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Co-Occurring Substance Abuse/Mental Health Disorders and Qualifying for Long-Term Disability

By Matt Lalande in Hamilton Disability Lawyer, Long-Term Disability on September 05, 2022

Co-Occurring Substance Abuse/Mental Health Disorders and Qualifying for Long-Term Disability

Estimated reading time: 14 minutes

It is common knowledge that substance use disorders mostly co-occur with a multitude of other physical and mental diseases. Studies have consistently shown the high co-occurrence and the elevated risk of mental disorders in individuals with substance use disorders. In one medical study, it was shown that about two thirds of all alcohol or drug-dependent persons in substance abuse treatment show at least one additional current mental disorder, whereas the lifetime prevalence ranges up to 90%. Mood and anxiety disorders are the most prevalent.

A substance use disorder is a mental disorder that affects a person’s brain and behavior, leading to a person’s inability to control their use of substances such as legal or illegal drugs, alcohol, or medications. Symptoms can range from moderate to severe, with addiction being the most severe form of substance abuse disorder. Individuals who experience a substance use disorder (SUD) during their lives may also experience a co-occurring mental disorder and vice versa. Co-occurring disorders can include anxiety disorders, depression, attention-deficit hyperactivity disorder (ADHD), bipolar disorder, personality disorders, and schizophrenia, among others. Having one of these disorders makes a person more likely to develop the other.

What is the link between substance abuse and mental health disorders? Why do they often co-occur and more importantly – why is understanding medical co-morbidities important in terms of litigation long-term disability claims?

What does Co-Morbidity Mean?

Co-morbidity refers to the existence of two conditions at the same time. For example, in many cases of addiction, there is often an underlying co-morbid mental health issue which compliments the substance abuse (or vice-versa). This means that the presence of one condition can exacerbate the symptoms of the other – which is difficult when approaching a treatment regime. Neither condition necessarily causes the other, but they often co-exist together. Substance abuse and mental health issues can both be considered chronic brain disorders. This means that when someone struggles with addiction, the substance they abused may have permanently changed the way their brain functions. In the same way that a person with diabetes or heart disease must manage their condition for the rest of their life, someone with an addiction must also find ways to cope with their disorder. This can be difficult, as simply stopping drug use is often not enough.

Likewise, the changes that take place in the brain due to substance abuse occur in the same brain areas that are impacted by serious mental health disorders such as borderline personality disorder, depression, anxiety, schizophrenia, and bipolar disorder.

Consequently, it should not be surprising that there is an extremely high rate of co-morbidity between addiction and other mental illnesses. While the link is complex, some mental health issues increase the risk factors for substance abuse. What this means is that some people with mental illnesses will turn to alcohol or drugs to cope with the pain of their mental health issues.

Substance Abuse Disorder and Mental Health Conditions

Substance abuse, also known as substance use disorder (SUD), is a mental condition that alters an individual’s brain and behavior. It affects a person’s ability to control their consumption of illicit drugs, medications, alcohol, or other impairment-inducing substances. The spectrum of SUD symptoms varies widely from moderate in individuals who use substances occasionally to severe in people with an addiction.

One of the most common mental health issues linked to the abuse of substance is Post-Traumatic Stress Disorder, or PTSD. A claimant with untreated PTSD may become anxious and hyper-vigilant, which may then cause that person to turn to substances to cope, which unfortunately, can make the PTSD worse — and mental illness even more complex to treat. A claimant may lose functioning in other areas of their lives, making it even more difficult to seek treatment. This can create a vicious cycle in which the PTSD and substance use disorders fuel each other, making it harder and harder to recover. If you or someone you know is struggling with PTSD and substance abuse, it’s important to get help from a qualified professional who can address both issues – and to contact a long-term disability lawyer to help with recovering monthly benefits if they have in fact been denied.

