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Co-occurring Disorders in The Treatment Continuum of Care and Higher Education

Co-occurring Disorders in The Treatment Continuum of Care and Higher Education

Arguably the single greatest misconception for families experiencing a crisis about co-occurring disorders is that they are uncommon and only factor into the recovery process if manifesting as severe and persistent mental health concerns. This misconception is very much the result of stigma in our society surrounding mental health concerns and substance use disorders. It’s not just a matter of us, as a society, being uninformed about mental health concerns … every one of us has a socially trained response to their existence that leaves us really, really not wanting to acknowledge when they exist in ourselves or a family member. The reality is that essentially all humans struggle with some mental health issues at some if not several stages of their lives. They are not a new phenomenon and have existed as long as humans have.

While severe and persistent mental health concerns are fairly common in emerging adult populations receiving treatment for substance use disorders, they are oftentimes easier to address both from an individual and family systems perspective. The interventions are clearer cut in terms of the necessity for effective medications, in which clinical interventions are most effective and the value of longer term supportive subacute care is more evident. Equally important to the implementation of effective treatment protocols is the fact that the individual’s family, often, views the individual as a “sick” person who needs help getting “well.” Rarely if ever do individuals with co-occurring disorders get yelled at for suffering from schizophrenia or being on the autism spectrum. Additionally, this primary mental health concern often seems to soften the view of a co-occurring substance use disorder in that the individual’s drug and alcohol use is frequently viewed as a series of failed attempts to “self-medicate.”

Where co-occurring disorders get less clear cut for families and individuals dealing with them, and where social stigma keeps them hidden, is in the arena of “less severe” mental health concerns. When individuals attempt suicide, they are viewed with empathy and compassion. When individuals struggle with depression year after year they’re “just not popular” amongst their peers, or are “always so negative.” The same is true of many other disorders. Hospitalized for an eating disorder? Empathy. Just struggle with disordered eating? “Unhealthy.” Panic attacks? Empathy. Anxiety disorder? “Honestly, is that even a real thing?” The list continues.

The reality is that virtually all individuals who struggle with a substance use disorder, struggle with varying degrees of additional co-occurring mental health concerns. Substance use disorder itself is a mental health concern, despite the fact that it is often viewed separately, so we should find it unsurprising that the same unwell organ that requires treatment for a substance use disorder also struggles with related illnesses. In no other treatable health condition do we expect a diseased organ suffering catastrophically in one of its functions to operate optimally in all of its other capacities.

Recovery isn’t fixing a car by replacing a broken part. Recovery is learning to walk again after a spinal injury and then continuing to take care of your health so that your likelihood of repeating the injury dramatically decreases.

It is for this reason, above all others, that we need to provide long comprehensive continuums of care which extend from acute care interventions, through subacute care and into higher education or other communities that support a culture of wellness. Recovery isn’t fixing a car by replacing a broken part. Recovery is learning to walk again after a spinal injury and then continuing to take care of your health so that your likelihood of repeating the injury dramatically decreases.

Just as bodies take time to heal, minds do as well. Just as we must work to maintain physical health, we must work to maintain mental health. Just as we don’t expect an individual with a broken leg to run a marathon while healing, we should not expect an individual struggling with a mental health concern to “snap out of it.” After tens of millions of treatment episodes in the past half century we, as the treatment industry, all need to be equipped to treat trauma as a norm, not as an exception. We all need to be able to treat depression as a norm, not as an exception. We need to be able to treat lack of emotional regulation and behavioral disorders as a norm, not as an exception. The list goes on and on.

In closing, I would like to leave you with two final thoughts. The first is that I do not know where all the serene, emotionally well-adjusted, joy filled individuals with high self-esteem in conjunction with a life-threatening substance use disorder are going to treatment, but they certainly aren’t showing up at our facilities. The second, is that I definitely struggled with my own co-occurring mental health concerns when I finally accepted help over 16 years ago. Those co-occurring mental health concerns didn’t get addressed and checked off a list over the course of two weeks—they were treated over the course two years extending well beyond my own acute care episode. I was set up for success in my recovery and then surrounded with the supportive infrastructure for long enough that successful recovery transitioned from an intangible concept into a reality for myself and my family. My family was taught about my recovery process and set up for success as well. If we really want people to succeed, we’re going to have to first treat and then provide long-term low level support services for both substance use disorders and co-occurring mental health concerns for as long as they take without the shaming pressure of “hurry up and be fully recovered so we can all get on with our lives. You’ve been in treatment for 30 days already. Why can’t you just get it?”

Andrew Burki outcome based reimbursement









Andrew Burki, MSW
CEO, Life of Purpose

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