Co-occurring disorders: self-harm and addiction

What is self-harm?

Self-harm is a mental health disorder that affects many people around the world. Some people self-harm by physically cutting, burning or hitting themselves, poisoning themselves with medicine or other chemicals, abusing drugs or alcohol, deliberately overeating or starving themselves or exercising to a dangerous extent.

This behaviour can be a way to express distress, act out feelings of frustration or anger, or to seek short-term pain relief. It is important to remember that people who self-harm do not usually want to cause lasting injury or illness to themselves, but it becomes a compulsive action that can seriously affect their health and their lives.

What are the different levels of self-harm?

While different people self-harm in different ways, there are three main levels that can be categorised as follows:

Superficial

This is when there is no break in the skin, such as pinching or biting oneself, or where the impact of the activity is very temporary with only minor physical pain.

Moderate

This involves breaking the surface of the skin to cause bleeding, for instance through scratching or cutting themselves with a sharp object, or where the person makes themselves physically ill. The minor injuries caused may require some degree of medical treatment.

Severe

This type of self-harm may involve an object being used that will cut into muscles and tissues so severely that it requires surgical procedures to repair tissue damage done, or where the activity causes long-term damage to health.

What are the signs of self-harm?

There are some warning signs that could indicate someone you know is self-harming. These include things such as:

While the rate of self-harm is increasing around the world, only half the people suffering from this condition seek help. If you notice any of these signs in a friend or family member, it is important to talk to them and let them know they can confide in you. Sometimes simply letting people know that you understand what they are going through can be a huge comfort for those struggling with self-harm and can ensure they do not feel isolated.

What causes self-harm?

While people self-harm from every age, gender and demographic, it is most common among women, girls, young people and people from groups who are more likely to suffer discrimination, such as LGBTQ+ individuals and people of colour. Self-harm can be caused by many different things, including:

Environmental causes

• Bullying
• Emotional, physical or sexual abuse
• Bereavement for a loved one who has passed
• Serious illness or injury

These types of trauma can create mental health issues such as post-traumatic stress disorder (PTSD) which may lead to self-harm, substance abuse (which in itself is a form of self-harm) or other destructive behaviours.

Psychological and mental health conditions

• Depression
• Generalised anxiety disorder (GAD)
• Obsessive compulsive disorder (OCD)
• Borderline personality disorder (BPD)
• Bipolar disorder
• Eating disorders

Self-harming can have a huge emotional and psychological impact on the person doing it, which is why it needs to be taken seriously as part of an overall mental health diagnosis.

How can self-harm be treated?

Self-harm is not always easy to address, particularly when it has become a compulsive act and the person feels like they have no self-control. However, there are many different treatments and support options available that provide people with both positive coping tecniques as well as the support they need. You should first speak to a doctor at your local GP surgery who may then refer you for the following types of treatment:

• Talking therapies like cognitive behavioural therapy (CBT) help teach people how to deal with negative thoughts and behaviours through changing thinking patterns or feelings
• Psychodynamic therapy looks at what happened in the past and the significant role it is now having on a person’s life and mental health.
• Dialectal behaviour therapy helps individuals identify where their emotions are in relation to each other so they can better understand them and react accordingly.
• Motivational interviewing encourages patients into action by looking at their goals, aspirations and desires rather than focusing on their problems.
• Certain medications may also be prescribed to help with the underlying reason that the person self-harms. These may include antidepressants or anti-anxiety medication to help with depression, PTSD and panic attacks.

For discreet access to support for self-harm, you may also want to try the services offered by the following links:

What is addiction?

Addiction can be described as any type of compulsive need for a substance or activity, whether that be alcohol, illicit or prescription drugs, or a behavioural activity such as gambling, porn or sex. Addiction changes the way your brain works on a chemical level, which means you are unable to control yourself without experiencing negative consequences. This process itself is called ‘addictive behaviour’ because it does not occur overnight, but instead comes about over time through exposure and repeated use of certain addictive substances or behaviours, until eventually there isn’t anything else that can fulfil this need.

Addiction is a treatable condition, and it is very important that you seek professional help if you are engaged in compulsive drinking, drug use or any other addictive behaviour.

What are the causes of addiction?

Addiction can have a number of different causes. Some people are born with a predisposition for addiction because they have inherited certain genes. Other people develop an alcohol or drug addiction as a result of self-medicating in order to cope with difficulties in their lives or the symptoms of a separate physical or mental illness.

Environmental factors such as being brought up in a home where alcohol and drug abuse are prevalent can also increase a person’s chances of addiction, as they copy the behaviour of the people around them.

What are the signs of addiction?

There are many signs that indicate addiction, including:

If you notice any of these signs in yourself, or a friend or family member, it is important to talk to them and let them know there is professional assistance out there for them which could help them transform their lives.

What are co-occurring mental health disorders?

A co-occurring disorder is when a person has two or more mental health conditions at the same time, such as addiction and self-harm, or addiction and depression. Co-occurring disorders are complicated and require specialised treatment following dual diagnosis, as there needs to be an integrated approach that takes into account both diagnoses simultaneously. The major issue with co-occurring disorders is that each mental illness will often feed off the other in a vicious cycle, with each making the symptoms of the other more intense.

How is self-harm connected to alcohol and drug addiction?

There is a very close connection between self-harm and addiction.

