Resources

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What Are Anxiety Disorders?

Anxiety is a normal reaction to stress and can be beneficial in some situations. It can alert us to dangers and help us prepare and pay attention. 

Anxiety disorders are the most common of mental disorders and involve excessive fear or anxiety.  Treatments help most people lead normal productive lives.

How Common Are Anxiety Disorders?

In any given year the estimated percent of U.S. adults with various anxiety disorders are:  specific phobia 8 %

       social anxiety 7 %

            panic disorder 2-3 %

    agoraphobia 2 %

                generalized anxiety 2%

Women are more likely than men to experience anxiety disorders.

Anxiety refers to anticipation of a future concern and is more associated with muscle tension and avoidance behavior.

Fear is an emotional response to an immediate threat and is more associated with a fight or flight reaction – either staying to fight or leaving to escape danger.

In general, for a person to be diagnosed with an anxiety disorder, the fear or anxiety must: Be out of proportion to the situation or age inappropriate Hinder your ability to function normally

Types of Anxiety Disorders 

Generalized Anxiety Disorder is a chronic disabling psychiatric condition that involves excessive anxiety and  worry that interferes with daily activities. The worry is generally related to a number of events or activities and is associated with at least three of the following symptoms restlessness,  feeling on edge or easily fatigued, difficulty concentrating, muscle tension, irritability or problems sleeping. Often the worries focus on everyday things. these symptoms persist at least for 6 months.

Panic Disorder the core symptom of panic disorder is recurrent panic attacks, an overwhelming combination of physical and psychological distress. During an attack several of these symptoms occur in combination: Palpitations or rapid heart rate, Sweating, Trembling or shaking,

Feeling of shortness of breath, Chest pain

Feeling dizzy, light-headed or faint, Feeling of choking, Numbness or tingling,  Nausea or abdominal pains, Feeling detached

Fear of losing control, Fear of dying

Because symptoms are so severe, many people who experience a panic attack may believe they are having a heart attack or other life-threatening illness and may go to a hospital ER. Panic attacks may be expected, such as a response to a feared object, or unexpected, apparently occurring for no reason.  Panic attacks may occur with other mental disorders such as depression or PTSD.

Phobias, Specific Phobia

A specific phobia is excessive and persistent fear of a specific object, situation or activity that is generally not harmful. Patients know their fear is excessive, but they cannot overcome it. 

exposure to the phobic stimulus provokes anxiety and may lead to a panic attack. the aversive stimulus is often avoided or if tolerated, may be experienced as frightening. 

there are five subtypes of specific phobia:

1)animal 2) natural environmental 3) blood-injection 4)situational 5) other type

Agoraphobia

Agoraphobia is the fear of being in situations where escape may be difficult or embarrassing, or help might not be available in the event of panic symptoms. The fear is out of proportion to the actual situation and lasts generally six months or more and causes problems in functioning. A person with agoraphobia experiences this fear in two or more of the following situations: Using public transportation, Being in open spaces, Being in enclosed places, Standing in line or being in a crowd,

Being outside the home alone. The individual actively avoids the situation, requires a companion or endures with intense fear or anxiety. Untreated agoraphobia can become so serious that a person may be unable to leave the house. A person can only be diagnosed with agoraphobia if the fear is intensely upsetting, or if it significantly interferes with normal daily activities.

Social Anxiety Disorder a person with social anxiety disorder has significant anxiety and discomfort about being embarrassed, humiliated, rejected or looked down on in social interactions. People with this disorder will try to avoid the situation or endure it with great anxiety. Common examples are extreme fear of public speaking, meeting new people or eating/drinking in public. The fear or anxiety causes problems with daily functioning and lasts at least six months.

Risk Factors the causes of anxiety disorders are currently unknown but likely involve a combination of factors including genetic, environmental, psychological and developmental. Anxiety disorders can run in families, suggesting that a combination of genes and environmental stresses can produce the disorders.

Diagnosis and Treatment

The first step is to see your doctor to make sure there is no physical problem causing the symptoms. If an anxiety disorder is diagnosed, a mental health professional can work with you on the best treatment. Unfortunately, many people with anxiety disorders don’t seek help. They don’t realize that they have an illness that has effective treatments.

