Drugs, Alcohol, and Behavioral Health Q & A

Co-occurring disorders exist when behavioral health issues—such as eating disorders and pathological gambling—and substance use disorders—such as drug and alcohol use disorders—occur simultaneously.^{1, 2, 3}

In 2014, more than 20 million American adults suffered from an addiction to drugs or alcohol, and nearly 8 million of them had a co-occurring mental health disorder.¹ To ensure the best recovery outcome, it’s important to treat both substance use and behavioral health issues at the same time.⁴ To help you better understand the two disorders, we’ve asked and answered many common questions about drugs, alcohol, and behavioral health.

Q: Do people with substance use disorders or behavioral addictions have poor willpower?

A: Though the first few times you take a drink, use a drug, or engage in a behavior, it is generally done by choice, addiction is recognized as a disease. The chemical changes in the body and brain of someone who takes drugs can alter their ability to control the impulses and overwhelming urges to continue engaging in an addiction, even if they want to stop.⁵ Often, the fear or pain of experiencing withdrawal symptoms also contribute to continued substance use.

Q: What is a behavioral addiction?

A: A behavioral addiction can develop when you participate in an activity or behavior that becomes compulsive and interferes with your ability to function in various life areas, such as work, school, socialization, or emotional regulation.⁶ Similar to substance use disorders, behavioral addictions are rewarding, but you can develop a tolerance to the behaviors, meaning you need to do more of the behavior to get the same rush of reward you initially did. This tolerance can lead you to engage in a behavioral addiction more frequently, even after experiencing negative consequences to physical health, mental health, relationships, performance at work, school, or home, finances, or even legal troubles.^{6, 7}

Behavioral addictions may include:^{2, 7, 8}

• Eating disorders.
• Exercise addiction.
• Gambling addiction.
• Internet addiction.
• Pornography addiction.
• Sex or love addiction.
• Shopping addiction.
• Tanning addiction.
• Video game addiction.

Q: How common are co-occurring behavioral addiction and substance use disorders?

A: While the rates vary depending on the type of behavioral addiction, research suggests that almost half of people with an eating disorder also suffer from a substance use disorder.^{2, 9} Gambling addiction is also strongly linked to drug and alcohol addiction.³ Other behavioral addictions have not been as thoroughly studied, but the similarities to how behavioral addictions and substance use disorders affect the brain are well established.^{2, 3, 4, 5, 6}

Q: What drives a person to substance abuse or other problematic behaviors?

A: Addictions to substances or behaviors can persist for many reasons, the primary of which is they make you feel good because drugs, alcohol, and certain behaviors release chemicals in the brain that create a rush of pleasurable feelings.^{3, 5} In other cases, addiction can act as a way to self-medicate an underlying medical or mental health disorder, such as depression or anxiety. Addictions may also be linked to trauma that was never properly addressed.⁶ Finally, when you stop the substance use or behavior suddenly, you may experience symptoms of withdrawal, which could lead you to continue using to avoid dealing with the discomfort or pain of them.^{5, 6, 7}

Q: Are there withdrawal symptoms for behavioral addictions?

A: While withdrawal symptoms for drug and alcohol use are well established, some evidence also shows that behavioral addictions may also produce withdrawal symptoms. Gambling withdrawal symptoms, for instance, can include restlessness or irritability.³ Behavioral addiction withdrawal symptoms may also include depressed mood, strong cravings, or anxiety, and physical symptoms such as fatigue, altered eating habits, and changes in sleep patterns.^{7, 8, 9}

Q: What is a dual-diagnosis treatment program?

A: Dual diagnosis, or co-occurring disorder treatment, occurs in facilities that are trained to manage substance use and other mental health disorders simultaneously. Addressing both issues at once increases the likelihood of long-term recovery.^{4, 10}

Q: What is treatment like for co-occurring disorders?

A: Using integrated treatment, which involves a combination of individual and group counseling, along with medication (as needed) to treat any underlying medical or mental health conditions, is the most effective way to treat co-occurring disorders.¹¹ Treatment works best when it is tailored to meet the specific needs of each individual patient.¹⁰

Q: Why do treatment facilities do mental health screenings?

A: According to a survey conducted in 2014, more than 20 million adults in America struggled with a substance use disorder.¹ Of those, 7.9 million were dually diagnosed with a mental health disorder.¹ Treatment facilities conduct mental health screenings to determine if there is another mental health disorder present, since it affects treatment planning.¹⁰

Q: How long does the treatment process last?

