Substance Abuse and Mental Health

Substance abuse and mental health have always been intertwined, and both play a significant role in overall health.

In recent years, there has been an increased focus on understanding addiction, mental health disorders, and how they can coexist. This is a dual diagnosis or having a “co-occurring disorder” – that causes additional difficulties for those affected.

This blog post explores the various aspects of dual diagnosis. It includes its risk factors, common symptoms, and available treatment options.

Is Drug Addiction a Mental Illness?

Yes, drug addiction is a mental illness.⁴ According to the National Institute of Mental Health (NIMH), drug addiction is a severe type of substance use disorder (SUD). 

It falls under the category of SUDs in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This means that addiction is a clinical disorder that affects your brain and behavior.

Addiction is not just having a lack of willpower or moral failing; it’s a complex disease that involves changes in the brain’s structure and function. It can coexist with other mental health disorders, making diagnosing and treating it challenging.

What is a Dual Diagnosis?

A dual diagnosis, also called a co-occurring disorder, is when you simultaneously have an SUD and a mental health disorder. This means that you can struggle with addiction and may also have depression, anxiety, bipolar disorder, schizophrenia, or another mental illness.

Co-occurring disorders can develop when you use substances to cope with your mental health disorder symptoms. On the other hand, substance use can also cause or worsen certain mental health symptoms.

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What are the Signs of Co-Occurring Disorders?

People with co-occurring disorders can show signs and behavior that they’re using substances to treat mental health symptoms. It can be anything from missing their prescription medication to developing vices.

A person may be managing a co-occurring disorder with substances if they are:

• Taking the substance in larger amounts or over a longer period than intended
• Having a persistent desire for the substance
• Struggling to cut back on, control the intake of, or quit using a substance
• Spending a lot of time trying to obtain the substance which takes a toll on other work and life responsibilities
• Continuing to use the substance despite adverse effects on physical or mental health and professional or personal relationships
• Developing a higher tolerance for the substance over time, which results in needing a larger amount to achieve the desired effect
• Experiencing withdrawal symptoms when trying to cut back on or quit using the substance
• Using the substance to avoid or alleviate withdrawal symptoms

Signs of Mental Health Issues and SUD

Some common signs of mental health issues, which can also be signs of a SUD, include:¹

• Mood swings
• Irritability
• Appetite changes
• Changes in sleep patterns
• Lacking motivation
• Appearing fearful
• Paranoia or anxiety
• Engaging in secretive or suspicious activities
• Frequently getting into trouble
• Weight gain or weight loss

These signs may vary, depending on the person’s mental illness and other conditions. If you or someone you know exhibits any of the above signs, contact a healthcare professional to receive treatment for both conditions.

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Treatment for a Dual Diagnosis

When a mental health disorder and SUD co-occur, integrated treatment is necessary for successful recovery. This type of care addresses both conditions simultaneously by a team of specialists with training in mental health and addiction.

Treatment for a dual diagnosis may involve:

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is a talk therapy that helps unpack the root cause of mental health issues. The goal of CBT is to:

• Identify and change unhelpful thoughts and behaviors
• Improve problem-solving abilities
• Learn healthy coping skills for managing stress, triggers, and cravings

CBT can also help you learn how to manage symptoms of both disorders. It's a suitable treatment option for people with co-occurring conditions as it focuses on the relationship between thoughts, emotions, and behaviors.

Dialectical Behavioral Therapy (DBT)

Dialectical behavioral therapy (DBT) is a specific type of CBT that can help people with co-occurring disorders better manage intense emotions, impulsivity, and self-destructive behaviors. It teaches skills like mindfulness, emotion regulation, and distress tolerance to improve coping abilities.

Assertive Community Treatment

Assertive community treatment involves a community of people with similar mental health struggles. They can provide support, understanding, and encouragement during recovery.

Support Groups

Support groups can also provide community, understanding, and accountability during recovery. They may be specific to mental health disorders or substance use disorders or focus on dual diagnosis.

Inpatient and Outpatient Programs

Inpatient and outpatient rehabilitation centers rely on medical and mental health professionals to assist and monitor people undergoing detox and rehabilitation.

Inpatient programs are typically more intensive, providing round-the-clock care. In contrast, outpatient programs allow you to receive treatment in a facility and return home afterward.

Medication-Assisted Treatment (MAT)

Sometimes, medication-assisted treatment is necessary for managing symptoms of mental health disorders or substance use disorders during recovery. Medications can address cravings, withdrawal symptoms, mood disorders, and other symptoms that may interfere with healing.

Holistic Therapies

Holistic therapies include meditation and yoga, nutritional guidelines, and body movement to release natural endorphins. These activities address psychological, societal, ethical, and spiritual dimensions in treating a person’s well-being.