Although each anxiety disorder has unique characteristics, most respond well to two types of treatment: psychotherapy and medications. These treatments can be given alone or in combination. Cognitive behavior therapy (CBT), can help a person learn a different way of thinking, reacting and behaving to help feel less anxious. Medications will not cure anxiety disorders, but can give significant relief from symptoms. The most commonly used medications are anti-anxiety medications (generally prescribed only for a short period of time) and antidepressants. 

Self-Help, Coping, and Managing

There are a number of things people do to help cope with symptoms of anxiety disorders and make treatment more effective. Stress management techniques and meditation can be helpful. Support groups (in-person or online) can provide an opportunity to share experiences and coping strategies. Learning more about the specifics of a disorder and helping family and friends to understand better can also be helpful. Avoid caffeine, which can worsen symptoms, and check with your doctor about any medications.

References:

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth edition. 2013.
2. David Kupfer et al. Oxford American Handbook of Psychiatry.
3. Ranna Parekh, M.D., M.P.H. American Psychiatrist Association

What Is Posttraumatic Stress Disorder?

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that can occur in people who have experienced or witnessed, a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault.  However, exposure could be indirect rather than first hand. For example, PTSD could occur in an individual learning about the violent death of a close family. It can also occur as a result of repeated exposure to horrible details of trauma such as police officers exposed to details of child abuse cases.

Prevalence it is present in about 7.8 % of the population. Women are twice as likely as men to have PTSD. 

Co-morbidity 84 % have another lifetime diagnosis. Most common are Major Depression, Substance Use Disorder and Social Phobia. 

Diagnosis People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch. Many people who are exposed to a traumatic event experience symptoms like those described above in the days following the event. For a person to be diagnosed with PTSD, however, symptoms last for more than a month and often persist for months and sometimes years. Many individuals develop symptoms within three months of the trauma, but symptoms may appear later. For people with PTSD the symptoms cause significant distress or problems functioning. 

Treatment: 1) Psychotherapy 

Trauma-focused psychotherapies “Trauma-focused” means that the treatment focuses on your memory of the traumatic event or its meaning. Three of the most effective trauma-focused  psychotherapies: Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) therapy and Eye Movement Desensitization and Reprocessing (EMDR)

                       2) Pharmacological

PTSD may be related to changes in the brain that are linked to our ability to manage stress. People with PTSD appear to have different amounts of certain  neurotransmitters in the brain. 

SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) are types of antidepressant medication that are believed to treat PTSD by putting these brain chemicals back in balance. 

SSRIs/SNRIs are recommended for PTSD:

• Sertraline 
• Paroxetine
• Fluoxetine 
• Venlafaxine 

References: 

1.  American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth edition. 2013. 
2. David Kupfer et al. Oxford American Handbook of Psychiatry.  
3. Felix Torres, M.D., DFAPA, MBA   American Psychiatrist Association 
4.  https://www.mentalhealth.va.gov/ptsd/treatment.asp 

What Is Depression?

It is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. 

Prevalence: 10-25 % in females.

                       5-12 % in males.

in both cases variable across populations. Women are more likely than men to experience depression.  

Risk factors: 

Genetic:  2-4 times increased risk for those with a first degree relative with recurrent major depressive disorder

Childhood experiences: Loss of Parents (especially before age 11), lack of parenteral care, parental substance use disorder or antisocial traits, childhood sexual abuse.

Personalities traits: anxiety, impulsivity and obsessionality. People with low self-esteem, who are easily overwhelmed by stress, or who are      generally pessimistic appear to be more likely to experience depression.

Marital status: high rates with separation or divorce 

Adverse life events: especially loss events in vulnerable individuals.

Social stressors: lack of confiding relationship.

Physical illness: especially if chronic, severe or painful. Higher rates are noted in neurological disorders, post myocardial infarction, diabetic and cancer.

Co-morbidity: about two-thirds of patients will also meet criteria for for another psychiatric disorder (anxiety disorders, substance use disorders and personality disorders).

Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.

