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What is the Common Comorbidity in Substance Abuse?

What is comorbidity? Read on to learn about comorbidity, common signs and symptoms, risk factors, and treatment options.

Substance Abuse

Substance abuse (or substance abuse disorder) is a prevalent medical condition occurring worldwide in several communities and societies. Substance abuse disorder is quite dangerous for several reasons, the most common of which is that it’s usually accompanied by several withdrawal symptoms ranging from mild to very severe. But that’s not all; there is also the potential for patients to experience comorbidity and dual diagnosis situations.

There are several misconceptions about comorbidity, what it is, and why it occurs; many people often mistake comorbidity for dual diagnosis when they are quite different. It is important that you know exactly what comorbidity is.

What is Comorbidity?

Comorbidity is a medical term used increasingly frequently in a hospital or other diagnosis and treatment facility environment. You may have heard your doctor use the term “comorbidity” in a few cases, but what exactly does it mean?

Comorbidity Meaning

Comorbidity (also known as co-occurring conditions, multimorbidity, and coexisting conditions) is a medical term used to describe a situation where a person has more than one medical condition co-occurring or when one illness follows another for a relatively short period of time. 1

Comorbidity has been observed with several medical conditions such as diabetes, high blood pressure, stroke, mental health conditions, and even substance abuse.

In this case, comorbid substance use disorder is a situation where one or more health conditions are co-occurring with substance abuse disorder. Comorbidity “severity” differs from condition to condition depending on the co-occurring disease. It is usually difficult to predict with any absolute accuracy the risk of death in patients who have comorbid substance use disorder. However, an index has been developed for that specific purpose. It is known as the Charlson Comorbidity Index (CCI).

Comorbidity: A Deeper Look

Charlson Comorbidity Index

The Charlson Comorbidity Index (CCI) is a diagnostic tool developed in 1987 by Mary Charlson and colleagues.2 It is an index used to estimate the likelihood of mortality for patients with comorbidities within one year of hospitalization. The “original” Charlson comorbidity index only contained about nineteen conditions. However, it has been revised and updated severally.

Every disease on the index is assigned a “score” based on its severity. A CCI score of 1-2 is classified as mild, 3-4 is classified as moderate, and CCI scores of 5 and above are classified as severe (indicating a serious chance of patient mortality occurring within one year of hospitalization).3 A typical evaluation of a patient with the Charlson comorbidity index would involve identifying these comorbidities and summing up their scores to arrive at a final CCI score. 3

Comorbidity vs. Dual Diagnosis: What is the Difference?

Some people commonly use comorbid disorder (or comorbid substance use disorder) in place of dual diagnosis and vice versa. Although these two terms might appear to be similar, they are quite different. You must be able to differentiate between them.

Dual Diagnosis

Dual diagnosis is a medical term used to describe situations where a mental illness condition co-occurs with ONE other medical condition. Usually, the accompanying medical condition is substance use or abuse disorder.4 On the other hand, comorbid disorder refers to medical situations where two or more diseases occur together at a particular time. It is also used to refer to situations where these health conditions arise in “close” succession. 4

Comorbidities can interact with one another, although they can also occur in isolation. Some diseases may increase your chance of acquiring others or often happen together. A cardiac arrest, for example, is frequently associated with stroke or vascular illness. Hypertension and anemia can accompany the chronic renal disease.

How Common is Comorbidity?

Comorbidities are quite common, with several studies showing that over half of all mental illness patients will present with at least one other medical condition or disorder (usually substance abuse disorders and other mental illness conditions). 5 It is interesting to note that comorbid conditions are not only restricted to adults alone. There has been a somewhat significant increase in comorbid conditions in teens with mental illnesses like depression and anxiety occurring with increasing frequency. 5

Comorbid Substance Abuse and Mental Illnesses

As mentioned earlier, substance abuse is a common problem, usually observed with psychiatric comorbidity. This psychiatric comorbidity includes several different mental health conditions occurring simultaneously with substance abuse disorder.

Is Substance Abuse a Mental Illness?

This is a somewhat challenging question to answer as it is quite complicated. Some people think that substance abuse should be classified as a mental illness since it directly impacts the brain’s normal functioning. 6 However, substance abuse is usually regarded as different from mental illness. Regardless, there is no doubt that substance abuse disorder is closely related to mental health disorders, and they typically present as co-occurring disorders in most cases.

Substance Abuse and Mental Illness: Which Comes First?

