The term “concurrent disorders” is poorly defined. It usually refers to two or more mental illnesses. Usually, one of the mental conditions is substance dependency; the other condition is a psychiatric diagnosis. The term “coexisting mental diagnosis” is probably preferable (more precise, less pejorative). However, I will continue using the term “concurrent disorders” for the purposes of this blog since it is the commonly (and currently) used nomenclature.
Concurrent disorders are inextricably linked. One condition predisposes to the other. Many addicts/alcoholics describe the presence of existential angst (“dis-ease”) predating their drinking/using, perhaps even going back to their earliest childhood recollections. Most addicts/alcoholics have some degree of concurrent psychopathology, perhaps not significant enough to be given a label, but contributing nevertheless to the addiction/alcoholism.
It is important to realize that concurrent disorders, like physical illnesses, come in spectrums or degrees of severity, not in black and white categories of presence/absence. Therefore, more subtle mental symptoms that do not meet the criteria for a full-blown diagnosis may still be significant enough to affect the course of a patient’s addiction/alcoholism.
Concurrent disorders are inextricably linked and should therefore be treated holistically, yet the medical profession has unfortunately divided itself into the psychiatric specialty (which, generally speaking, has little or no expertise in addiction) and the addiction field (which often has no understanding or interest in psychiatric disorders). The two specialties rarely communicate with each other. This unfortunate state of affairs stems from the fact that for a long time, addictions were not considered to be mental illnesses, but rather deliberate lifestyle choices made by morally deficient individuals. Personally speaking, I have had to seek out psychiatrists and addictionists who are not dismissive of each others’ specialties and are able to communicate with each other if the need arises.
Generally speaking, a concurrent psychiatric disorder cannot be diagnosed until at least six months of abstinence have been achieved. This is to rule out psychiatric disturbances arising out of drug/alcohol dependance/withdrawal symptoms. Sustained abstinence often (but not always) leads to concurrent symptoms or behaviours resolving completely or at least subsiding significantly, especially in those who do not have a concurrent disorder.
It turns out that many addicts/alcoholics who DO have a concurrent medical disorder become addicts/alcoholics by self-medicating maladaptively in response to an unrecognized, undiagnosed, underlying psychiatric disorder. What starts out as self-medicating, “shopping around” for a “healing” substance (alcohol, THC, opiates, cocaine,…), may temporarily alleviate the symptoms of an unrecognized psychiatric illness. However, this leads to a full-blown addiction that takes on a life of its own and may supersede the severity of the original mental illness!
And this leads us to the following important conclusion: the diagnosis of a concurrent disorder should not take the focus off the addiction which still needs to be managed and treated seriously.
On the other hand, many addicts/alcoholics suffer from past trauma and post-traumatic stress disorder. This concurrent disorder contributes especially to the persistence of alcoholism and addiction and must be attended to if the substance dependency is to be successfully treated.
In an ideal world, concurrent disorders would be treated holistically by one all-encompassing medical discipline. Historically however, the medical profession still considered addictions to be moral weaknesses long after it had accepted the disease model for all the other mental illnesses (schizophrenia, mood disorders, anxiety disorders, etc…). The best that can be hoped for at the present time is an improved, enlightened communication and mutual respect between psychiatrists and addictionists.
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