Mental health disorders and substance use disorders frequently co-occur.
In fact, according to the 2014 National Survey on Drug Use and Health, about 39.1 percent of people with a substance abuse problem also have some type of mental health disorder.
Because of this high prevalence of mental health disorders among those who struggle with substance abuse, it is important to be aware of the challenges of treating these co-occurring disorders. The frustrating symptoms of mental health disorders, such as depression and anxiety, may cause some people to try to self-medicate with drugs or alcohol. Alternately, those who abuse substances may begin to exhibit signs of certain mental health disorders due to the changes in brain chemistry and structure that these substances can bring about.
Understanding the prevalence of mental health disorders inthose who struggle with substance abuse can help to make sure that the right kinds of integrated, comprehensive treatments are provided, making it possible to achieve recovery from the disorders involved and maintain it into the future.
Mental health issues are considered to constitute a major risk factor for developing a substance use disorder. While the reasons for this are not fully known, there are a number of commonalities across these disorders that may contribute to a person who struggles with mental illness being vulnerable to substance abuse. According to the National Institute on Drug Abuse, these include:
- Effects that substances have on the brain can manifest as symptoms of certain mental disorders; for example, cocaine use can damage the system that regulates stress and anxiety.
- People struggling with mental illness may use substances to mitigate mental health symptoms – a phenomenon known as self-medication – and develop a dependence on the substance over time.
- Underlying brain conditions may make a person more susceptible to both mental health disorders and substance use disorders, such as problems with the dopamine system that regulates pleasure and reward responses in the brain.
- These complex factors may all contribute to a person’s vulnerability to both substance abuse and mental illnesses of various kinds. The following descriptions provide some examples of the prevalence of substance abuse with certain mental health issues.
People with mood disorders, such as depression or bipolar disorder, are very likely to engage in substance use and abuse. A research review in the American Journal of Psychiatry demonstrates that the lifetime prevalence of bipolar disorder with any substance use disorder is 47.3 percent; for bipolar I disorder, it is as high as 60.3 percent. Meanwhile, alcohol abuse is present in 40.3 percent of those with major depression, and 17.2 percent of people with depression abuse drugs.
A number of people will take drugs to self-medicate for the symptoms of depression. Stimulants like cocaine or meth can create a high that masks depression for a while, while sedatives or alcohol are sometimes used to “numb” the feelings of depression. A person struggling with bipolar disorder may use both types of drugs, or others, to manage fluctuations in mood.
The problem is that the damage these substances can inflict on the person’s dopamine and other systems can make it harder and harder to feel well as tolerance to the drug increases – that is, as the person becomes used to the drug’s effects, the person needs more and more of the substance to achieve the positive feelings of the substance. An example of this is described in the Primary Care Companion to the Journal of Clinical Psychiatry, in which chronic cocaine use damages the dopamine system, resulting in dysphoria, or an inability to feel pleasure.
A study from Psychiatric Times demonstrates that anxiety disorders and substance abuse also frequently occur together. In fact, nearly 10 percent of those who have generalized anxiety disorder also experience drug dependence, while nearly 3 percent develop alcoholism. In contrast, people with panic disorder have a similar prevalence of alcoholism, while prevalence for drug dependence is only 6.4 percent. Substance abuse in general is a challenge for this varied group of mental health disorders.
Anxiety disorders also contribute to benzodiazepine (benzo) abuse and addiction. These prescription anti-anxiety drugs are highly addictive, and their overuse and abuse have led to co-occurring anxiety disorders with benzo abuse. While this isn’t the only contributing factor to benzo abuse, it represents a problem for those who are treated for anxiety using these drugs, and for their doctors.
Anorexia, bulimia, and binge eating disorder each have different substance abuse prevalence rates:
- Of people who have a binge eating disorder, 67 percent have a co-occurring mental disorder; of these, 22 percent have a substance use disorder, according to Comprehensive Psychiatry. Binge eating and substance abuse seem to occur frequently in people who also have issues related to trauma, or PTSD.
- According to European Eating Disorders Review, 80 percent of people who have bulimia abuse alcohol; prevalence of other substance use is about 50 percent. People who have bulimia are also more likely to use drug types across the spectrum than those with other eating disorders.
- People with anorexia seem less likely than those with other eating disorders to abuse drugs or alcohol; however, co-occurrence of anorexia and substance abuse is still common. People with anorexia who also display binge-purge behaviors are most likely to have a substance use issue, and those who purge are more likely to abuse substances than those who do not purge, based on a study from International Journal of Eating Disorders.
Another article in Psychiatric Times reports that the risk for substance abuse in people with schizophrenia is 4.6 times higher than for the general population. One study found a 74 percent lifetime prevalence of substance abuse in people who had just experienced their first psychotic episode. Cannabis, alcohol, and nicotine are the substances most often abused by this population.
There are still a lot of questions about how substance abuse affects psychotic disorders, and vice versa. In some cases, it seems that substance use, such as cannabis use, can increase the risk for developing a psychotic disorder later in life. However, there is also a hypothesis that this only happens when there is already a predisposition to psychosis.
Which Came First?
For treatment of these co-occurring disorders, a challenge often lies in trying to determine which issue arose first. According to the Psychiatric Times article on anxiety and substance abuse, one study showed that the anxiety disorders developed before the co-occurring substance use disorder in about 75 percent of cases. However, as evidenced by the discussion of psychotic disorders, it is not always clear which came first, and there are occasions where substance abuse can create symptoms of or even assist in development of a mental health disorder.
No matter which occurs first, these co-occurring disorders often influence and feed one another, creating cycles that intertwine the disorders until it is difficult to tell where the mental health disorder ends and the substance abuse begins, requiring both to be treated in order for either to be managed effectively.
Treating Co-occurring Disorders
It is possible to meet the challenge of co-occurring mental health and substance use disorders. Experts in comorbid conditions can, through a series of interviews, tests, and research, determine the nature of co-occurring disorders and create individualized, integrated treatment plans to help treat both or multiple disorders. Therapies such as Cognitive Behavioral Therapy, in combination with other therapies as appropriate for the individual, can help the person learn to recognize thought and behavior patterns and insert new responses, learning to manage both substance abuse and the symptoms of mental health disorders with a lower chance of relapse for each disorder.
Seeking treatment through a certified, reputable rehab facility that is experienced in co-occurring disorders is the first step in finding this type of treatment. With this type of caring, individualized treatment, people struggling with substance use and mental health disorders can find the path to recovery and continued management of these conditions.