Evidence-Based and Promising Practices for Co-Occurring Disorders: A Holistic Approach

This podcast episode, hosted by Dr. Donnelly Snipes, delves into current research on evidence-based and promising practices for treating co-occurring disorders, particularly addiction alongside mood disorders, pain, and PTSD. Dr. Snipes emphasizes that effective treatment necessitates a concurrent and comprehensive approach addressing all presenting biopsychosocial issues, highlighting the interconnectedness of physical health, mental well-being, and recovery environments. She cautions against early personality disorder diagnoses in recovery, suggesting many symptoms abate as neurotransmitters stabilize and coping skills improve. The discussion underscores the limitations of addressing only one aspect of a client's struggles, illustrating how untreated depression can undermine sobriety, and substance abuse can impair recovery from mood disorders or PTSD.

The episode reviews several key interventions, starting with Cognitive Behavioral Therapy (CBT) as the "gold standard" for a wide array of conditions, including addiction, anxiety, depression, and even schizophrenia and dementia, emphasizing its behavioral component and adaptation for specific populations. Mindfulness-Based Interventions (MBIs) are presented as a close second "gold standard," demonstrating effectiveness comparable to CBT and psychopharmacology across various disorders and age groups, promoting personal agency. Relaxation therapies, including deep breathing and progressive muscular relaxation, are discussed for their physiological benefits in regulating the sympathetic-parasympathetic balance and reducing arousal, particularly useful for chronic pain, anxiety, and anger, often paired with biofeedback for enhanced self-regulation.

Dr. Snipes then explores more novel and adjunctive therapies. Virtual Reality (VR) is introduced as a versatile tool for cognitive training, sensory immersion, and social skills, showing promise in pain reduction (e.g., burn care), enhancing quality of life for dementia patients through reminiscence therapy, and as an adjunctive for depression and suicidality by fostering presence and positive imagery. Transcranial Direct Current Stimulation (tDCS), a non-invasive neuromodulatory technique, is presented as "probably effective" for various pain conditions, Parkinson's disease, stroke rehabilitation, non-drug resistant depression, and reducing auditory hallucinations and alcohol cravings, offering an alternative for those unable to take medication.

Finally, the podcast stresses the critical role of lifestyle interventions. Nutritional interventions are highlighted for their impact on brain-derived neurotropic factor (BDNF), systemic inflammation, and neurotransmitter synthesis, with specific nutrients like omega-3s, fiber, and vitamin D being crucial. The gut-brain axis and the importance of gut health are also emphasized. Sleep hygiene is identified as a fundamental yet often overlooked factor, with sleeplessness directly correlating with increased pain sensitivity (hyperalgesia), anxiety, depression, and HPA axis dysfunction, posing a significant risk for relapse in addiction and mood disorders. The episode concludes by advocating for a multidisciplinary approach that integrates these diverse strategies to support comprehensive client recovery and well-being.

Effective treatment requires concurrent treatment of all presenting biopsychosocial issues.

Cognitive behavioral therapy is still the gold standard for addiction anxiety dementia depression eating disorders insomnia ocd and schizophrenia.

When you're working with someone with schizophrenia you're not trying to convince them that their reality is wrong and yours is right you're trying to help them live the highest quality of life as possible given their reality their phenomenological reality.

Mindfulness-based interventions consistently outperform active control conditions like health education relaxation and supportive psychotherapy.

VR assisted burn virtual reality assisted burn and non-burn wound care reduced opioid need by 39% compared to no virtual reality while levels of pain and anxiety were similar.

Recurrent pain often leads to maladaptive neuroplasticity tdcs imp um not in pairs it improves that neuroplasticity and it's been found as being quote probably effective in reducing neuropathic fibromyalgia migraine and post-operative pain.

13 main nutrients have been identified an implication in the pathophysiology of depression and systemic inflammation and include folate iron long chain omega-3 fatty acids magnesium potassium selenium thiamine vitamin a b6 b12 cd and zinc.

Sleeplessness has been shown to induce a generalized state of hyperalgesia.

Addiction mood disorders and sleep disturbances may reflect a neurobiological dysfunction and may not spontaneously recover which leads to an increased risk of relapse.

If sleep hygiene interventions aren't cut doing the trick and people are still feeling groggy sleep studies and multi-disciplinary interventions can also be useful.