How Mental Illness and Addiction Influence Each Other

“Mental Illness and alcoholism or drug abuse interact in a complex dance,” says James Garbutt, M.D. professor of psychiatry at the University of North Carolina at Chapel Hill and research scientist at UNC’s Bowles Center for Alcohol Studies. “Mental Illness can increase the risk for alcoholism or drug abuse, sometimes because of self-medicating. On the other hand, alcoholism can lead to significant anxiety and depression that may appear indistinguishable from a mental illness. Finally, one disorder can be worse than the other.

There are other factors that could explain the frequent simultaneous occurrence of addiction and mental illness, including:

Genetics ~ Genetic factors seem to account for some of the co-morbidity (having both disorders at the same time) of substance abuse and mental disorders. Studies comparing identical and fraternal twins found more instances of having two disorders among the identical twins, indicating that genetics likely plays some role.

Chemical deficiency ~ Neuro-chemical factors were also found to be a common thread when mental disorders and addiction occur together. A reduction in the amount of serotonin, a chemical critical to brain functioning, may be the reason that alcoholism and anxiety disorders coincide so often. There is also evidence that addiction and mental disorders are associated with the dysfunction of a group of brain chemicals called monoamine oxidases.

People with mental health problems may use drugs and alcohol:

To feel normal they may use drugs or alcohol because it helps them feel normal and accepted. It may make them feel like they don’t have a mental health problem or are not different from others. To self-medicate they may use drugs or alcohol to reduce anxiety, depression, sleep problems, tension, hallucinations (like hearing voices), and to relieve the side effects of medication. Using drugs and alcohol may increase their thoughts of suicide.

The first step in getting sober is detoxification, or detox. During detox, they must not use any drugs or alcohol so their body can cleanse itself. They may experience withdrawal symptoms, so detox usually takes place while they are receiving medical care. If the problems are severe the person may require treatment at a hospital or other facility.

Detox is followed by therapy and sometimes medications. Most likely the person will attend individual or group therapy for both problems.

Treating two sets of symptoms ~ it is very important, but often difficult, to distinguish which symptoms are psychiatric and which are addictive. A person must be substance-free for at least two weeks in order to tease apart the various symptoms.

Alcoholism and chemical dependence are long-term illnesses, with symptoms that come and go in differing strengths and varieties over time. Such diseases are called relapsing/remitting conditions.

Relapse ~ if your relative does relapse try not to get frustrated or angry. For many people relapse is a part of the recovery process, and it doesn’t mean the treatment isn’t working. Be patient.

Newsletter June 2014

Pot Use 7 Times More Likely for Mentally Ill

It might surprise some, and come as no shock to others, that people living with mental illness are more than seven times likelier to use marijuana than people who don’t have mental illness. That is the result of a Canadian study appearing in Comprehensive Psychiatry, reviewing United States data. Specifically, more than 4% of mentally ill participants reported using marijuana at least weekly, compared to 0.6% of participants that did not have a mental illness.

The chief problem with the fact, according to head of addiction medicine at Kaiser Permanente West Los Angeles Medical Center, Dr. Escobedo, is that marijuana use can worsen symptoms of mental-health conditions. Escobedo said some people with mental illness use marijuana because they say it helps them sleep. But using marijuana to do that simply reinforces using the drug in a common “continuous cycle”. With mental illness, it’s important to think in the long term and drugs like marijuana only address short term symptoms and feelings.

“In the short term when you are dumbed out or drugged up, you may not notice your symptoms,” said Escobedo. “But in the long term, it always makes them worse.”

The use of illegal street drugs to curb mental-health symptoms is often referred to as “self medication,” and is seen as an effort to control or minimize otherwise distressing thoughts or feelings. The Canadian study found that of mentally ill people reporting at least a weekly basis, the rates were quite high for those diagnosed with bipolar disorder, personality disorders and substance use disorders (a substance use disorder is an addiction to, dependence on, or abuse of alcohol or drugs).

The combination of a mental illness and a substance use disorder is known as Dual Diagnosis (also known as “co-occurring disorders”). Research strongly indicated that to recover fully, a person suffering with a dual diagnosis needs treatment for both problems — focusing on one does not ensure the other will go away. Dual diagnosis services should integrate assistance for each condition, helping people recover from both in one setting, at the same time.

Unfortunately, despite much research that supports its success, mental health services tend not to be well prepared to deal with patients having both afflictions. Often only one of the two problems is identified. If both are recognized, the individual may bounce back and forth between services for mental illness and those for substance abuse, or they may be refused treatment by each of them. Fragmented and uncoordinated services create a service gap for persons with co-occurring disorders.

Providing appropriate, integrated services will not only allow for their recovery and improved overall health, but can ameliorate the effects of disorders on family, friends and society at large. Hopefully, more treatments and better understanding are on the way.