According to studies, many people with substance use disorders (SUD) usually have one or more co-occurring mental health disorders. 7 It can be challenging to identify which condition occurs first as they commonly occur together or closely one after the other. However, it should be noted that mental illness conditions can result in substance abuse disorders. Also, for a person with a predisposition to or at risk of experiencing mental health disorders, substance abuse may be the tipping point that manifests the condition. 7

The Most Abused Substances

When you hear the term “substance abuse,” it is very likely you immediately think of “painkillers or narcotics.” Although these drugs are commonly abused in societies globally, the term “substance abuse” applies to much more than just painkillers and narcotics. Commonly abused substances include the following:

  • Alcohol
  • Opioids (could include raw opium or other medications containing opioids such as opioid painkillers)
  • Stimulants
  • Other drugs

The Most Common Comorbidities in Substance Abuse

As mentioned earlier, substance use disorder (SUD) is usually accompanied by psychiatric comorbidity. This psychiatric comorbidity can include several mental health conditions ranging from anxiety comorbidity to depression comorbidity. Common comorbidities in substance abuse include the following:

  • Anxiety Disorders
  • Major Depression
  • Bipolar Disorder Comorbidity
  • Schizophrenia Comorbidity
  • Mood Disorders
  • Personality disorders
  • PTSD Comorbidity
  • ADHD Comorbidity
  • OCD Comorbidity

Again, it is important to note that it is very much possible for a single individual to present with two or more of these comorbidities.

Signs and Symptoms of Comorbidity

Because substance use comorbid disorder involves the occurrence of two or more medical conditions (usually mental health conditions), the signs and symptoms of comorbidity you will be able to observe will depend largely on the mental illness (or illnesses) co-occurring with substance use disorder. This means that the comorbidity symptoms you will be able to observe are divided into two different types: signs of substance abuse and signs of mental illness.

Common Signs of Substance Abuse

Substance abuse symptoms are the easiest to identify of the two types of comorbidity signs and symptoms. It must be noted that early detection of these symptoms and correct interpretation of the symptoms as relating to substance abuse is essential for patient survival. Substance abuse has been identified as a causative or “tipping” factor in many mental health illness conditions. So early detection could prevent the development of these mental disorders.

The common signs of substance abuse include:8

  • Legal issues
  • Withdrawal from family and friends
  • Aggression and irritability
  • Financial issues
  • Alterations in sleep patterns and appetite
  • Mood swings
  • Anxiety and paranoia
  • Difficulty focusing
  • Lack of motivation
  • Poor personal hygiene

Common Signs of Mental Illnesses

Substance use comorbid disorder is also accompanied by mental health conditions. The mental health disorder (or disorders) present is usually what determines the mental illness signs and symptoms you’ll be able to observe. Nevertheless, some common symptoms could be indicators of a mental illness condition. These signs include the following: 9

  • Anxiety and excessive worrying
  • Depressive moods or euphoric feelings
  • Insomnia
  • Alterations in appetite
  • Visual and auditory hallucinations
  • Substance abuse
  • Problems interacting with other people
  • Withdrawal
  • Suicidal tendencies
  • Increase in aggressive tendencies 

Mental Health Indicators

Comorbidity Causes and Risk Factors

Accurately pinpointing the causes of comorbidities can be quite tricky. This is because some comorbidities develop and randomly occur together. There is no direct link between the two (or more) conditions other than occurring together. Some comorbidity conditions are linked by genetic, environmental, or behavioral variables. 10

Overall, individually occurring medical conditions in comorbidities can be linked together by the following factors:

Overlapping Risk Factors

It is also possible that comorbidity conditions occur due to another medical condition serving as the causative agent for the other medical health issues. 10

Overlapping Genetic Vulnerabilities

Research on comorbidity occurrence has shown that the gene interactions of an individual play an important role in the occurrence of comorbidities in that person. 11

Area of the Brain Affected

If the comorbid conditions affect e same area of the brain, there is an increased likelihood that the presence will result in the development of the other. 11

Causes of Comorbidity in Substance Abuse

Comorbid substance use disorders usually consist of substance abuse disorders and two or more mental health conditions. However, these mental health conditions may have “physical” health implications. Substance abuse disorder and mental illnesses are closely related since they usually occur together or after the other. Research has shown that comorbid substance abuse disorder can occur in two different ways:

Mental Illnesses Can Lead to Substance Abuse:

Some mental health issues have been linked to developing a drug abuse problem. For example, some evidence indicates that patients with mental illness may self-medicate with drugs or alcohol. While certain medications can assist with mental illness symptoms, they can also aggravate them. Furthermore, when a person develops a mental illness disorder, brain alterations may intensify the pleasurable benefits of drugs, making the individual more likely to continue using them.

