What role does trauma play in co-occurring disorders?

person casually crossing her arms

There’s a lot to unpack in this question. First, let’s define co-occurring disorders. Also referred to as dual diagnosis, co-occurring disorders occur when a patient has multiple disorders, but is most commonly used to refer to the specific situation in which a patient has a mental illness as well as a substance abuse disorder. When a substance use disorder and a psychiatric disorder co-occur, they don’t necessarily have the same severity nor do they necessarily develop at the same time. This sometimes makes co-occurring disorders difficult to diagnose, and patients with co-occurring disorders may need more aid or treatment, as they often experience more severe challenges in medical and mental health.

In order to aid a patient with co-occurring disorders, it is first important to diagnose them – the DSM-5 says that there are eleven symptoms signifying a substance use disorder. (Mild drug abuse disorders may only exhibit two or three of these symptoms.) The DSM-5 also outlines diagnostic criteria sets for each mental health disorder, with symptoms that are exhibited by those suffering from each disorder as well as the time periods that the symptoms must be an issue and other disorders that the individual could potentially be suffering from. Once a diagnosis has been made, targeted treatment can then begin.

Generally, integrated treatment is recommended for patients with co-occurring disorders, which is a comprehensive rehabilitation program that incorporates a holistic approach to medicine and therapy, so that patients can reorient themselves physically, mentally, emotionally, and spiritually. However, there have also been studies that discuss the importance of treatment programs that are trauma-informed for those with co-occurring disorders, particularly for women with co-occurring mental health and substance abuse disorders. This is because that women with these co-occurring disorders often have a history of interpersonal violence, and therefore greatly benefit from treatment that aims to help them resolve and overcome the resultant trauma.

But what is trauma? Trauma, as well as post-traumatic stress disorder, is what some people develop after having experienced a shocking or dangerous event. Generally speaking, basically everyone experiences a range of reactions from trauma, but most of these people recover naturally from initial symptoms. If they continue to experience problems (such as feeling stressed or frightened even when not in danger, or re-experiencing the event long after it happens), this may be a sign of PTSD. Women who have co-occurring disorders have often undergone traumatizing childhood experiences (such as physical and sexual abuse, witnessing violence, and neglect) which can provoke or exacerbate their co-occurring disorders.

This niche of patients is what concerns the Women, Co-occurring Disorders, and Violence Study (WCDVS), a major federal effort to address the effects of trauma in women with co-occurring disorders. This study developed new service approaches, leading to eight core services: resource coordination and crisis intervention; staff knowledgeable about trauma; holistic treatment of mental health, trauma, and substance use issues; and the involvement of consumers in service planning and provision. They then conducted extensive studies in order to assess the efficiencies of these newly developed services. The studies concluded that a great percentage of patients improved substantially when treated with the integrated trauma counseling services. This trend only strengthened the longer the patients continued with the treatment program.

Of course, there is still a good amount of research to be done in order to fully dismantle and standardize the incorporation of trauma treatment into the rehabilitation programs for co-occurring disorders, but it seems evident that acknowledging the trauma that aggravates co-occurring disorders in women is important in order to adequately treat the results. The role of trauma in co-occurring disorders is an important one, and must be acknowledged by medical professionals in order for them to provide their patients with the appropriate care, customized to their individual needs.

Additional Resources
American Addiction Centers
National Institute of Mental Health