The co-existence of a mental disorder can highly interfere with the treatment of the substance use disorder and is associated with a higher psychopathological severity, repeated relapse, poorer treatment outcomes and generally poorer prognosis for the individual. Co-occurring disorders can include depression, anxiety, bipolar disorder, schizophrenia, attention-deficit hyperactivity disorder (ADHD), personality disorders, and many more. In recent years, an integrated treatment has been shown to be the most effective approach to treat co-morbidity, but individuals with co-occurring mental disorders often face considerable difficulties when trying to get adequate integrated treatment for their multiple problems. Similarly, the co-existence of substance abuse disorder can interfere with the treatment of a mental health disorder.

Common Risk Factors

Genetics and substance abuse: our genes determine our physical and behavioral characteristics, which are passed on to us by our parents. Our DNA dictates our eye color, hair color, height, and other physical traits. It also influences our behavior, such as how aggressive or withdrawn we are. People who abuse alcohol may be genetically predisposed to alcoholism. The development of an alcohol use disorder is also dependent on social and environmental factors. Some people who have inherited genes making them susceptible to alcoholism are responsible drinkers or never take a drink in their life. Individual variations in genetics have been demonstrated to influence stress response and predispose some individuals to develop a substance use disorder following exposure to stressful life events. A person’s reaction to stressful life events is also influenced by environmental factors such as peer pressure, the availability of substances, and family attitudes towards substance use.

Genetics and Mental Illness: certain mental illnesses, such as depression and schizophrenia are more common in people with a family history of these disorders. People with mental illness have a higher risk of turning to substance abuse as a way of coping. Mental disorders can be hereditary (and environmental), which partially explains the complex link between genetics and addiction. It has been reported over the last several decades that there are a number of mental health illnesses that can be hereditary, including ADHD, autism, bipolar disorder, depression, and schizophrenia. Untreated or unmanaged mental illness is often a major risk factor for substance abuse. It is important to seek professional help if you or someone you know is struggling with mental health issues in order to prevent further complications.

Adverse Child Events: exposure to traumatic experiences, especially those occurring in childhood, has been linked to substance use disorders (SUDs), including abuse and dependence. Experiences such as emotional, sexual or physical abuse – or even neglect, are well known to significantly increase the risk for a number of substance abuse and mental health disorders and psychiatric disorders in adulthood.

Underlying Mental Health Issues – researchers have also found that individuals suffering from depression, anxiety, post-traumatic stress disorder (PTSD), and certain mental conditions usually turn to alcohol and drugs to self-medicate. While some of these substances may offer temporary relief to alleviate the symptoms associated with these illnesses, they end up doing more harm than good in the long run. Not only do the symptoms get worse over time, but the changes in the brain caused by the substances’ “rewarding” effects also make it more likely for those individuals to continue using them and even increase the quantities they consume.

Integrated Treatment of Co-occurring Disorders

When clinicians attempt to only treat substance abuse, they may miss the fundamental issue at hand. Oftentimes, mental illness, addiction, and trauma are closely intertwined. For example, someone may use alcohol as a form of self-medication to cope with the pain of past trauma. Or, an individual may turn to opioids to help ease the symptoms of a mental illness. If left untreated, PTSD can lead to further substance abuse as a way of coping. This, in turn, can worsen the PTSD symptoms and create a self-destructive spiral. It is important to take a holistic approach when treating co-occurring disorders. This means addressing all aspects of the person’s health – mental, physical, and emotional. Individuals with a substance abuse disorder seeking help should be evaluated by a qualified healthcare professional. This is the first step in developing a treatment plan that will address all of the individual’s needs.

Making an accurate diagnosis is often challenging because of the similarities and overlapping nature of the symptoms in both SUD and mental health disorders. Normally, healthcare providers will employ a comprehensive set of tools to assess a person and minimize the chances of a missed diagnosis. Only then can targeted treatment be administered to the person. The treatment plan will typically include various medications and behavioral therapies. Each of these needs to be tailored to a person’s unique needs based on their specific mental disorder, choice of substance, the combination of symptoms, and age. Each treatment course must be given ample time to work before introducing new medications and therapies.

Medications

Several medications have proven effective in treating alcohol, nicotine, and opioid addiction. These drugs are also designed to reduce the symptoms of various underlying mental health disorders. For instance, naltrexone, buprenorphine, and methadone are used to treat individuals recovering from an opioid use disorder.