Depression symptoms  include:

• Feeling      sad or having a depressed mood
• Loss of interest or pleasure in activities once enjoyed
• Weight loss or gain unrelated to dieting
• Trouble sleeping or sleeping too much
• Loss of energy or  fatigue
• Feeling worthless or guilty
• Difficulty concentrating or making decisions
• Thoughts of death or suicide

Symptoms must last at least two weeks for a diagnosis of depression.

Also, medical conditions  and pharmacological treatment can mimic symptoms of depression so it is important to rule out general medical causes.

Depression Is Different From Sadness or Grief/Bereavement

 The grieving process is natural and unique to each individual and shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from usual activities. They are also different in important ways:

• In grief, painful feelings come in waves.
• In      grief, self-esteem is usually maintained. 
• For some people, the death of a loved one, losing a job or being a victim of a physical assault or a major disaster can bring on major depression.    
• When grief and depression      co-exist, the grief is more severe and lasts longer than grief without depression.  Distinguishing between them can help people get the help,      support or treatment they need.

How Is Depression Treated?

the range of treatment modalities includes psychotherapy, pharmacotherapy or a combination of two. If is clinically indicated electroconvulsive therapy. 

Psychotherapy: usually for patients with mild to moderate depressive symptoms. Cognitive Behavior Therapy is a form of therapy focused on the present and problem solving. CBT helps a person to recognize distorted thinking and then change behaviors and thinking. Psychotherapy may involve only the individual, but it can include others ( couples or family therapy). Group therapy involves people with similar illnesses. In many cases, significant improvement can be made in 10 to 15 sessions.

Pharmacotherapy: Brain chemistry may contribute to an individual’s depression and may factor into their treatment. Thus, antidepressants might be prescribed to help modify one’s brain chemistry.  They are not habit-forming. Generally antidepressant medications have no stimulating effect on people not experiencing depression.

Antidepressants may produce some improvement within  7-15 days of use. Full benefits may not be seen for two to three months. If a patient feels little or no improvement after several weeks, his or her psychiatrist can alter the dose of the medication or add or substitute another antidepressant. In some situations other psychotropic medications may be helpful. It is important to let your doctor know if a medication does not work or if you experience side effects.

Electroconvulsive Therapy (ECT) involves a brief electrical stimulation of the brain while the patient is under anesthesia. A patient typically receives ECT two to three times a week for a total of six to 12 treatments.  It is usually managed by a team of trained medical professionals including a psychiatrist, an anesthesiologist and a nurse or physician assistant.

Self-help and Coping

There are a number of things people can do to help reduce the symptoms of depression. For many people, regular exercise helps create positive feeling and improve mood. Getting enough quality sleep on a regular basis, eating a healthy diet and avoiding alcohol (a depressant) can also help reduce symptoms of depression.

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth edition. 2013.
2.  David Kupfer et al. Oxford American Handbook of Psychiatry. 
3. Ranna Parekh, M.D., M.P.H.
   American Psychiatrist Association 

What is a Personality Disorder?

 A personality disorder is a way of thinking, feeling and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time. The pattern of experience and behavior begins by late adolescence or early adulthood and Without treatment, personality disorders can be long-lasting. Personality disorders affect at least two of these areas:

• Way of thinking about oneself and others
• Way of responding emotionally
• Way of relating to other people
• Way of controlling one’s behavior

Types of Personality Disorders

• Antisocial personality disorder (APD): a pattern of disregarding or violating the      rights of others. APD may repeatedly lie or deceive others, or may act      impulsively).

• Avoidant personality disorder (APD): a pattern of extreme shyness, feelings of      inadequacy and extreme sensitivity to criticism. APD may view themselves as not being good enough or socially inept).

• Borderline personality disorder (BPD): a pattern of instability in personal      relationships, intense emotions, poor self-image and impulsivity. A person      with BPD may go to great lengths to avoid being abandoned, have repeated suicide attempts, display inappropriate intense anger or have ongoing feelings of emptiness.

• Dependent personality disorder (DPD): a pattern of needing to be taken care of and submissive and clingy behavior. People with DPD may have difficulty making daily decisions without reassurance from others or may feel uncomfortable or helpless when alone because of fear of inability to take care of themselves.