Substance Abuse Can Contribute to The Development of Mental Illness:

People with substance abuse disorder also run the risk of developing mental illness comorbidity conditions. This is because substance use disorder affects and alters the brain’s configuration to increase susceptibility to mental disorders, mainly if these alterations occur in the same areas of the brain that the mental illness condition is known to affect.

Comorbidity Risk Factors

Comorbidity can develop in anyone irrespective of age or gender. However, there are several risk factors that, when present, significantly increase the possibility of substance use comorbid disorder occurring. These risk factors include the following:

  • Disorder type
  • Sex
  • Socioeconomic status
  • Environmental factors
  • Age: Comorbidity occurs more commonly in adults, although it has been observed in younger people.
  • Other factors such as access to healthcare and congenital diseases

Comorbidity Diagnosis and Treatment Options

Because of the high comorbidity between substance abuse disorders and other psychological disorders, a systematic approach to treatment and management that detects and analyzes each condition sequentially, offering therapy as needed, is required. Typically, substance abuse and mental health disorders occurring in “isolated” conditions are relatively straightforward to diagnose. 11

However, in substance use comorbid disorder, accurate identification is made even more difficult in substance use comorbid disorder by the similarity between drug-related signs such as withdrawal and those of possibly concomitant mental diseases. 11

How is Comorbidity Diagnosed?

As a result of the fact that comorbidity makes accurate diagnosis more challenging, achieving a proper and precise diagnosis necessitates broad evaluation procedures that are less likely to result in a missed or incorrect diagnosis. In comorbidity diagnosis, people beginning treatment for mental conditions are usually evaluated for substance abuse disorders, and vice versa. 11

Substance Abuse Treatment

Upon diagnosis of a substance abuse disorder, treatment in a certified treatment facility usually involves the following:

The detoxification process involves cleansing the body of and reducing drug concentrations in the body in a secure, safe setting. It is usually recommended that detoxification be done as an “inpatient” treatment because detoxification is generally associated with some pretty severe drug withdrawal effects.

Detoxification usually involves a gradual tapering of the “drug dose” to minimize the severity and occurrence of side effects. It may also involve gradual replacement of the substance of abuse with another drug entirely to eliminate dependence effectively.

Inpatient Treatment

Inpatient treatment is usually recommended for patients with little or no social support, unstable living conditions, or severe substance abuse dependency issues. Patients who fall into the above-listed categories stand a better chance of safely and fully recovering from their substance abuse problems in an inpatient treatment setting.

Inpatient treatment ensures patients are cut off from all possible distractions in the outside world, thereby enabling them to focus on getting better fully. It also allows for a better chance of safe drug withdrawal since medical specialists will always be on hand to monitor patients and effectively take care of any withdrawal symptoms accompanying detoxification and treatment. 12

Outpatient Treatment

On the other hand, outpatient treatment is usually recommended for people who have a less severe substance abuse problem and a more functional social support system. It is also an ideal therapy option for people who, for one reason or the other, may be unable to commit to full-time “inpatient care” in a treatment facility. Patients who opt for this treatment option will be able to maintain their daily routine while reporting to their treatment centers on days when they have appointments with their medical care providers.

It is important to know that outpatient treatment may be converted to inpatient treatment if your doctor feels your health is at risk for one reason or the other. 12

Mental Illnesses Treatment

Mental illness treatment in substance use comorbid disorder usually starts with identifying the present mental illnesses. Once this is done, “focused” therapy can then begin. The most used therapy type in mental illness treatment is behavioral therapy.

Behavioral therapy is a treatment that seeks to discover and assist in modifying potentially harmful behaviors. It is founded on the premise that all habits are taught and learned so that they can be modified. Behavioral therapy helps identify negative behaviors, isolate their root causes, and modify these behaviors for improved patients’ health. There are two commonly used behavioral therapy types. They include:

Mental Health Treatment Opportunities

Treatment for Comorbidity at Genesis Recovery


If you have substance use comorbid disorder and are searching for an excellent treatment center option for you, Genesis Recovery is where you want to be. Genesis Recovery is a San Diego-based state-licensed, nonprofit drug and alcohol rehabilitation center dedicated to improving the lives of people suffering from addiction and substance abuse.

What To Expect

At Genesis Recovery, patients will undergo a unique holistic treatment approach that excellently combines clinical treatment, support systems, faith-nurturing activities, and a 12-step program to ensure total recovery from substance abuse disorders and addiction. Several insurance companies like Humana and BlueCross BlueShield cover treatment at Genesis Recovery.

Contact Us Today

At Genesis Recovery, your recovery and wholeness are our priority. Hence, if you’re ready to kick substance abuse and addiction for good, reach out today and let’s help you get started.


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