People may have chronic medical conditions, along with substance abuse.
When two different conditions occur in an individual at the same time, the situation is referred to as comorbidity. Certainly, any medical condition can be comorbid with substance abuse, but some of the more common comorbidities with substance abuse include:
Yes, people with substance use disorders should go to rehab. People who have comorbid conditions along with their substance use disorder should get involved in rehab programs that can specifically address their issues.
Most rehab facilities are equipped to handle people who also have other medical conditions.
Addiction is associated with a variety of health problems that are caused directly or indirectly by drug and alcohol abuse. When you enter treatment, your different medical issues will be addressed according to Maslow’s hierarchy of needs.
That means pressing physical needs that threaten your safety are a top priority. Once serious conditions are stabilized, other issues like mental and behavioral health can be addressed.
For that reason, addiction treatment needs to be able to address physical, psychological, and social problems.
Serious or complicated medical issues, like a need for invasive surgery, may need to be referred to specialists that are better equipped to treat you.
However, there are several common medical issues that you could have when entering addiction treatment. Effective treatment will address these issues in medical detox, inpatient services, or through referrals.
Some of them, like central nervous system depressants, can cause potentially life-threatening symptoms. The potential for withdrawal is an important factor in determining your level of care. Acute withdrawal potential may need medical detox.
Addiction can also lead to homelessness and financial instability, which can make it difficult for you to fulfill your daily needs. People presenting to treatment are often underweight and malnourished. Treatment centers often have an onsite nutritionist that helps make sure your body is getting the nutrients it needs to heal. You may also learn how to shop and cook for yourself at some point in the treatment process.
Fatty deposits and scarring develop that impede your liver’s ability to function. Your lungs can be affected by drugs that are inhaled or snorted, causing infections, pneumonia, and cancer. Drugs also affect your nervous system, which controls your heart rate and blood pressure, which can affect your heart health. Intravenous drug use can also lead to clotting and deep vein thrombosis, which can be fatal.
Within the group of individuals who have substance abuse issues, there is a special case of comorbidity where the person with a substance use disorder has another diagnosable mental health disorder. This type of comorbidity is referred to as dual diagnosis or co-occurring disorders.
Most rehab facilities are equipped to handle this special case of comorbidity. Some rehab facilities specialize in treating people with dual diagnoses.
Based on the findings of the National Comorbidity Survey, some general principles can be related to the relationship between health conditions and substance use disorders.
The relationship between substance abuse, mental health, and physical health is complex and often intertwined. Some medical conditions may be the result of substance abuse, whereas others may be relatively independent of substance abuse issues.
A person with a severe psychological disorder, such as major depressive disorder (MDD), may turn to substance abuse to self-medicate their symptoms. In other cases, individuals with substance abuse issues are more vulnerable to developing specific types of psychological disorders. For example, a risk factor for PTSD is a previous history of substance abuse.
Typically, the approach in rehab is to attempt to treat all conditions concurrently.
Because of the complex relationship between physical health, mental health, and substance abuse, the majority of rehab centers must be able to provide treatment for many different chronic medical conditions, dual diagnoses, and substance abuse issues.
Individuals who have severe medical conditions that are not stabilized may not be able to participate in residential treatment programs until the conditions are stabilized. However, most reputable rehab facilities can provide a holistic type of care that most of their clients need.
Before any person is admitted to a rehab facility, they should undergo a comprehensive assessment of their physical, psychological, and social functioning. The assessment is the initial step for the treatment of any substance use disorder.
It is designed to understand the person’s needs and used to develop a personalized treatment plan. This plan would include addressing any medical conditions during treatment.
If someone has a serious medical condition that requires immediate hospitalization, this will take precedence over placement in a residential unit for the treatment of the substance use disorder.
Inpatient rehab occurs when the person is placed in a hospital or clinic where they have access to medical care 24 hours a day. The person is supervised by medical personnel and other treatment providers, and any medical conditions can be immediately addressed in the facility.
