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Concurrent

Disorders
By: Rachel Townsend, Rae Slattery, Kaitlin Salim, Kristine Snarr
Introduction To Our Client
Sam is a 17 year old boy who was diagnosed with
Depression and Generalized Anxiety at the age of
13. Sam has resorted to abusing alcohol and
certain illegal drugs in order to cope during high
points of Depression and Anxiety. He was
diagnosed with a concurrent disorder after it was
found out that he uses substances in order to deal
with his previously diagnosed mental illnesses.
After meeting Sam, and talking to him about his
decision to abuse substances as a way to cope, he
explained how the alcohol and drugs seem to
relieve his Anxiety and Depression symptoms for a
short time, but eventually it makes the symptoms
worse.
Introduction To Our Client
Sam is currently taking 20mg of Citalopram once a day to
help with his Anxiety and Depression symptoms. While
mixing his medication with alcohol and drugs, Sam has
reported feeling drowsy, having impaired thinking, feelings
of paranoia, trouble sleeping, poor coordination and
thoughts of self-harm.
His mental illnesses and addictions are affecting his school
performance, personal relationships and family
relationships. His parents have noticed that he is
increasingly withdrawing himself from social events, from
his peers and is beginning to not act like himself anymore.
They are afraid that if he does not get help soon, things will
just get worse and worse until it is too late to do anything.
What Are Concurrent Disorders?
A concurrent disorder is when an individual
experiences both mental illness and a substance
use disorder.

A substance use disorder is a condition in which


gambling, sex, drugs, or alcohol are used in
excess and cause major impairments.

Concurrent disorders can include a wide range


of combinations, such as an anxiety disorder
and a drinking problem, or schizophrenia and
cannabis dependence.
5 Main Combinations of Concurrent Disorders:
Mood & Anxiety Disorders
Ex. Depression, Panic Disorder

Severe & Persistent Mental Health


Disorders
Substance
+
Ex. Schizophrenia, Bipolar Disorder

Use Disorder Personality Disorders


Drugs or Alcohol Ex. Borderline Personality Disorder

Eating Disorders
Ex. Anorexia Nervosa or Bulimia

Other Substance Use + Mental Health Disorders


Gambling or Sexual Disorders
Learning Now that you know more about
concurrent disorders and our client, what
Check: combination does Sam seem to have?
Sam's Concurrent Disorder
Sam has one the most common combination of concurrent disorders.

Substance Use
+
Mood/Anxiety Disorder
Due to the nature of concurrent disorders and the
combination of a variety of mental illnesses and
substance use problems, there is no single symptom
or group of symptoms common to all combinations.

While certain symptoms may depend on their mental


illness, there are symptoms associated to substance
use disorders that could be applicable.
Signs &
Symptoms These include:
 Dependence
 Harmful Use
 Acute Intoxication
 Withdrawal
Determining the prevalence rates for concurrent disorder
is difficult. Many cases are misidentified because some
disorders mimic others, so doctors assume it is just the
one disorder, not considering the fact that it can be 2
similar issues at the same time. However, depending on
the setting, prevalence rates have been found to range
from 20 to 80 percent (Canadian Mental Health
Prevalence Association, n.d.).
It is important to remember that those who suffer from a
mental illness have higher rates of substance abuse and
addiction. A study in Edmonton, Alberta showed almost a
third of mentally ill people also had a substance use
problem, almost a third of those with alcohol dependency
also had a psychiatric diagnosis, and among drug users,
almost half had a mental illness (Canadian Mental Health
Association, n.d.).
Concurrent disorders beginning in childhood or
adolescence are often more severe than those with onset
later in life. The earlier the disorders are caught, diagnosed,
and subsequently treated, the better the outcome.
Because concurrent disorders refer to any combination of
mental health disorder and substance abuse, symptoms

Importance Of and their durations can vary widely. All symptoms may not
appear simultaneously, one disorder may seem worse at
various times depending on the client's environment and
Duration Of mindset. Durations for specific symptoms largely depends
on the disorders in question.

Symptoms It does not entirely matter which disorder occurs first, the
presence of both a mental health and substance use
disorder is enough to warrant a diagnosis of a concurrent
disorder. However, sometimes substance abuse can mimic
symptoms of various mental health disorders, such as
alcohol-induced depression. In these cases, it is helpful to
know if the mental health disorder preceded the substance
use. This will determine if the diagnosis is truly a
concurrent disorder.
Importance Of Duration Of Symptoms:
Sam's Concurrent Disorder
Given the many variations and combinations with concurrent disorders, let's look at the
importance of duration of symptoms in Sam's case.

As we know, Sam has the first combination of


concurrent disorders that we discussed:

Substance Use
+
Mood/Anxiety Disorder
Importance of Duration of Symptoms
SUBSTANCE USE
A maladaptive pattern of substance use for longer than intended
and when discontinued causes an individual to experience
pathological signs and symptoms, such as tolerance and withdrawal
Tolerance is the need for increased amounts of the substance to
achieve the desired effect or achieving less of an effect when using
the same amount as before
Withdrawal is the appearance of a drug discontinuation syndrome
and the need to take more of the drug in order to avoid the
symptoms of discontinuation
Individuals engage in extensive but unsuccessful efforts to control
their substance use, spend a great amount of time and effort trying
to obtain the substance, experience cravings, use the substance in
dangerous situations, fail to fulfill obligations of work or school, and
suffer major impairments in social, occupational, or recreational
communities, despite being aware of the harmful effects of the
substance
Importance of Duration of Symptoms

