Substance Abuse and Mental Illness

Dual Diagnosis, Co-Occuring Disorder and Comorbidity – I’m confused

Dual diagnosis is a term used to describe people with a mental illness who have coexisting problems with drugs and/or alcohol. Sometimes, it is referred to as a co-occurring disorder. To cause more confusion, the definition of comorbidity is “the presence of one or more disorders, occurring with a primary disorder” — in other words, it’s similar to dual diagnosis. The treatment of people with co-occurring substance abuse (or substance dependence) and mental illness is more complicated than the treatment of either condition alone. This is unfortunately a common situation—many people with mental illness have ongoing substance abuse problems, and many people who abuse drugs and alcohol also experience mental illness.

The bottom line — the relationship between mental illness and substance abuse or dependency is complex.

Why?

• Drug abuse may bring about symptoms of another mental illness. Increased risk of psychosis in vulnerable marijuana users suggests this possibility.
• Mental disorders can lead to drug abuse, possibly as a means of “self-medication.” Patients suffering from anxiety or depression may rely on alcohol, tobacco, and other drugs to temporarily alleviate their symptoms.
These disorders could also be caused by shared risk factors, such as—
• Overlapping genetic vulnerabilities. Predisposing genetic factors may make a person susceptible to both addiction and other mental disorders or to having a greater risk of a second disorder once the first appears.
• Overlapping environmental triggers. Stress, trauma (such as physical or sexual abuse), and early exposure to drugs are common environmental factors that can lead to addiction and other mental illnesses.
• Involvement of similar brain regions. Brain systems that respond to reward and stress, for example, are affected by drugs of abuse and may show abnormalities in patients with certain mental disorders.
• Drug use disorders and other mental illnesses are developmental disorders. That means they often begin in the teen years or even younger—periods when the brain experiences dramatic developmental changes. Early exposure to drugs of abuse may change the brain in ways that increase the risk for mental disorders. Also, early symptoms of a mental disorder may indicate an increased risk for later drug use. (from drugabuse.gov – see citation below)

Some bad news

Abuse of drugs and alcohol always results in a worse outcome for a person with mental illness. People who are actively “using” are less likely to follow through with the treatment plans that were put in place. They are less likely to take their medicine and more likely to miss appointments. People with mental illness who abuse substances are also at increased risk violent acts. The most scary is that people who abuse drugs and alcohol are more likely to (a) attempt suicide and (b) to die from their suicide attempts.

What can be done?

Treatments are complicated. First, you have to find out if there are any life-theatening complications from dugs and alcohol.  The following  situations need quick medical care in a hospital.

• Severe  alcohol intoxication
• Use of amphetamines, crack, and cocaine
• Use of benzodiazapines, opiates (e.g., oxycodone, oxycontin) and other “downers”
• Withdrawal from a physical dependence

A person with heavy use might need inpatient detoxification.  This way they can be monitored. For people who don’t require a detox, they might choose an inpatient rehab  or supportive “sober” housing. Other people may choose to return home to their friends and family, who can be helpful and encouraging  Most treatment and rehabilitation settings will include therapy .

What can be done?

Some people will require medication. The following medication treatments have been safely tested in multiple studies. For people with alcoholism, available medications include disulfiram (Antabuse), acamprosate (Campral) and naltrexone (Revia). For people with opiate abuse, available medications include naltrexone (Revia, Vivitrol), methadone and buprenorphine (Subutex, Suboxone). Given how tricky theses choices can be — it is important for dual diagnosis suffers to talk with, doctors, family members and counselors. With a good support group, the proper medical treatment will help a person life a quality life.

Support Groups

Dual Recovery Anonymous is a 12 step self-help program that is based on the principals of A.A. and the experiences of men and women in recovery with a dual diagnosis. The DRA program helps us recover from both our chemical dependency and our emotional or psychiatric illness by focusing on relapse prevention and actively improving the quality of our lives. In a community of mutual support, we learn to avoid the risks that lead back to alcohol and drug use as well as reducing the symptoms of our emotional or psychiatric illness.

More information:

National Institute of Drug Abuse. Comorbidity: Addiction and Other Mental Disorders Retrieved from http://www.drugabuse.gov/publications/drugfacts/comorbidity-addiction-other-mental-disorders on October 17, 2014