Behavioral Therapies

Various behavioral therapies have shown promising results in treating people with co-occurring substance abuse and mental health disorders. Depending on the severity of a person’s condition, a healthcare professional may use behavioral therapy on its own to treat the disorders or alongside medications for a more holistic approach.

Here’s an overview of common behavioral therapies used to treat co-occurring SUDs and mental health disorders.

Cognitive Behavioral Therapy (CBT) – cognitive behavioral therapy is a type of psychological treatment that helps people change their thinking and behavior. The goal of cognitive behavioral therapy is to help people learn how to better manage their emotions, thoughts, and behaviors. cognitive behavioral therapy is based on the idea that our thoughts, feelings, and behaviors are all connected. So, if we want to change our behavior, we need to also change our thoughts and feelings. cognitive behavioral therapy emphasizes the importance of learning new skills and strategies to help manage emotions, thoughts, and behaviors. cognitive behavioral therapy is usually provided in a one-on-one setting with a therapist. However, cognitive behavioral therapy can also be provided in a group setting.

Dialectical Behavior Therapy (DBT) DBT is a form of CBT that was created to treat individuals with borderline personality disorder. It has shown to be effective in treating persons with co-occurring substance abuse and mental health disorders. DBT focuses on helping the individual develop four key skills: mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation.

  • Mindfulness is the practice of being present in the moment and accepting one’s thoughts and feelings without judgment.
  • Distress tolerance refers to an individual’s ability to cope with difficult situations in a healthy way. This may involve developing a better understanding of why they feel the need to turn to substances in the first place.
  • Interpersonal effectiveness is the skill of being able to communicate assertively and set boundaries with others.
  • Emotional regulation refers to an individual’s ability to manage their emotions in a healthy way. Part of this may involve learning how to cope with triggers that lead to substance abuse.

Assertive Community Treatment (ACT)

Assertive Community Treatment (ACT) is an evidence-based model of care that is designed to meet the needs of individuals with serious mental illness. ACT teams are multi-disciplinary and provide comprehensive, coordinated services in the community. Services are typically provided on an outpatient basis and can include case management, psychiatric care, individual and group therapy, medication management, and skills training. The goal of ACT is to help individuals maintain their recovery and experience improved quality of life. Although ACT was originally developed for adults with serious mental illness, it has also been adapted for use with adolescents and young adults. Numerous studies have shown that ACT is effective in reducing hospitalization rates, improving treatment outcomes, and increasing satisfaction with services.

Therapeutic Communities (TC)

Therapeutic Communities (TC) are a type of treatment program that focuses on helping individuals recover from substance abuse disorders and other mental health conditions. TCs typically involve a residential setting in which participants live and work together, sharing responsibility for the community and organized around a set of shared values and goals. Therapeutic work is often done in small groups, and residents are expected to take an active role in their own treatment, including participating in self-reflection and feedback. The goal of TCs is to help residents develop the skills and knowledge necessary for leading a healthy, productive life in the community. Therapeutic Communities have been shown to be an effective treatment modality for substance abuse disorders and other mental health conditions, and they can provide a supportive environment for long-term recovery.

Contingency Management (CM)

Contingency Management (CM) is a research-based approach that uses reinforcement to increase desirable behaviors and decrease undesirable behaviors. It is based on the premise that all behavior is motivated by its consequences, which can either be positive (reinforcing) or negative (punishing). In CM, reinforcers are used to increase the desired behavior, while punishers are used to decrease the undesired behavior. The most commonly used reinforcer is contingency money, which can be given for engaging in desired behaviors such as attending therapy sessions or abstaining from drug use. Contingency Management has been shown to be an effective treatment for a variety of disorders, including substance abuse, schizophrenia, and attention-deficit/hyperactivity disorder.

