The connection between substance abuse and mental health issues can be attributed to shared risk factors, as well as the effect that either can have on the other. Substance abuse can increase the risk of a mental health issue, and vice versa.
Understanding this connection is important because it plays a role in both diagnosis and treatment. Treating someone with a co-occurring disorder, or a dual diagnosis is a different process versus treating someone with a mental health disorder without addiction, or a substance use disorder and no other mental health issues.
What is a Co-Occurring Disorder?
Co-occurring disorders are any instance of a mental health disorder with a substance use disorder. While substance use disorders are also mental health issues, their unique relationship with other mental health conditions, substance-based pathology, and difference in treatment leads to a drawn distinction.
The use of addictive substances affects the brain in ways other drugs do not. Addictive substances are always psychoactive, in the sense that they influence the brain and mind. They do this by passing through the blood-brain barrier and interacting with the cells in the brain.
Many other drugs that aren’t addictive do this as well. But what sets drugs like methamphetamine, opium, cocaine, nicotine, and alcohol apart from drugs like beta-blockers and selective serotonin reuptake inhibitors is the way these drugs play a role in affecting the reward system of the brain, and achieving a supraphysiological release of dopamine.
In other words, addictive drugs can change the way your brain processes its own reward chemicals, by interacting directly with the release of these chemicals, as well as a number of other unique mechanisms.
For the most part, a single experience with a drug like cocaine or alcohol is not enough to induce a substance use disorder. But it is enough to prime the brain towards the next experience.
The way drugs interact with the brain can also exacerbate and trigger the onset of different mental health symptoms. Depressants like alcohol and stimulants like cocaine can increase anxiety symptoms, and cause depression-filled crashes. Drugs like marijuana can trigger psychotic episodes and increase the severity of schizophrenic symptoms. Different drugs can exacerbate PTSD symptoms and induce panic attacks.
If the prerequisites for a mental health disorder were present before an addiction, then continued drug use can lead to the onset of severe symptoms or make existing ones stronger.
Something else happens in reverse. Patients with depression, anxiety, and other mental health issues are more susceptible to the addictive effects of drugs like alcohol because the short-term effect of an addictive drug is euphoria. Alcohol is particularly potent for people with anxiety issues because it mimics the effects of an anti-anxiety drug. However, once the short-term intoxication is gone, the only way to get it back is by drinking again. This is called self-medication.
Diagnosing a co-occurring disorder is valuable because it affects the way a patient’s treatment must be handled. Co-occurring disorders are not just co-occurring, they are also co-dependent. One feeds on the other, and it’s important to develop concurrent and cohesive strategies to treat them together.
Treating a Co-Occurring Disorder
Co-occurring disorders treatment involves multiple treatments simultaneously. An addiction can have mental and physical consequences. The most direct example is withdrawal. Quitting drug use after months or years of near-constant daily use can lead to a physical reaction. It can be stronger in some than others. In many cases, there are post-acute withdrawal symptoms that come weeks later as well.
Withdrawal differs from patient to patient and drug to drug but can range from flu-like symptoms to severe shivers and nausea. Some drugs, particularly depressants like alcohol, need to be medically detoxified because a very sudden stop can lead to fatal withdrawal symptoms, particularly arrhythmias.
Detoxification is the first step towards addressing co-occurring substance abuse and mental health issue. Getting away from the drug(s) in question and being in an environment away from other forms of drug use can help address cravings and maintain sobriety. It’s important for the next step.
Talk Therapy and Medication
Both therapy and medication play an important role in addressing co-occurring disorders. There are many forms of talk therapy, but most are based on a combination of cognitive-behavioral therapy and dialectical behavior therapy.
These are therapy techniques that challenge negative and unwanted thoughts and introduce positive changes in behavior. Dialectical behavior therapy specifically challenges irrational thinking and helps patients frame arguments against their own intense emotions and behaviors.
Intensive talk therapy can help patients with a dual diagnosis build the toolkit needed to address recurring thoughts that act as symptoms of their condition. But in many cases, just talking things out isn’t enough.
Medication often plays a role, as well. Conditions like anxiety and depression can be blunted through non-addictive antidepressants and anti-anxiety meds. These don’t “cure” the unwanted thoughts and mood changes, but they can help make it easier to cope, fight back, and feel joy again.
In conjunction with pharmacology for mental health, there are also medications for nicotine, alcohol, and opioid addiction. Some medication has been studied specifically for the treatment of multiple disorders, such as depression with alcohol use, or anxiety with alcohol use.
Experiential and Group Therapy
Aside from one-on-one treatment, group therapy and experiential or community therapies are also important steps in the treatment process. Sharing fears, hopes, and experiences with others who have gone through similar problems can be eye-opening and can help people remind themselves that they are not alone in their struggles.
Experiential therapies refer to hands-on immersive interventions that utilize caring for animals, expressing oneself through art, or guided roleplay to work through anxieties and other issues.
A Long-Term Process
Co-occurring substance use and mental health disorder will require a long-term treatment approach. An inpatient or outpatient treatment program can help a patient learn the tools they might need to continue coping with their symptoms, through thought exercises, medication, and group therapy, but a support system is also important.
Friends and family will have to learn more about their loved one’s conditions, and how they might affect their thinking and behavior.
They can learn to watch out for the warning signs of a relapse or episode, help promote coping skills, and be there for them when they need someone to talk to.