Adjustment Disorder and Addiction Treatment
Adjustment disorder is a stress-related mental health condition that often co-occurs with substance abuse or addiction. Stressful or traumatic events trigger negative feelings and behaviors, and when these persist beyond a few months or cause significant impairment they may be diagnosed as adjustment disorder. As a way to cope some people may turn to drugs and alcohol. But treatment for both substance use disorder and adjustment disorder can lead to recovery and successful resolution of feelings related to the stress or trauma.
What Is Addiction and Adjustment Disorder?
Addiction, which is referred to by professionals as substance use disorder, is use of a drug or alcohol that has gotten out of control and that negatively impacts a person’s health, relationships, work, and other areas of life. A substance use disorder can be mild to severe and may include the use of one or more illicit drugs, prescription drugs, or alcohol. It is common for a mental illness to underlie addiction and substance misuse.
One mental illness that may trigger or contribute to a substance use disorder is adjustment disorder. This is categorized as a trauma disorder, because it is a reaction to a very stressful life event or a series of stresses. What triggers this condition varies by person, but some common stressors include relationship breakups, difficulties at work, serious or chronic illness, natural disasters, or major life changes such as retirement.
These kinds of stressful situations impact people differently, and while most will recover from them and readjust to changes, some will continue to struggle for months or longer. They may experience negative emotions, difficulty sleeping, changes in eating and sleeping habits, and social withdrawal that go on for much longer than would be expected. Adjustment disorder needs to be treated with support from professional mental health caregivers.
Facts and Statistics
Adjustment disorder is currently categorized in the Diagnostic and Statistical Manual of Mental Disorders as a trauma or stress-related disorder along with PTSD.
- A person may be diagnosed with adjustment disorder when coping mechanisms for stress fail to work and negative reactions to a stressor continue for three months or longer.
- Adjustment disorder may occur in response to any major life change but also to a traumatic experience like assault or natural disaster.
- There are subtypes of adjustment disorder that are categorized by depression, anxiety, and abnormal behaviors. Depression is the most common subtype.
- The rate of occurrence of adjustment disorder in the U.S. ranges from 12 percent to 23 percent, depending on the study.
- Seventy percent of patients diagnosed with adjustment disorder have a co-occurring mental illness or substance use disorder.
- A person may turn to drugs or alcohol to cope with the stressful situation triggering adjustment disorder. This can lead to a substance use disorder and makes the diagnosis of adjustment disorder more difficult.
Symptoms and Diagnosis of Addiction and Adjustment Disorder
Addiction, or substance used disorder, is diagnosed by looking at a list of 11 criteria. Meeting just two or three of these can indicate a mild substance use disorder. More than that can lead to a diagnosis of a disorder that is moderate or severe.
- Using more and larger amounts of a substance than intended
- Trying to stop or use less and failing
- Spending a lot of time using, getting, or recovering from a drug or alcohol
- Neglecting responsibilities in order to use
- Giving up previously enjoyed activities to use more
- Using drugs or alcohol in spite of relationship problems
- Continuing to use a substance even when it causes or worsens symptoms of a physical or mental health condition
- Using substances in dangerous situations
- Experiencing cravings for a substance
- Developing a tolerance
- Going through withdrawal when not using
The first criterion in diagnosing adjustment disorder is the presence of some type of stressor or trauma. The other criteria include that symptoms begin within three months of that stressful or traumatic event and that the person experiences either more than normal levels of distress or stress that interferes with normal functioning. Adjustment disorder cannot be diagnosed if the symptoms are typical of grief or of another mental illness. Some of the possible symptoms of adjustment disorder include:
- Feelings of sadness and hopelessness
- Being unable to enjoy life
- Feeling worried, anxious, overwhelmed, or stressed
- Difficulty sleeping
- Loss of appetite
- Difficulty focusing on tasks
- Struggling to function as normal
- Withdrawing from friends and family
- Avoiding responsibility
- Suicidal thoughts
Anyone who is struggling with a substance use disorder, whether co-occurring with a mental illness or not, is at risk of overdose. Any abused substance can cause an overdose, but the biggest risk is with use of opioids and when mixing drugs. Different substances cause unique symptoms, but in general an overdose can cause drastic changes in breathing, heart rate, and blood pressure, sleepiness or loss of consciousness, shortness of breath, chest pains, and abdominal cramping with nausea or vomiting. An overdose should be treated as a medical emergency.
Causes and Risk Factors
Adjustment disorder is one kind of mental illness for which the underlying cause is known: a specific or ongoing source of stress or trauma. However, what is not well understood is why some people react to stress this way while others do not. Genetics are likely to play a role, as does the nature of the stress. The more traumatic the event—the more personal, severe, or long-lasting—the greater the risk is of developing adjustment disorder.
There is no single cause of a substance use disorder, but there are many known risk factors. These include genetics and family history, peer pressure and being around people who use substances, access to drugs or alcohol, and the type of drug used, as some are more addictive than others. Having a mental illness is also a risk factor, and that can include adjustment disorder.
Withdrawal and Detox
Substance use disorder must be treated and managed along with treatment for adjustment disorder. This means going through detox so that the patient can go into treatment sober. Detox triggers withdrawal, which can be very uncomfortable. Symptoms vary but may include agitation, irritability, depression, aches and pains, tremors, nausea, stomach cramping, and vomiting. Withdrawal from most drugs is not dangerous; the exceptions to this are withdrawal from alcohol and benzodiazepines.
While withdrawal and detox are not typically dangerous they can trigger relapses, and these can lead to overdose. For all of these reasons, detox should be assisted and supervised by professionals. A complete treatment plan for substance use disorder and adjustment disorder will include a period of guided detox.
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Adjustment disorder and substance use disorder in the same individual is a case of co-occurring disorders. It is common for one person to struggle with one or more mental illnesses with or without substance use disorders because there are common risk factors and each condition influences or contributes to the other.
Someone who is living with both an adjustment disorder and substance use disorder may also have other co-occurring disorders, especially if one or both is left untreated. Adjustment disorder is most commonly diagnosed with personality disorders, anxiety disorders, and mood disorders like major depression.
Treatment and Prognosis
The most effective treatment plans are individualized and address all of a patient’s needs. That means screening for substance use disorder and any mental illnesses. If a person is treated only for adjustment disorder, ongoing substance use may cause symptoms to recur. And, only treating the addiction will not address adjustment disorder, which in turn can lead to a substance use relapse.
Treatment begins with detox and continues with a comprehensive, long-term plan that manages the addiction and helps resolve symptoms associated with adjustment disorder. Addiction is largely treated with therapy, which provides a way to explore feelings, triggers for substance use, and strategies for making positive changes in the future. Addiction can also be managed with medication in some cases. The best treatment plan will also include strategies and plans for preventing relapses in the future.
For adjustment disorder the main part of treatment is therapy. Any type of therapy may be used, depending on the therapist and patient, but the goals are to face and process the stress or trauma that triggered symptoms, to reframe that event, and to learn and use healthy coping strategies. Treatment should also help a person make changes to go back to a better quality of life and to restore greater function in all areas of life.
The prognosis for someone struggling with adjustment disorder and an addiction is good if he or she is willing to commit to ongoing treatment. By itself, adjustment disorder is usually resolved within six months. However, an addiction can complicate the situation. A substance use disorder is a chronic illness, and successful recovery may require years of management, including support group attendance and occasional therapy.