• Histrionic personality disorder (HPD): a pattern of excessive emotion and attention seeking. People with HPD may be uncomfortable when they are not the center of attention, may use physical appearance to draw attention to themselves or have rapidly shifting or exaggerated      emotions.

• Narcissistic personality disorder (NPD): a pattern of need for admiration and lack of empathy for others. A person with NPD may have a grandiose sense of self-importance, a sense of entitlement, take advantage of others or lack empathy.

• Obsessive-compulsive personality disorder (OCPP): a pattern of preoccupation with orderliness,      perfection and control. A person with OCPP may be overly focused on details or schedules, may work      excessively not allowing time for leisure or friends, or may be inflexible      in their morality and values. 

• Paranoid personality disorder (PPD): a pattern of being suspicious of others and seeing them as mean or spiteful. People with PPD often assume people will harm or deceive them and do not confide in others or become close to them.

• Schizoid personality disorder (SPD): being detached from social relationships and      expressing little emotion. A person with SPD typically does not seek close relationships, chooses to be alone and seems to not care about praise or criticism from others.

• Schizotypal personality disorder (SPD): a pattern of being very uncomfortable in close relationships, having distorted thinking and eccentric behavior. A person      with SPD may have odd beliefs or odd or peculiar behavior or speech or may have excessive social anxiety.

Diagnosis of a personality disorder requires a mental health professional looking at long-term patterns of functioning and symptoms. Diagnosis is typically made in individuals 18 or older. 

Treatment

Certain types of psychotherapy are effective for treating personality disorders. Psychotherapy can help a person understand the effects of their behavior on others and learn to manage or cope with symptoms and to reduce behaviors causing problems with functioning and relationships. The type of treatment will depend on the specific personality disorder, how severe it is, and the individual’s circumstances.

Commonly used types of psychotherapy include:

• Psychoanalytic/psychodynamic therapy
• Dialectical behavior therapy
• Cognitive behavioral therapy
• Group therapy
• Psychoeducation     

There are no medications specifically to treat personality disorders. However, medication, such as antidepressants, anti-anxiety  or mood stabilizing medications, may be helpful in treating some symptoms. 

In Addition, self-care and coping strategies can be helpful:

• Learn about the condition. 
• Physical activity and exercise can help manage many symptoms(stress, anxiety and depression).
• Avoid drugs and alcohol. 
• Get routine medical care. 
• Join a  personality disorder support group.
• Write in a journal to express your emotions.
• Try stress management techniques.
• Stay connected with family and friends.

Family members can be important in an individual’s recovery and can work with the individual’s health care provider on the most effective ways to help and support. But having a family member with a personality disorder can also be distressing and stressful. Family members may benefit from talking with a mental health provider who can provide help coping with difficulties.

References

1. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Association. (2013).
2. David Kupfer et al. Oxford American Handbook of Psychiatry. 
3. Rachel Robitz, M.D. American Psychiatrist Association 

What Is Addiction? 

Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control. Those changes may last a long time after a person has stopped taking drugs(1).

 Addiction is a lot like other diseases, such as heart disease. Both disrupt the normal, healthy functioning of an organ in the body, both have serious harmful effects, and both are, in many cases, preventable and treatable. If left untreated, they can last a lifetime and may lead to death(2).

 Do people choose to keep using drugs?  The initial decision to take drugs is typically voluntary. But with continued use, a person’s ability to exert self-control can become seriously impaired. This impairment in self-control is the hallmark of addiction. Brain imaging studies of people with addiction show physical changes in areas of the brain that are critical to judgment, decision-making, learning and memory, and behavior control(3). These changes help explain the compulsive nature of addiction.

Risk Factors

Biological include their genes, stage of development, and even gender or ethnicity. Also, teens and people with mental disorders are at greater risk of drug use and addiction than others.

Environmental are those related to the family, school, and neighborhood. Aggressive behavior in childhood, Lack of parental supervision, Low peer refusal skills,  Drug experimentation,  Availability of drugs at school, Community poverty.  