GENERALIZED ANXIETY DISORDER DEPRESSION


• Extreme anxiety and apprehension about events or activities, • Five symptoms need to be present for at least two weeks for
such as school, on more days than not for at least six months diagnosis
• The individual has difficulty controlling the anxiety • At least one symptom must be either depressed mood or
• Only one symptom is required for diagnosis in children such as anhedonia (loss of pleasure or motivation
restlessness, fatigue, impairment in attention and • Additional symptoms include changes in sleep, appetite, energy
concentration, irritability, muscle tension, or sleep disruption level, concentration, feelings of hopelessness or guilt, slowed or
agitated thinking or behaviour, and suicidal thoughts
• For the diagnosis of children or adolescents, irritability may
substitute for depressed mood, and failure to make expected
weight gains can substitute for significant weight loss in adults
Normal Behaviour vs. Concurrent
Disorder Behaviours
NORMAL BEHAVIOURS CONCURRENT DISORDER BEHAVIOURS
Relate to other people Lose trust in close family members
Feel secure with family and friends Cut themselves off from the outside world
Regulate emotions at appropriate Hostile with friends, families
times
Stop participating in family events/enjoyed
Trusting activities
Affectionate Hard to express feelings and thoughts
Able to relax Struggle to make simple decisions or set
and complete goals
Ability to adapt to different demands
and stresses of daily life
In order to properly treat Concurrent Disorders, it is best to address
the substance abuse and mental illness simultaneously, if possible.
Occasionally the mental health issues can get worse
while you’re working on both issues, so at that point it
is recommended to stop and work on just the mental health issue(s)
first before proceeding with the addiction issue(s).

Effective A patient suffering from mental illness can benefit from treatments
such as group or individual therapy, or medications. Sometimes a

Treatment combination of both is required.

Integrated treatment is also beneficial for the patient. This treatment


ensures that recovery is smooth for the patient and helps in other
areas of the person’s life such as education, employment and housing.
It can help prevent relapses, ensure treatment success and make sure
their needs are being met (CAMH, 2004).
Type of Treatment Outcome

Psychoeducation- Help patients and their families deal with their problems, build a
Possible
Education about mental
health and substance
recovery support plan and make/implement plans to prevent their
problems.
Treatment
abuse.
Options
Psychotherapy- “Talk Helps patients understand why they think the way they do. Or why
Therapy.” they act or interact with others in the way they do. Can be a short
term or long term treatment plan.

Family Therapy Helps teach families and patients about substance abuse and mental
health disorders, as well as offering individual help for the family
members.

Peer Support Groups A group of people who all have concurrent disorders, who can all
accept and understand each other while sharing their experiences.
Recently diagnosed patients can benefit from the experiences of
others.
CAMH’s
Concurrent
Disorders
Transformation

CAMH is making changes to serve


individuals with concurrent disorders
more holistically. Centre for Addiction and Mental Health, & George, T. (2016, October 25). CAMH’s Concurrent
Disorders Transformation. Retrieved from https://www.youtube.com/watch?v=P6qI7gob7uQ
Discussion Question
 What are some ways you think someone can possibly prevent themselves from
falling into a Concurrent Disorder?

 How might the presence of both mental health and substance use disorders
complicate and affect each other?
References
Brasch, J. (2016). Intro to concurrent disorders. Retrieved from https://www.csam-smca.org/wp-content/uploads/2016/02/Concurrent-Disorders.pdf
Centre for Addiction and Mental Health, & George, T. (2016, October 25). CAMH’s Concurrent Disorders Transformation. Retrieved from
https://www.youtube.com/watch?v=P6qI7gob7uQ.
Concurrent Disorders. (n.d.). Retrieved from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/concurrent-disorders.
Daniel K. Hall-Flavin, M. D. (2017, June 9). Antidepressants and alcohol: What's the concern? Retrieved from https://www.mayoclinic.org/diseases-
conditions/depression/expert-answers/antidepressants-and-alcohol/faq-20058231.
Department of Health and Community Services (2015). Concurrent disorders guidelines. Retrieved
from https://www.health.gov.nl.ca/health/mentalhealth_committee/mentalhealth/pdf/Concurrent_Disorders.pdf
Ontario Shores Centre for Mental Health Sciences. (n.d.). Concurrent Disorders. Retrieved
from https://www.ontarioshores.ca/finding_help/about_mental_illness/mental_illnesses/concurrent_disorders.
Shatkin, J.P. (2015). Child and adolescent mental: A practical, all-in-one guide.
Canadian Mental Health Association (n.d.). Concurrent Disorders. Retrieved from https://ontario.cmha.ca/documents/concurrent-disorders/
Centre for Addiction and Mental Health (2004) Concurrent Substance Use and Mental Health Disorders; An Information Guide. Retrieved from
https://www.camh.ca/-/media/files/guides-and-publications/concurrent-disorders-guide-en.pdf
O’Grady, C., Skinner, W. (2007). A Family Guide to Concurrent Disorders. Centre for Addiction and Mental Health. Retrieved from
https://www.camh.ca/-/media/files/guides-and-publications/partnering-with-families-guide.pdf
Neuman, F. (2013). Determining What is Normal Behavior And What is Not. Psychology Today. Retrieved from
https://www.psychologytoday.com/us/blog/fighting-fear/201305/determining-what-is-normal-behavior-and-what-is-not