder could make the substance use disorder worse and cause dangerous interactions with potential medications. Therefore, it is important to treat co-occurring disorders together, also known as integrated treatments.

Integrated treatments can improve outcomes in many ways, including:

• Abstinence from substance use
• Improved mental functioning
• Increased chance of successful treatment for both disorders
• Better quality of life
• Decreased chances of hospitalization
• Lower chances of medication interactions
• Increased housing stability
• Fewer arrests

Managing Co-occurring Disorders in Recovery

Many of the coping mechanisms for mental health and substance use disorders overlap, making it easier to manage co-occurring disorders in recovery. Some of the ways to manage both types of disorders include:

• Sleep hygiene
• Eating good foods throughout the day
• Exercising regularly
• Meditation, breathing exercises, and yoga
• Continued therapy
• Utilizing support systems

Attending peer support meetings, seeing a psychiatrist, and possibly medications for an addiction or a co-occurring mental disorder often benefit the other disorder. Having a good attitude and learning about one’s disorders can empower a person and allow them to manage their co-occurring disorders in recovery.

Living with a co-occurring mental health disorder in recovery can provide extra challenges, but the more you learn about your disorders, the more you will be able to understand and take control of your life. By using integrated treatments to treat co-occurring disorders simultaneously, you improve your potential outcome and decrease potential negative side effects. Much of what you do for addiction recovery also benefits your mental health disorder, making it easier to manage your co-occurring disorders. Real Recovery Sober Living is Florida’s largest and best-rated sober living community. Our men’s sober living homes are clean and affordable, and we create an environment that is safe, fun, and provides accountability. Our mission is to provide a safe and stable recovery environment with a strong community support system to help men successfully transition back into the real world. Call us today at (727) 290-9156.