Drugs of Abuse

 Alcohol, club drugs, cocaine, fentanyl, Hallucinogens, Heroin, Inhalants, kratom, Marijuana, MDMA, Methamphetamine, Opioids, Over the Counter Medicines, Prescription Medicines, Steroids, Tobacco/Nicotine/ Vaping, Synthetic  Cathinone and Cannabinoids.  

Why do people take drugs?

To feel good: Drugs can produce intense feelings of pleasure. To feel better: Some people who suffer from social anxiety, stress, and depression start using drugs to try to feel less anxious and depressed. To do better: Some people feel pressure to improve their focus in school or at work or their abilities in sports. Curiosity and social pressure:  In teens peer pressure can be very strong. 

Symptoms of substance use disorder 

• Impaired control: a craving or strong urge to use the substance; desire or failed      attempts to cut down or control substance use.

• Social problems: substance use causes failure to complete major tasks at work, school or home; social, work or leisure activities are given up or cut back because of substance use.

• Risky use: substance is used in risky settings; continued use despite known problems.

• Drug effects: tolerance (need for larger amounts to get the same effect); withdrawal symptoms (different for each substance).

• Time: a great deal of time is spent in activities to obtain the substance , use it  or recover from its effects.

 What are the consequences of drug addiction?

People with addiction often have one or more associated health issues, which could include lung or heart disease, stroke, cancer, or mental health conditions. Imaging scans, chest X-rays, and blood tests can show the damaging effects of long term drug use throughout the body. 

Drug use can also increase the risk of contracting infections. HIV, hepatitis B and C can occur from sharing injection equipment or from unsafe practices such as condom-less sex. Infection of the heart and its valves (endocarditis) and skin infection (cellulitis) can occur after exposure to bacteria by injection drug use.

 How can addiction harm other people?

Substance or medication use during pregnancy can cause her baby to go into withdrawal after it’s born, which is called neonatal abstinence syndrome (NAS). Some drug-exposed children will have developmental problems with behavior, attention, and thinking.  Negative effects of secondhand smoke involuntary exposure to secondhand smoke increases the risks of heart disease and lung cancer in people who have never smoked. Increased spread of infectious diseases  Injection drug use is a major factor in the spread of HIV, hepatitis B, C, and can be the cause of endocarditis and cellulitis.  Drugs that are misused can cause intoxication, which hinders judgment and increases the chance of risky sexual behaviors such as condom-less sex.  Increased risk of motor vehicle accidents In 2016, almost 12 million people ages 16 or older reported driving under the influence of illicit drugs,  

 After alcohol, marijuana is the drug most often linked to impaired driving. Research studies have shown negative effects of marijuana on drivers, including an increase in lane weaving, poor reaction time, and altered attention to the road. 

 Can addiction be cured? 

Like other chronic diseases such as heart disease or asthma, treatment for drug addiction usually isn’t a cure. But addiction can be managed successfully. Treatment enables people to counteract addiction’s disruptive effects on their brain and behavior and regain control of their lives. 

How Is Addiction Treated?

Effective treatments for addiction are available. Treatment varies depending on the type of drug and the characteristics of the patients. Matching treatment settings, interventions, and services to an individual’s particular problems and needs (medical, psychological, social, vocational, and legal problems) is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society. It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, and culture.  

 Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment. As with other chronic illnesses, relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted. 

The first step on the road to recovery is recognition of the problem. The intervention of concerned friends and family often prompts treatment.  Sanctions or enticements from  employment settings, and/or the criminal justice system can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions.

 A health professional can conduct a formal assessment of symptoms to see if a substance use disorder exists. Even if the problem seems severe, most people with a substance use disorder can benefit from treatment. Because addiction affects many aspects of a person’s life, multiple types of treatment are often required. For most, a combination of medication and individual or group therapy is most effective. Treatment approaches that address an individual’s situation and any co-occurring medical, psychiatric and social problems can lead to sustained recovery. 

Behavioral therapies vary in their focus and may involve addressing a patient’s motivation to change, providing incentives for abstinence, building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, improving problem-solving skills, and facilitating better interpersonal relationships. Also, participation in group therapy and other peer support programs during and following treatment can help maintain abstinence.  

