Substance Use Disorders (SUDs) and other psychiatric disorders such as depression, bipolar, Post Traumatic Stress Disorder (PTSD) or Attention Deficit Hyperactivity Disorder (ADHD) frequently co-occur. That may be because one causes the other (SUDs can cause substance related mood or anxiety disorders among others, and untreated depression, bipolar, schizophrenia, ADHD or PTSD can lead to substance use which can progress into a SUD) or because both conditions share a common set of risk factors.
Having co-occurring disorders worsens the prognosis for either condition, but the literature shows that treating any underlying non-SUD psychiatric disorders will improve the odds of sustained recovery for the SUD, and vice versa. We note that in order to ensure accuracy in the diagnosis of the co-occurring non-SUD disorder, it is important to separate the expected effects of the substance from the observed symptoms (for example, increased energy after using cocaine, is an expected effect of cocaine, rather than evidence of mania). As such the symptoms of these co-occurring disorders are best assessed after a few weeks following substance use discontinuation to ensure that the observed symptoms are not merely due to intoxication or withdrawal. As such, upon initial presentation, it might be prudent to start with treating the SUD and then treating residual symptoms. Once the initial diagnoses have been confirmed, it is reasonable to treat both conditions simultaneously.
Access “11: Psychiatric Comorbidities: Diagnosis and Treatment of Comorbid Psychiatric Disorders and Opioid Use Disorders” at: https://pcssnow.org/education-training/training-courses/11-psychiatric-comorbidities-diagnosis-treatment-comorbid-psychiatric-disorders-opioid-use-disorders/
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