• Substance use and addictive behaviours can both have hugely negative effects on health, finances and relationships, but because the person has no self-control, they cannot stop
• Alcohol and illicit drug use often present as a means of coping with emotional pain or distress caused by difficult life situations or other underlying mental disorders
• Dealing with an underlying mental illness can also trigger addiction as some people begin using substances as an alternative coping mechanism to self-injury
• Others may inflict self-injury because they are frustrated about their condition and the difficult emotions it causes.

How do the two conditions affect each other?

Self-harm and addiction are both very serious conditions that can have a huge impact on an individual’s life. The biggest issue for someone who is suffering from both as co-occurring disorders is how they can fuel each other, resulting in both conditions becoming worse.

Self-harm can become a consequence of substance use, while using drugs and alcohol can become a means of dealing with the difficult feelings associated with self-harming. This is a vicious cycle that can be incredibly difficult for a person to break out of without professional help.

For some people, substance misuse itself is a form of self-injury, particularly behaviours such as alcohol and drug abuse, which can cause serious health issues and also damage people’s lives in other ways.

What is their effect on mental illness and health?

Self-harm and addiction can have a devastating impact on an individual’s mental health. Many people who suffer from co-occurring disorders also have other mental health issues, such as depression and anxiety, which makes their condition even more difficult. A person who is struggling with self-harm and addiction simultaneously may feel that their life has spiralled out of control. They may feel that they are unable to cope with the thoughts and feelings which make self-harm and substance use seem like an escape.

However, addressing self-harm alone without treating addiction, or vice versa, will not fully treat this complex disorder. Immediate treatment for both conditions is vital to make a successful self-harm and addiction recovery.

How are the conditions diagnosed together?

Self-harm and addiction are often diagnosed together when a person is admitted to hospital or into a rehab clinic. There needs to be an integrated approach that is conscious of both diagnoses to ensure successful treatment; otherwise, one condition will continue to exacerbate the other.

The diagnosis will often involve a mental health professional who will diagnose the conditions based upon their symptoms. The person’s family may also be involved in the process, and the medical professional may ask for their input to get a better understanding of the condition. We also offer support for friends and family of loved one through our family support programme.

What are the treatment options?

Treating co-occurring disorders requires specialised treatment plans.

Self-harm is a way of dealing with emotional pain and distress, so the first step in treating this disorder should be mental health counselling or psychotherapy to help an individual learn healthier ways to cope with their thoughts and feelings rather than using self-harm as a means to get rid of them.

Treating addiction requires a comprehensive rehab programme where a combination of detox, addiction therapy and certain medications are used to address every aspect of addiction. Undergoing treatment for addiction can be tough, and so it is very important that anyone who enters rehab is mentally stable and prepared.

There are the two main options available for addiction treatment: residential rehab and outpatient rehab.

Residential rehab (UKAT’s approach)

Residential rehab centres are specialised treatment facilities where people live while undergoing inpatient addiction treatment. These programmes focus on treating the individual physically and emotionally to ensure all aspects of their condition are addressed.

The individual will usually be offered detox to help with the physical effects of addiction, and will then participate in different types of therapy to develop self-control and coping strategies. This holistic approach is usually the most effective treatment method because overcoming addiction requires you to address all of the underlying causes in order to prevent relapse in the future.

At UKAT, our guidance and support extend long after you leave rehab, and we will assist you with one year’s free aftercare in the form of weekly group sessions. Our aftercare programme is designed to help you continue the positive lifestyles changes and support network during rehab. For example, you may want to attend Narcotics Anonymous if you had a drug addiction or Alcoholics Anonymous for alcohol addiction.

Outpatient rehab

Outpatient rehab centres are where someone can attend during the day for addiction therapy without having to leave home or work commitments behind. This is often seen as a good option for people with extensive home responsibilities because it means they will be able to carry on with their normal lives while undergoing treatment. However, this means that individuals suffering from self-harm and addiction face continued exposure to addictive triggers, meaning it is more difficult to focused on self-harm and addiction recovery.

When both addiction and self-harm are treated by outpatient means, it can be problematic to effectively monitor the person while they are at home. This means that relapse is more likely to occur and will be easier to conceal from the therapist or medical professional who is treating them.

What are the potential withdrawal symptoms and dangers?

When undergoing treatment for alcohol or drug addiction, there are various potentially dangerous withdrawal symptoms that a person may experience during the initial detox process. These may include:

At UKAT, a medical professional gives every client a full medical assessment before they begin their alcohol or drug treatment, which will identify whether they are likely to develop these withdrawal symptoms. If this is the case, the person may be given certain detox medication to help keep them safe and comfortable during these first stages of their treatment plan. This is called medical detox and will often involve the person receiving round-the-clock supervision to maintain their health and wellbeing.

For people who are suffering from another mental illness, there are other potential dangers that come with addiction treatment. At UKAT, we are conscious during the admissions process of ensuring that all potential clients are stable enough to go through rehab. If we are concerned about the condition of someone who self-harms or who has other mental health conditions, we will advise them to seek professional treatment for those first before returning for addiction treatment.

Seeking help for self-harm and addiction

Mental health conditions like addiction and self-harm can cause you to feel isolated and that you have no control over your life or body. However, it is so important to understand that there are many avenues of help available for you.

Get in touch with us today and we can give you further information about how to get the treatment you need and begin your addiction recovery journey.