Inpatient rehab units are often used for individuals undergoing complex medical detox programs, those who have significant issues with mental illnesses that require hospitalization, or those who have major health issues that need intensive medical treatment. In these programs, the person remains in the medical unit 24 hours a day.
Residential addiction treatment programs (rehab programs) do not have access to medical care on-site 24 hours a day. In these programs, clients concentrate on treating addiction issues and may have other medical conditions addressed by a nurse or physician, but they do not need 24-hour medical supervision.
Most of these individuals have medical issues or other mental health issues that are relatively well stabilized. The bulk of the treatment can be directed at their substance abuse problem. They do have 24-hour access to medical care if they need it, but they must leave the residential unit in case of emergencies.
A sort of middle ground between inpatient treatment programs and residential programs is at the partial hospitalization program.
In a partial hospitalization program, the client will typically live in a facility with other clients who are being treated for substance use issues. They live on the campus of a hospital or very close to a hospital where they can receive immediate medical attention if they need it. They do not stay in the hospital or clinic, but they are close enough where they can access those facilities very quickly.
People who are being treated for a substance use disorder on an outpatient basis may also have comorbid conditions that need to be addressed. These are usually also addressed as an outpatient unless they become so severe that the person needs to be hospitalized.
Unlike residential treatment units and inpatient units, people undergoing outpatient treatment go to a clinic to have their issues treated and then return home. They do not live in the treatment center.
It is unusual for just one physician to address all the needs of a complex situation where a person has a medical condition, another psychological disorder, and a comorbid substance use disorder. Instead, the trend in medicine and therapy now is to rely on specialists who have intensive training in one or just a few areas to address specific issues.
When a person has a complicated situation where they have some medical conditions along with a substance use disorder, their needs are treated by a team of different specialists who address one particular area. They will often be able to communicate with other members of the team to assess the overall functioning and improvement of the individual.
For instance, on inpatient units and residential treatment units where clients with complicated issues are being treated, the integrated treatment team will often meet and discuss progress.
Individuals being treated for multiple issues on an outpatient basis would also be treated by different treatment providers who can communicate with one another if they want to (provided the client signs a release to allow different treatment providers to communicate with one another).
Some medical conditions will take precedence over the direct treatment of substance abuse. Typically, these are very serious or life-threatening conditions.
For instance, a person with severe cirrhosis of the liver, cancer, or someone who suffered a heart attack may initially be treated only for the medical condition. Specific interventions for substance abuse may occur later after the medical condition is brought under control and stabilized.
Such individuals may be given medicines to address withdrawal symptoms while they are being treated for their medical condition, but formal therapy and other treatments aimed specifically at substance abuse may be delayed until the medical condition is stabilized.
There are instances where a person has a relatively mild or easily controlled medical condition, and substance use disorder treatment can take precedence over treating the medical condition.
For instance, many disorders that are the result of substance abuse, like hypertension, may resolve to a great extent when the person gets control of substance abuse and can maintain their abstinence.
However, all conditions should be addressed if the client is treated holistically.
The bottom line is that no one should use a pre-existing medical condition as an excuse not to go to rehab. It is very common for individuals with substance use disorders to have comorbid medical conditions and co-occurring mental health disorders.
The initial step in the treatment of any substance use disorder is for treatment providers to perform a thorough assessment of the person’s medical and psychological health. Pressing medical concerns will be identified and treated along with the substance use disorder.
Most rehab facilities can treat these conditions. If they can’t, they will refer the client to an appropriate provider.
(August 2018). Comorbidity. National Institute on Drug Abuse. Retrieved March 2019 from https://www.drugabuse.gov/related-topics/comorbidity
(August 2017). Dual Diagnosis. National Alliance on Mental Illness. Retrieved March 2019 from https://www.nami.org/learn-more/mental-health-conditions/related-conditions/dual-diagnosis
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(February 2011). Mental Disorders and Medical Comorbidity. Substance Abuse and Mental Health Services Administration. Retrieved March 2019 from https://www.integration.samhsa.gov/workforce/mental_disorders_and_medical_comorbidity.pdf
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