Aftercare Programs

After completing a treatment program, ongoing support is essential for long-term recovery. Aftercare programs provide continued support and resources to prevent relapse and manage co-occurring disorders.

These programs may include:

• Support groups (e.g., 12-step programs)
• Individual therapy
• Medication management
• Sober living arrangements

What Risk Factors Do Addiction And Mental Health Disorders Share?

Those with mental health disorders and people with SUDs share several risk factors, including:

• Genetics and family history
• Early exposure to trauma or adverse childhood experiences (ACEs)
• Impaired coping skills and difficulty managing stress
• Poor impulse control and decision-making abilities

Any brain functioning changes from substance use can also take a mental toll.⁴ However, just because addiction and a mental health disorder co-occur doesn’t mean one caused the other. 

What Comes First, Mental Illness or Substance Use?

Sometimes, people may use substances to cope with or self-medicate their mental health disorder. For others, prolonged substance use can alter brain chemistry, leading to mental health disorders.

The interactions between mental health disorders and substance use are often complex. This demands comprehensive, integrated treatment for people with co-occurring disorders.

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Why Do People Abuse Drugs?

Several factors can contribute to substance abuse, including:

• Genetic predisposition
• Underlying mental health conditions
• Environmental factors
• Social influences

For some people, experimenting with drugs or alcohol may lead to addiction due to the brain's changes in reward and pleasure pathways.

Others may use substances to cope with stress, trauma, or difficult emotions.⁴ Some drugs that treat symptoms of mental health disorders can also become addictive or worsen symptoms over time.⁴

How Do Drugs Change the Brain?

Drugs can alter brain function in various ways, including:^2,5,6

• Mimicking neurotransmitters and hijacking the reward and pleasure pathways in the brain
• Damaging neurons or interfering with their communication
• Triggering a release of abnormally high levels of dopamine, leading to an intense "high" that reinforces drug use
• Changing your behavior and weakening your ability to control impulses

These changes in brain chemistry can lead to addiction. In some cases, they worsen or trigger mental health disorders.

Who is at Risk of Abusing Drugs?

Certain factors can increase the risk of developing SUD, including:

• Family history of addiction or mental illness
• Trauma or adverse childhood experiences
• Co-occurring disorders
• Social and environmental influences (peer pressure, access to drugs)

People with mental health and personality disorders also have an increased risk of prescription opioid misuse. This is due to the overlap between these disorders and chronic pain conditions that may require opioid treatment.

A person with SUD might also develop another mental health disorder like anxiety. They may start to feel anxious if they haven’t had their fix. This means they’ve become reliant on drugs or alcohol to function.⁴

What's the Connection Between Substance Use and Mental Health?

There's a complex relationship between substance use and mental health. Some people may use drugs or alcohol to cope with stress, trauma, or other difficult emotions. This can lead to addiction as the substance becomes a means of self-medication.

Here are some statistics on co-occurring disorders³:

• In one study, forty-three percent of people in addiction treatment for prescription painkillers also exhibit symptoms of mental health disorders. These include depression and anxiety.
• About one in four people with a serious mental illness, a diagnosable mental, behavior, or emotional disorder, also have an SUD.
• More than 60 percent of adolescents in community-based treatment programs for SUD also struggle with other mental illnesses.

Frequent and prolonged drug use can also cause changes in brain chemistry that can contribute to or worsen mental health disorders. For example, heavy alcohol use can lead to depression or anxiety due to its impact on neurotransmitters.

Which Mental Health Disorders Often Co-occur with Substance Use Disorder (SUD)?

About half of people with SUD also experience a co-occurring mental health or personality disorder. These disorders include:^3,4

• Depression
• Anxiety
• Bipolar disorder
• Post-traumatic stress disorder (PTSD)
• Borderline personality disorder (BPD)
• Antisocial personality disorder (ASPD)
• Psychotic illness
• Schizophrenia
• Attention-deficit hyperactivity disorder (ADHD)

What is a Comorbidity?

Comorbidity refers to having two or more illnesses at once, which can be physical or mental. It may include a co-occurring disorder, depending on a person’s condition. It's essential to address all of a person’s conditions as they can interact and worsen each other if left untreated.²

Treating multiple disorders simultaneously rather than separately can lead to better outcomes for those with dual diagnosis. This approach is integrated treatment, where mental health and substance use disorder specialists work together to provide comprehensive care.

Summary

Substance use disorders often occur alongside mental health disorders. They share common risk factors and can influence each other's development.

Drugs can alter the brain's reward and pleasure pathways, leading to addiction or worsening symptoms of existing mental health conditions. Therefore, integrated treatment for both conditions is typically necessary for successful recovery.

If you or a loved one is struggling with co-occurring disorders, seek support from healthcare professionals and community resources. Seeking treatment can help manage symptoms and aid in building a healthier, happier life.

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