I grew up seeing the detrimental impacts of not properly treating COD. My biological father started drinking a lot and would have multiple affairs with various women. Shortly after the marriage, he started assaulting my mom. Fortunately, they got divorced, and my dad was later diagnosed with Borderline Personality Disorder. My dad wasn’t the only one impacted by co-occurring disorders. I also grew up around my uncle, who struggled with alcoholism. As a young girl, I never knew what to expect from him. Sometimes he was happy and affectionate, but other times he was distant and angry. He was diagnosed with Bipolar disorder. He and I were close, but because of his behavior and irresponsibility, we grew apart. Watching someone I loved so much transform so dramatically because of untreated substance abuse and mental illness was incredibly puzzling and painful. It has left a lasting impact on how I view COD.
Co-occurring disorders (COD) refer to the simultaneous presence of both mental disorders and substance abuse disorders. Despite being discovered many years ago, we still haven’t found a way to treat COD effectively. My claim for this research paper is that, as a society, we need better integrated treatment models for people suffering from co-occurring disorders, and we need to change our perspective from blaming the addict to understanding the addict. Current treatment models are too focused on visible behavior instead of targeting the invisible wounds. I believe that it's essential that substance abuse treatments require mental health assessments to ensure that the patient is being treated properly. My claim derives from research articles I've studied over the past 10 weeks, as well as my past experiences. This paper will go over four sources that support my claim and one source that contradicts it.
The recent movie Beautiful Boy portrays the stark realities of co-occurring disorders and the damaging impacts it has on individuals. I started watching, not expecting much. But as the movie continued, I felt like I was on a roller coaster of emotion. Suddenly, tears rushed down my face. This movie made me realize how broken our view on addiction is. As a society, we tend to blame the individual suffering for making bad decisions, but instead, we need to consider other factors that might contribute to the individual making these decisions. A particular scene from the movie stuck out to me.
"Until one day I woke up in a hospital and someone asked me, 'What's your problem?' And I said, 'I'm an alcoholic and an addict.' And he said... 'No, that's how you've been treating your problem.”. Nic initially identifies addiction as the main issue. Then, after a conversation with a person in the hospital, he realizes that he's been filling an empty void in himself using drugs. This enticing quote in the movie highlights a misinterpretation of addiction. Nic's addiction is not just portrayed as bad decision-making or a lack of willpower, but a desperate need to cope with emotions he doesn't fully understand. The film shows the multiple attempts at rehab and support groups, none of which fully succeed because they focus on the exterior instead of the interior of the issue. This supports the argument that dual diagnosis treatment is essential, and healthcare needs to be updated to effectively treat patients suffering from co-occurring disorders. Substance abuse is generally not the root cause but a symptom of the primary concern. Beautiful Boy highlights the urgent need for a more compassionate and holistic approach to treating co-occurring disorders.
To expand on this idea from a research-based perspective, I found myself looking at “Co-occurring disorders in substance abuse treatment: Issues and prospects”. The scholarly article, published in the Journal of Substance Abuse Treatment, Patrick M. Flynn, a professor who is primarily interested in behavioral health services research and improving treatment strategies that focus on reducing drug abuse, discusses the epidemiology of co-occurring disorders (CODs) and stresses the results of study findings for the current and the potential of substance abuse treatment. Flynn expresses that treatment for co-occurring disorders remains fragmented, despite increased understanding. He stands for a reformation through integrated care supported by planning and consistent examination. The article supports this point by using prior studies, clinical trials, and national guidelines. “ More than 25 years ago Woody and Blaine (1979) drew attention to an emerging literature describing a relationship between mental health problems (depression) and substance use disorders among substance abuse treatment clients. In spite of those early findings, the effort to develop an effective response to mental health problems is a more recent, if increasingly emphasized, concern of substance abuse treatment”(Flynn 1). This quote underscores that despite this connection being discovered more than 25 years ago, the effort to help those struggling with co-occurring disorders is fairly recent. “Overall, 6.6% of individuals with co-occurring disorders not involving serious mental disorders reported receiving both substance abuse and mental health services compared to 15.5% of individuals with co-occurring disorder involving serious mental illness.” This quote examines the data from the National Survey of Drug Use and Health. It indicates that a huge portion of individuals in the general population experiencing co-occurring disorders do not receive care for either substance abuse or mental health disorders.“Treatment systems have historically developed separately, leading to fragmented services for individuals with COD” (Flynn & Brown, 2008, p. 38). This quote appears early in the article, where the authors discuss why current treatments are inadequate. They argue that many treatment centers focus on substance abuse and don’t incorporate mental health screenings. The term “fragmentation of services” refers to how mental health and substance use services are often split between different providers or systems, leading to disjointed and ineffective care. The implications of this concept are significant. If dual-diagnosis patients aren’t identified correctly, their treatment plans will fail to address core mental health issues that might be driving their substance use. This leads to high relapse rates and treatment failure. This concept is vital to policymakers, treatment providers, and patients. It reveals a critical flaw in the structure of many treatment programs. It shifts the focus from improving treatment content to rethinking how patients are identified and evaluated. If screening is improved and services are integrated, it could lead to better long-term outcomes, reduced relapse, and more efficient use of healthcare resources. As I continued reading this article, I realized that the availability of treatment for COD patients is a huge concern. The article's main claim is that co-occurring disorders obstruct substance abuse treatments, expressing the need for specialized approaches and focused training for treatment providers to form a better understanding of individuals diagnosed with co-occurring disorders. This article highlights the importance of early diagnosis and funding for comprehensive, integrated treatments.