Long-Term Disability Resulting From Substance Abuse and Mental Health Disorders

Unfortunately, many claimants suffering from alcohol or drug addictions are denied long-term disability benefits if they are not participating in a treatment program that the disability carrier “approves”. Normally, once the program is complete, the disability carrier will expect the claimant to get back to some type of work. Treatment programs can be very effective, and attendance is often essential for success. However, the problem is that these programs can be difficult to adhere to, and attendance is often a problem. There are a number of reasons why people may struggle to stay in treatment, including the stigma attached to alcoholism, the cost of treatment, and the difficulty of committing to abstinence. If the claimants quit the program – then benefits will likely be wrongly cut off.

It is important that long-term disability claimants who suffers from substance abuse and who’s benefits have been terminated retain an experience long-term disability lawyer who can assist with proper clinical investigation. Our Hamilton long-term disability lawyers will not only explore a claimants substance abuse issues, but will explore the claimant’s history from childhood onwards – and request clinical documentation from all prior and present providers – whether hospital, doctors, clinics, imaging clinics, specialists, experts, rehab providers, counselors, therapists, psychologists, medication printouts – and anything else necessary to prove that the claimant suffers from a mental health disorder which may have caused or contributed to a person’s co-morbid substance abuse issues.

Individuals with co-occurring substance abuse and mental health disorders often get their disability claims denied by their insurance providers – and if this happens to you we can help. Our Hamilton long-term disability lawyers have been representing claimants who suffer from substance abuse and mental health issues since 2003 – and we can help get your long-term disability benefits back on track. We offer free no-obligation consultations, and we do not charge any legal fees unless we are successful in getting you the benefits you deserve.

If you or someone you know is struggling with substance abuse and mental health issues, please contact us today to set up a free consultation. We would be happy to help you get the benefits you need and deserve. Call us no matter where you are in Ontario at 1-844-LALANDE or local in the Southern Ontario region at 905-333-8888. Alternatively, you can send us a confidential email through our website – and we would be happy to explain your long-term disability rights and legal options to you, at no cost.

FAQ Summary

Is there a co-occurrence between mental health issues and substance abuse?

Yes, studies have consistently shown the high co-occurrence and the elevated risk of mental disorders in individuals with substance use disorders and vice versa.

What is a Substance Use Disorder?

A substance use disorder – or SUD for short, is a mental disorder that affects a person’s brain and behavior, leading to a person’s inability to control their use of substances such as legal or illegal drugs, alcohol, or medications.

What does co-morbidity mean?

Co-morbidity refers to the existence of two conditions at the same time. For example, in many cases of addiction, there is often an underlying co-morbid mental health issue which compliments the substance abuse (or vice-versa). 

What is the most common mental issue that is linked to substance abuse?

One of the most common mental health issues linked to the abuse of substance is Post-Traumatic Stress Disorder, or PTSD. A client with untreated PTSD may become anxious and hyper-vigilant. They may turn to substances to cope, which unfortunately, can make the PTSD worse — and their mental illness becomes even more complex.

Does having a mental illness interfere with the treatment of substance abuse?

The co-existence of a mental disorder can highly interfere with the treatment of the substance use disorder and is associated with a higher psychopathological severity, repeated relapse, poorer treatment outcomes and generally poorer prognosis for the individual.

Is substance abuse genetic?

yes, people who abuse alcohol may be genetically predisposed to alcoholism – but the development of an alcohol use disorder is also dependent on social and environmental factors.

is mental illness genetic?

Yes, certain mental illnesses, such as depression and schizophrenia are more common in people with a family history of these disorders. People with mental illness have a higher risk of turning to substance abuse as a way of coping. Mental disorders can be hereditary (and environmental), which partially explains the complex link between genetics and addiction. 

Is childhood trauma linked to substance abuse?

Experiences such as emotional, sexual or physical abuse – or even neglect, are well known to significantly increase the risk for a number of substance abuse and mental health disorders and psychiatric disorders in adulthood.

Citations: Adamson SJ, Todd FC, Sellman JD, Huriwai T, Porter J. Co-existing psychiatric disorders in a New Zealand outpatient alcohol and other drug clinical population. Australian and New Zealand Journal of Psychiatry. 2006;40:164–170. doi: 10.1080/j.1440-1614.2006.01764.x.

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