Co-morbid disorders: Co-morbid is a medical term used to describe the presence of more than one significant health problem in a person.

Concurrent disorders: The term Concurrent Disorders (CD) refers to co-occurring substance-related and mental disorders. Clients said to have CD have one or more substance-related disorder as well as one or more mental disorder. CD exist "when at least one disorder of each type can be established independent of the other and is not simply a cluster of symptoms resulting from [a single] disorder." (CSAT 2005, p.3)

Double Trouble and Double Jeopardy: often refers to self-help groups specifically designed to meet the needs of people with concurrent disorders. For more information, please see Double Trouble in Recovery

Dual Diagnosis/Dual Disorders/Co-occurring Disorders: outside of Canada, these terms are often used to describe what we call concurrent disorders. Much of the literature that comes from the U.S. uses these terms, and focuses on severe mental illness and co-occurring substance use problems. In Canada dual diagnosis is used to describe co-occurring developmental delay and mental illness.

Harm Reduction: Harm reduction is a set of practical strategies that reduce negative consequences of drug use, incorporating a spectrum of strategies from safer use, to managed use to abstinence. Harm reduction strategies meet drug users "where they're at," addressing conditions of use along with the use itself.

Mental health disorders: The major relevant categories of mental disorders for concurrent disorders are: schizophrenia and other psychotic disorders; mood disorders; anxiety disorders; somatoform disorders; factitious disorders; dissociative disorders; sexual and gender identity disorders; eating disorders; sleep disorders; impulse-control disorders; adjustment disorders; personality disorders; disorders usually first diagnosed in infancy, childhood, or adolescence. (COCE, SAMHSA definitions & terms)

Mentally Ill Chemical Abusers (MICA) and Chemically Abusing Mentally Ill (CAMI): MICA is a term sometimes used to describe people whose primary problem is mental illness, who have co-occurring substance use problems; CAMI refers to people whose primary problem is substance use, who also have mental health problems. Both terms originate in the U.S. literature.

Motivational interviewing: MI is defined as a directive, client-centred counseling style for eliciting behaviour change by helping patients to explore and resolve ambivalence. It is a technique that has proven to be effective in substance abuse settings.

Recovery consists of "gaining information, increasing self-awareness, developing skills for sober living, and following a program of change. (Lowinson et al., 1992,p. 533). As defined in the President's New Freedom Commission on Mental Health (NFCMH), recovery is "the process in which people are able to live, work, learn, and participate fully in their communities. For some individuals, recovery is the ability to live a fulfilling and productive life despite a disability. For others, recovery implies the reduction or complete remission of symptoms. (NFCMH, 2003, p. 5). When people with a concurrent disorder are in recovery, it is implied that they are abstinent from the substance causing impairment, are able to function despite symptoms of mental illness, and participate in life activities that are meaningful and fulfilling to them."

Recovery is both a process and a goal. It is learning to successfully manage a disorder, having control over symptoms and having quality of life.

Recovery is defined differently for each individual, but is generally thought to include measures such as: hopefulness, renewed meaning and purpose, managing the symptoms of schizophrenia, remission form substance abuse, living independently, having a job, having friends and social support, and quality of life.

Relapse is the return to active substance use in a person with a diagnosed substance use disorder or the return of disabling psychiatric symptoms after a period of remission related to a nonaddictive mental disorder. Relapse is both an anticipated event in the course of recovery and a process in which warning signs appear prior to an individual's actual recurrence of impairment.

A relapse occurs when a person in recovery re-experiences problems or symptoms associated with his or her disorders. With substance use disorders, a relapse means a return to problem substance use after a period of abstinence or controlled use. A relapse of a mental illness like schizophrenia means a return or flare-up of the symptoms of psychosis. A relapse of one disorder can sometimes trigger relapse with the other.13

Relapse is common for people with serious mental disorders like schizophrenia, particularly for those struggling with a substance use disorder. Because people with concurrent disorders face additional barriers to adequate treatment and housing, and subsequently do not obtain them, they are more likely to experience relapses

Relapse does not mean failure; instead, relapses should be seen as opportunities to learn how to better handle the illness. With every relapse, it is possible to learn more about how to maintain health.

Remission refers to the absence of distress or impairment due to a substance use or mental disorder. An individual in remission no longer meets DSM-IV criteria for the previously diagnosed disorder but may well benefit from relapse prevention services.

Sensitivity model posits that a biological sensitivity increases the vulnerability to the effects of substances in people with schizophrenia; smaller amounts of substances result in problems and normal substance use is problematic for clients with schizophrenia but not in general population.

Substance abuse, as defined in the DSM-IV-TR, is a "maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances. (American Psychiatric Association [APA], 2000.) Individuals who abuse substances may experience harmful consequences such as:

• repeated failure to fulfill roles for which they are responsible
• social and interpersonal problems
• legal difficulties
• use in situations that are physically hazardous

Substance dependence is "a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. (APA, 2000, p. 192). This maladaptive pattern of substance use includes all the features of abuse and additionally such features as:

• increased tolerance for the drug, resulting in the need for ever-greater amounts of the substance to achieve the intended effect
• an obsession with securing the drug and with its use
• persistence in using the drug in the face of serious physical or psychological problems

Substance use disorders is the term that refers to a habitual pattern of alcohol or illicit drug use that results in significant problems related to aspects of life, such as work, relationships, physical health, financial well-being, etc. There are two sub-categories - substance abuse and substance dependence. In some cases, substance use (as distinct from abuse or dependence) negatively impacts people with mental health problems.

Substance-Abusing Mentally Ill (SAMI): SAMI is used to describe people with serious and persistent substance use and mental health problems.