As I was doing this research, I came across an interview that drew me in, One Family’s Journey With Mental Illness and Addiction. I’m using this source as a real-life experience that highlights the need for integrated treatment. Nic shares how untreated mental disorders like bipolar disorder can lead to substance abuse as a form of self-medication. This source adds to the other sources by presenting a real-life consequence of neglecting co-occurring disorders. Nic Sheff shared that he attended multiple treatment centers before receiving a proper diagnosis for bipolar disorder. He stated, “It wasn’t until I got to that treatment center that they finally did have me meet with a psychiatrist and do the psychological testing, and I got the bipolar diagnosis, and started to get on medication for that. And yeah, it really changed things and it really helped.” Nic also emphasized the huge issue in treatment facilities, “The fact that I went to all those treatment centers and no one thought to look at my mental health issues beyond just my substance use disorder issues is troubling, for sure.” These points emphasize my claim of treating substance abuse disorder in conjunction with mental health disorders. Nic’s personal experience shows how harmful delayed diagnosis of bipolar disorder can be and how detrimental it was for his recovery. His experience exemplifies the need for integrated care plans and shows the importance of simultaneous treatment.
On the contrary, Salloum, I. M., & Thase discuss in their article , Impact of substance abuse on the course and treatment of bipolar disorder, the complexity of treatment and why some specialists believe mental stabilization must come first. “The presence of this so-called 'dual diagnosis' creates a serious challenge in terms of establishing an accurate diagnosis and providing appropriate treatment interventions. The inter-relationship between these disorders appears to be mutually detrimental”( Salloum 1). This quote displays the complexities of integrating this treatment model into real-life situations. It puts into perspective how the inter-relationship between these disorders is mutually detrimental. This quote highlights how it can be quite challenging to determine how to diagnose such patients. This article connects to other sources by highlighting the real-world difficulty of implementing integrated care. The authors state that active substance use can mask or mimic psychiatric disorders, making it difficult to diagnose accurately. For example, stimulant use may appear as mania, while withdrawal symptoms may resemble depression. They suggest that in many cases, substance use must be stabilized first or eliminated before a reliable mental health treatment plan can be implemented, advocating for consecutive treatment in certain cases rather than full integration from the start. While this source challenges the practicality of integrated treatment in certain cases, it highlights the need for a better system. It clarifies my claim by recognizing that integrated treatment must be flexible and personalized. This complex point of view paves the way to a deeper understanding of co-occurring disorders.
My final source dives deeper into this concept and guides users to effectively treat co-occurring disorders. Integrated Treatment for Dual Disorders: A Guide to Effective Practice is a clinical guidebook published in 2003. The book's author is Kim T. Mueser, a clinical psychologist and professor at the Center for Psychiatric Rehabilitation at Dartmouth Medical School. Dr. Mueser's research interests include family psychoeducation, the treatment of co-occurring psychiatric and substance use disorders, psychiatric rehabilitation for serious mental illnesses, and the treatment of posttraumatic stress disorder. Mueser’s book is both a practical guide and an academic argument that supports using integrated treatment for people who have both serious mental illness and substance use disorders. The book’s main goal is to show that integrated treatment works better than treating each issue separately and to give clear, research-based instructions for applying this ideology into practice. Mueser claims that this blueprint will not only improve care but also help people recover more effectively in the long run. One major section emphasizes the benefits of stage-wise treatment and motivational interventions, while another details program design, such as team roles and administrative structures. The guide also explores common obstacles to execution, such as infrastructure, training, identifying the target population, and funding challenges. The guide also effectively offers research-based solutions. “The patients confound the best efforts of public mental health systems and networks of treatment programs for addiction. As the authors of this book point out, the traditional approach has been to choose one diagnosis and focus treatment efforts on that before moving on to treat the second diagnosis”(Mueser 3). This guide emphasizes the importance of treating both mental health disorders together. The author states that typically and tragically, these approaches have often been futile. “ Greg was a 36-year-old man with schizophrenia and alcohol abuse. For 6 months he had been working with his case manager, Tom, whom he had been seeing regularly. At Greg's request Tom had helped him obtain a 6-hour-per-week job at a local recycling center. On Mondays, Wednesdays, and Fridays from 10:00 A.M. to 12 noon, Greg worked at the center. He was having trouble making it to work on time, and his boss was considering firing him. Tom and Greg discussed the problem, and Tom asked Greg what his drinking had been like since he started work. Greg said he was drinking three to four beers nightly to relax. Tom suggested that on nights before work, he try cutting down to one beer and see whether that made it easier to get up on time. Greg agreed to give it a try; he found that cutting down did make it easier to get up, and he was able to maintain his job”(Mueser 127). This case example shows how clinicians should respond to their clients to create a good relationship and effectively treat their disorder. Motivating clients with co-occurring disorders to begin working on their problems and helping them regain control over their lives is challenging but rewarding.
All of my sources, from a personal narrative to scientific articles, argue for an urgent need for an integrated and personalized approach to substance abuse. Co-occurring treatments need to be treated through compassionate and individualized care. Mental illness and substance abuse disorders often overlap; any treatment plan that ignores the other is setting up the patient for failure. Failing to address co-occurring disorders together not only impacts the individual but also their families.
My research and personal experiences have taught me that addiction is not a flaw in the individual but a coping mechanism for deeper, untreated pain. By continuing to treat substance abuse in isolation, we create a system that band-aids the wound instead of healing it. We need to restructure our treatment models to better fit the complexities of co-occurring disorders. Integrated care isn’t just a clinical recommendation, it’s a human necessity.