A: Everyone requires a different length of treatment, depending on the duration and severity of their substance use disorder and behavioral addiction, individual personality, willingness to change, and support available to them. While most inpatient treatment facilities provide 28-30–day treatment programs, research suggests that a minimum of 90 days of treatment provides better outcomes.¹⁰ This can be accomplished by staying longer at an inpatient treatment center (as your insurance or finances allow) or attending outpatient treatment or private therapy after the completion of a month-long inpatient program. Regularly attending self-help meetings can also improve your treatment outcome.¹⁰

Q: What happens if a relapse occurs?

A: Addiction is a chronic disease that is marked by periods of recovery and relapse in most cases.⁶ If a relapse does occur, it can indicate a need for further treatment or a different type of treatment. Relapse does not mean that treatment has failed, but is often viewed as a setback requiring additional help to overcome, and recovery is still possible.⁵

Q: Does the brain go back to normal after substance use and behavioral addictions are stopped?

A: Substance use and behavioral addictions create long-lasting changes in the brain that can affect the likelihood of relapse even after years of recovery.^{5, 10} Other long-term effects of addiction can alter the function of the brain, leading to difficulties in learning, memory, stress management, impulse control, judgment, and decision making. But with sustained recovery, this can be overcome in many cases, depending on the severity of the addiction and the type of substance used.⁵

Q: Will I be cured after treatment?

A: Addiction is a chronic disease, with relapse rates similar to other chronic diseases, such as diabetes or asthma.¹² This means that addiction cannot be 100% cured, but it can be effectively managed to reduce the impact that addictions have on your daily functioning, and help you to reclaim control over your life.¹²

Q: What is an aftercare plan?

A: During the treatment process, staff members work with you to develop a plan for maintaining your recovery after you leave the program. This involves identifying and planning for situations that can put you at risk for relapse and providing additional support services, such as self-help meetings, social support, private therapy, ongoing psychiatric care, or even long-term residential treatment facilities as needed. Aftercare plans are uniquely tailored to meet your specific needs.

Q: How do people in treatment manage ongoing cravings for behavioral addictions or substance use disorders?

A: Effective treatment programs educate patients on how to manage cravings by using therapeutic techniques, and in some cases, medication. Certain types of substance dependencies have FDA-approved medications to help reduce the intensity of cravings, such as Campral (for alcohol), naltrexone (for alcohol and opioids), and buprenorphine (for opioids).¹⁰ Medications can be used to manage cravings for behavioral addictions in some cases, or to manage underlying conditions that contribute to addiction and cravings, such as mood disorders or anxiety. Studies show that medications are most effective at reducing relapse when paired with behavioral and therapeutic techniques.¹⁰

Q: How do I know whether inpatient or outpatient treatment is the best choice?

A: During the intake process, a trained counselor or therapist will ask questions to help determine the best fit for treatment. Factors such as the length and severity of your addictions, the type(s) of substance and behavior(s) that you are addicted to, home environment, presence of additional medical or psychiatric conditions, motivation for recovery, lifestyle, job situation, and recovery supports at home or in the community all contribute to determining the best type of treatment that meets your needs. Other resources can help you decide, such as addiction hotlines, therapists, or medical doctors, but ultimately, the decision is up to you.

Q: How do I know if I have a behavioral addiction or just like to participate in an activity?

A: Behavioral addictions are characterized by many problematic developments that separate them from normal participation in an activity, including: ^{3, 5, 6}

• A compulsive need to participate in an activity.
• Impairment in one or more areas of functioning because of the compulsive behavior—including socialization, work, school, or at home.
• Tolerance: you need more of the activity to achieve the same rush or high you originally got.
• Continuing to participate in the behavior even after experiencing negative consequences.
• Irritability, anxiety, or other withdrawal symptoms when not able to participate in the behavioral addiction.
• Having difficulty or being unable to cut back or stop the behavior.
• Experiencing strong cravings or urges to participate in behavior.

Q: What is recovery from behavioral addiction and substance use disorders?

A: Recovery is a term used to describe the long-term process of replacing an addiction with actions that promote healthy behaviors, accountability for your actions, supportive social connections, personal growth, regaining control over your life, establishing a healthy balance, and maintaining a state of health and well-being.⁶ Recovery is best viewed as a marathon rather than a race, with no finish line. It is a life-long pursuit, and practicing healthy coping skills and relapse-prevention techniques can help support your recovery efforts. Recovery from substance use and certain behavioral addictions, such as gambling, generally involves abstaining from those substances and activities, while recovery from other behavioral addictions—such as eating disorders, exercise addiction, shopping addiction, and sex addiction—means learning to find a healthy balance with these activities in a way that doesn’t let the addiction control your life.