The Stress Vulnerability Model of Co-Occurring Disorders

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1 1 The Stress Vulnerability Model of Co-Occurring Disorders What causes a chronic illness such as mental illness or a substance use disorder? Why do some people develop a particular illness but not others? How does one of these illnesses affect the course of the other? These are common questions raised by people with co-occurring mental illness and substance use disorders and their family members. The stress-vulnerability model is a scientific theory that provides an understanding of what causes illnesses such as mental illness and addiction, and how they interact with each other, and the principles of treating these co-occurring disorders. The Stress-Vulnerability Model of Co-Occurring Disorders This model proposes that the course of an illness over time (such as severity of impairment and relapses), are the result of a combination of different factors, including: biological vulnerability interaction of symptoms of mental illness and substance use stress coping skills social support Biological Vulnerability Many people have biological vulnerabilities to different chronic illnesses such as asthma, high blood pressure or diabetes. In much the same way, people have a biological vulnerability to specific psychiatric disorders, such as bipolar disorder, major depression, schizophrenia, or anxiety disorders (such as panic disorder or posttraumatic stress disorder). In addition, the greater an individual s vulnerability to a particular disorder, the earlier it develops, and the more severe the symptoms associated with it will be. Genetics play a role in a person s biological vulnerability to a particular illness, but other factors play a role as well. In mental illness there may be a combination of factors, including prenatal nutrition, birth complications, and early experiences in childhood, such as the loss of a parent or abuse. This is why some families are more likely to have members with a particular psychiatric disorder than other families. The same genetic predisposition for addiction makes a person more vulnerable to develop a substance use disorder, so you may hear people say that it runs in the family. There is

2 2 also a greater likelihood that a person with a mental illness will also have a co-occurring substance use disorder, or vice-versa. Although vulnerability to mental illness is biological in nature, there are different steps people can take to reduce their vulnerability, including taking medication and not using alcohol or drugs. The figure below illustrates how the components of the stress-vulnerability model of co-occurring disorders interact with each other to influence the development and course of these two disorders. Although the vulnerability is biological in nature, there are different steps people can take to reduce their vulnerability, including reducing stress, taking medication, and managing the symptoms of each disorder. (See next section)

3 3 Alcohol and Drug Use Using alcohol or drugs can increase an individual s pre-existing biological vulnerability to a psychiatric disorder. Thus, substance use can trigger a mental illness, and lead to more severe symptoms and related impairments. People with co-occurring psychiatric and substance use disorders must manage the symptoms of both disorders to prevent relapsing in each one. Stress Stress in the environment can worsen biological vulnerability, increasing symptoms and causing relapses. Stress is anything that challenges an individual or requires them to adapt in some way. Common stressful events include losing a loved one, getting fired from a job, being a victim of crime, or having a lot of conflict with close people. The use of substances frequently creates stress in the relationships of people with co-occurring disorders, and this increased stress often leads to an increase in psychiatric symptoms. Stress is often associated with negative events, such as those described above. However, many positive events and experiences may be stressful as well. For example, performing well in school, getting a new job, starting a new relationship, having a baby, or being a parent all involve some degree of stress. While it is common to think of specific events or responsibilities as causing stress, it is also possible for stress to be caused by not having enough to do. People with a co-occurring disorders tend to have worse symptoms and are more prone to using substances when they have nothing purposeful or interesting to do with their time. Thus, the lack of meaningful involvement in one s life in areas such as work, school, parenting, or homemaking can be another source of stress. Coping Efforts Coping strategies can be a helpful way of handling stress and reducing its negative effects on vulnerability. Examples of coping skills include: relaxation skills for dealing with stress and tension social skills for connecting with people, dealing with conflict, and getting support coping skills for managing persistent symptoms, such as depression, anxiety, and sleeping problems

4 4 involvement in meaningful and structured activities such as work, school, or parenting, or other caregiving responsibilities Stress is a normal part of life. Effective coping enables people to be engaged in interesting, meaningful activities that may involve stress, such as working or being a parent. Coping efforts can make it possible for someone with a co-occurring disorder to live a normal life without suffering the negative effects of stress. Many people with co-occurring disorders have previously tried using substances to cope with stress and it has only increased symptoms. It is important that they learn effective coping strategies to replace substance use. Social Support Social support can also reduce the negative effects of stress on vulnerability. Social support comes from having close and meaningful relationships with other people. Supportive people can minimize the negative effects of stress on someone with a co-occurring disorder in a variety of ways, such as: helping the person solve challenging problems supporting the person in using coping strategies to deal with symptoms and urges to use substances being open and willing to talking about and resolving disagreements, misunderstandings, and areas of conflict that could otherwise lead to stress letting the person know that they are important and care about them supporting the person in pursuing personally meaningful goals People who have good social support are less vulnerable to the effects of stress on their psychiatric illness. Therefore, having strong social support enables people with co-occurring disorders to handle stress more effectively, and live a normal life. If social support systems have previously been made up of people that they used substances with, it will be critical to develop a social network made up of sober supports. Treatment Implications of the Stress-Vulnerability Model for Co-Occurring Disorders Based on an understanding of the stress-vulnerability model, there are many ways of helping people manage their psychiatric illness and co-occurring substance use disorder. In the broadest terms, the severity and course of a

5 5 co-occurring disorder can be improved by reducing biological vulnerability and increasing resiliency against stress. Reducing Biological Vulnerability Biological vulnerability can be reduced in two primary ways: avoiding alcohol or drug use, and using medication. Medication can be a powerful way of reducing biological vulnerability by helping to correct the imbalances in neurotransmitters (chemicals in the brain responsible for feelings, thinking, and behavior) believed to cause mental illness. By taking medication, the symptoms of a mental illness can be lowered and the chances of having a relapse can also be reduced. Avoiding alcohol and drug use can reduce biological vulnerability in two ways. First, because substances affect the brain, using alcohol or drugs can directly worsen those vulnerable parts of the brain associated with mental illness. Second, using substances can interfere with the corrective effects of medication on vulnerability. This means that somebody who is using alcohol or drugs will not get the full benefit of any prescribed medications for his or her mental illness, leading to worse symptoms and a greater chance of relapses. Increasing Resiliency Against Stress It is impossible for anyone to live a life that is free of stress. However, there are many ways people can learn how to deal with stress more effectively, and to protect themselves from the effects of stress on worsening symptoms and causing relapses, including: developing effective coping skills for managing stress, persistent symptoms, and cravings getting involved in meaningful activities that structure one's time and reduce the risk of relapse building sober supports that help one manage their mental illness and maintain their sobriety Conclusion Mental illnesses have a biological basis, and this biological vulnerability can be worsened by using alcohol and drugs, and improved by taking medication. In addition, the negative effects on biological vulnerability can be reduced by improving the person s ability to cope with stress, sober supports, and their involvement in structured, personally meaningful activities. The stress-vulnerability model of co-occurring disorders

6 6 identifies many ways that individuals with a mental illness and a substance use disorder and their family members can learn how to manage these illnesses and move forward in their lives. Finding Your Own Protectors and Stressors On the chart below, fill in the things that you have found have a negative effect on symptoms for you. Then fill in what you have found can improve or reduce symptoms.

7 7 and Substance Use People In Support System