What is schizophrenia?
Schizophrenia is a mental disorder that disrupts a person's ability to think clearly, distinguish what is real from what is not, manage emotions and relate to others. It can also result in deterioration in daily functioning and self-care. Some of the characteristic symptoms include the following: delusions (false beliefs), hallucinations (false perceptions such as hearing voices), disorganized speech (difficulty staying on track with a conversation or train of thought), disorganized behaviour (difficulties performing activities of daily living), flat or blunted 'affect' (decrease in emotional expressiveness), social withdrawal, and decreased motivation. (BC Partners for Mental Health and Addictions Information

What is psychosis?
The word "psychosis" is used to describe conditions that affect the mind, in which there has been some loss of contact with reality. The terms "early psychosis" or "first episode psychosis" mean that an individual is experiencing psychosis for the first time. Hallucinations, delusions (false beliefs), paranoia and disorganized thoughts and speech are symptoms of psychosis. These symptoms can seem so real that often the person does not realize that they are experiencing psychosis. Psychosis also affects feelings and behaviour.

Psychotic episodes are periods of time when symptoms of psychosis are strong and interfere with regular life. Although the lengths of these episodes are different according to each individual, and may only last a few hours or days, psychosis is most likely to continue for weeks, months or even years unless the person is given proper treatment.

The experience of psychosis varies greatly from person to person, and individuals experiencing psychosis may have very different symptoms.

What are substance use problems?
Substance Use Problems are complex behavioural disorders characterized by preoccupation with obtaining alcohol or other drugs (e.g. marijuana, cocaine, pain killers, sedatives), excessive consumption and loss of control over consumption. People may also develop tolerance for the substance, withdrawal if the substance is not available, and impairment in functioning with peers or at work. Over time, substance use will negative affect a person's daily life. Continued use impacts relationships, work performance, physical and mental health, and daily routines that support health and effective coping.
(BC Partners for Mental Health and Addictions Information <>)

Schizophrenia Symptoms
The symptoms of schizophrenia fall into two categories - "positive" and "negative" symptoms. The positive, or psychotic symptoms most often associated with schizophrenia include delusions, hallucinations and extremely disorganized thought, mood and behaviour. Positive symptoms appear during active phases of the disorder. Negative Symptoms - reductions in attention, memory, fluency of thought and language, emotional expression, judgment, decision-making and motivation - can be more persistent. These negative symptoms can lead to patterns of social withdrawal and alienation that may disrupt the person's ability to work and function normally.

People with schizophrenia will likely have one or more of the symptoms mentioned here. However, some of the symptoms are not unique to schizophrenia. It is always necessary to seek a mental health professional's assistance in making a diagnosis.

Positive symptoms
At some phase of the illness, schizophrenia always involves at least one or more of the following: delusions, hallucinations, disturbances in thinking, or disorganized behaviour.

Delusions are false beliefs that are not consistent with the person's culture, and have no basis in fact. Delusions may cause people to believe that their bodies or thoughts are being controlled by outside forces, that ordinary events have special meaning for them, that they are especially important or that they have unusual powers, or that their bodies have changed in some mysterious way. A common delusion experienced by people with schizophrenia is the belief that people are trying to harm them.

Hallucinations are disturbances in perception. If people hear, see, taste, smell or feel something that does not actually exist, they are hallucinating. The most common hallucinations are auditory; that is, people will hear voices talking about or to them.

Thought disorder
When a person's thoughts no longer connect in a way that makes it possible to communicate clearly with other people, they are said to have a thought disorder. Thoughts may be jumbled or they may seem to vanish temporarily. When talking, the person may seem to jump from subject to subject and/or may have trouble communicating in a way that is clear and logical.

Disorganized behaviour
A person with schizophrenia may have trouble completing everyday tasks such as bathing, dressing appropriately and preparing meals. During the acute phase of the illness, people will likely be unable to plan their days and follow through with tasks that they had previously performed effortlessly.

Negative Symptoms

Physical symptoms
Physical activity may slow down in people with schizophrenia, sometimes to a point where they become motionless and stare into space. On rare occasions, they may become excited and overactive and experience strange body sensations.

Reduced motivation
People with schizophrenia may have problems finishing tasks or making and carrying out long-term plans. They may also have less energy and drive, both before and after an active phase of illness.

Social withdrawal
People with schizophrenia may feel safer and calmer being alone. They may also become so absorbed in their own thoughts and sensations that they lose interest in the thoughts and feelings of others, and may stop speaking at times

Change in habits and ability to function
People with schizophrenia may become less concerned about the way they dress and lose interest in grooming and bathing. They may find it increasingly difficult to carry out daily activities such as shopping or going to work.

Excerpted from Schizophrenia: An Information Guide. Centre for Addiction and Mental Health. 1999. PDF

The following symptoms may also be associated with schizophrenia:

Disturbances in feeling or affect (mood)
At times, people with schizophrenia may find it hard to express their feelings. On the one hand, they may experience inappropriate or intense bursts of feeling that seem to come out of the blue. On the other hand, they may feel empty of emotions.

Ambivalence means having conflicting ideas, wishes and feelings toward a person, thing or situation. It may be hard for people with schizophrenia to make up their minds about anything, even fairly common decisions such as what to wear in the morning. Often, even if they are able to make a decision, it may be hard to stick with.

One of the earliest symptoms in people with schizophrenia may be a change in their sensitivity toward others. They may become more sensitive and aware of other people, or they may withdraw and seem to pay no attention to others. They may become suspicious and worried that people are avoiding them, talking about them or feeling negatively toward them.