Medications are an important element of treatment for many patients (control drug craving and relieve severe symptoms of withdrawal) especially when combined with counseling and other behavioral therapies. For example, methadone, buprenorphine, and naltrexone are effective in helping individuals addicted to heroin or other opioids stabilize their lives and reduce their illicit drug use. Acamprosate, disulfiram, and naltrexone are medications approved for treating alcohol dependence. For persons addicted to nicotine, a nicotine replacement product (patches, gum, lozenges, or nasal spray) or bupropion or varenicline. 

 An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs. 

Treatment may also include:

• Hospitalization manage the acute physical symptoms of withdrawal and can, for some, pave the way for effective long-term addiction treatment.
• Therapeutic communities       (highly controlled, drug-free environments) or sober houses.
• Outpatient programs

  
  

Many people find self-help groups for individuals (Alcoholics Anonymous, Narcotics Anonymous) as well as their family members (Al-Anon or Nar-Anon Family Groups) useful.

References: 

1.  American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth edition. 2013. 
2.  Drugs, Brains, and Behavior: The Science of Addiction. National Institute on Drug Abuse. Revised June 2020.
3.  David Kupfer et al. Oxford American Handbook of Psychiatry. 
4.  Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). National Institute on Drug Abuse Revised January 2018 
5. Ranna Parekh, M.D, American Psychiatrist Association 

What is a concurrent disorder?

Concurrent disorders is a term used to refer an individual who has both a psychiatric disorder and a substance use disorder.(anxiety disorder and an alcohol problem, schizophrenia and cannabis dependence, borderline personality disorder, heroin dependence, obsessive compulsive disorder and nicotine dependence). It's useful to think of them as independent problems that interact with each other.

Prevalence: 30 % of people diagnosed with a mental health disorder will also have a substance use disorder. In addition, 37 % and 53% of people diagnosed with an alcohol disorder and a substance use disorder  will have a psychiatric disorder at some point in their lives.  Co-occurring disorder are associated with higher health care utilization, more severe course of illness, worst treatment outcome, more medical co-morbidities and involvement in criminal activities as well as increased risk of violence/trauma/suicide/child abuse/neglect.

What accounts for the co-morbidity?

• Increased co-morbidity due to substance use causing psychiatric disorders in vulnerable individuals.
• Psychiatric disorders causing substance use disorders in vulnerable patients.
• Another underlying variable independently increases the risk (genetic, familial, social)..
• Bidirectional models can contribute to the onset and maintenance of co-morbidity. 

A person with concurrent disorders will often have more serious medical, social and emotional problems than if they had only one condition. Treatment may take longer and be more challenging.

Signs and symptoms the combinations of concurrent disorders can be divided into five main groups:

• Substance use + mood and anxiety disorders.
• Substance use + severe and chronic psychiatric disorders.
• Substance use + personality disorders.
• Substance use + eating disorders.
• Other substance use + mental health disorders, such as gambling and sexual disorders.

Treatment: Individuals have the best success when both problems are addressed at the same time, in a integrated treatment.  Interventions need to be matched not only to diagnosis but also to phase of recovery, stage of treatment and stage of change. 

 The team may include psychiatrists, social workers, psychotherapists or psychologists, vocational and occupational therapists and addiction counsellors. This treatment may take place in a single setting, such as a residential facility, or through a mixture of different resources such as family doctors, hospital outpatient clinics and community outreach teams.

The principles of pharmacological treatment

1. Treat clear symptoms clusters
2. Consider safety and side effects profiles and avoid medications with abuse liability and addiction potential.
3. Be aware of potential interaction between psychotropics and substances of abuse.

The principles of psychosocial interventions

1. Integrate evidence based treatment
2. Help the client to achieve abstinence, coping and recovery skills
3. Encourage establishing social support network
4. Utilize case management approach during vulnerable periods to help with adherence to medications and maximize retention.

References: 

1.  David Kupfer et al. Oxford American Handbook of Psychiatry. 
2. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/concurrent-disorders