The Most Common Mental Illnesses That Co-Exist With Substance Abuse
There’s no question that mental illness and substance abuse are often co-occurring. In fact, substance abuse can be caused by mental illness (as a means to self-medicate) but it can also make mental illness symptoms worse.
For a variety of reasons, certain mental disorders seem to appear most often with certain types of substance abuse. The following are four combinations that often co-exist together.
Antisocial Personality Disorder and Alcohol Abuse
According to the National Institute on Alcohol Abuse and Alcohlism (NiAAA), antisocial personality disorder (ASPD) is most closely linked to alcoholism in terms of substance abuse. Drug addiction is also common, but persons who suffer from alcoholism are an incredible 21 times more likely to also have symptoms of ASPD than those who don’t drink.
Both disorders tend develop early in life. In addition, alcoholism increases certain behaviors inherent to those with ASPD, including impulsiveness and lowered inhibitions. Indeed, some research points to the same mechanisms in the brain as being responsible for both impulsivity and alcoholism.
Anxiety Disorders and Cocaine Use
Cocaine is used by an estimated 17 million people worldwide, and is most prevalent in North America (5.3 million people.) About 1/5 of the 4.2 million Americans who use cocaine meet diagnostic criteria for cocaine abuse or dependence.
Cocaine is a powerful stimulant, meaning that it activates the central nervous system. It can produce effects like increased energy, talkativeness, and euphoria. However, it is those same stimulating effects that can lead to negative symptoms such as anxiety, agitation, and nervousness.
In fact, current cocaine users are twice as likely as non-users to have symptoms of depressive or anxiety disorders. Furthermore, up to 25% of non-treatment-seeking cocaine users may experience anxiety.
Even those who maintain long-term abstinence after chronic cocaine use may continue to suffer from symptoms related to anxiety. Anxiety symptoms may include excessive worry, panic attacks, and even paranoia. Anxiety itself is related to our innate “fight or flight” extincts that animals and insects have been using for millions of years to avoid danger.
Post-Traumatic Stress Disorder and Opioid Addiction
Post-traumatic stress disorder is a mental condition that is occurs after someone experiences severe trauma. They may have been very close to death, or close to someone else who died. It therefore common for persons in the military to suffer from this disorder.
For example, in a study of Iraq and Afghanistan veterans who suffered from pain, 18% of those with PTSD were prescribed opioids within 12 months of their pain diagnosis. Among those prescribed opioids, patients with PTSD were more likely than those without mental illness to receive a higher daily opioid dose, and receive two or more opioids.
For those who survive near-death encounters, they may have suffered severe injuries which require the use of prescription opiods in order to control pain. These painkillers may also serve as an unintentional self-medication of sorts, as they can boost mood and provide feelings of relaxation and well-being.
But opioids, however, are not indicated for long-term pain, despite their regular use. This is due to their propensity to produce both tolerance and dependency. Tolerance means that increasing amounts of the drug is needed to produce the desired effects. Dependency means that cessation of the drug results in unpleasant withdrawal symptoms.
These two effects together result in addiction and continued abuse, which may ultimately lead to overdose and death.
Depressive Disorders and Heroin Addiction
People with depressive disorders may turn to heroin as an escape. Heroin is an opioid, similar to prescription painkillers, which also are often used as a means to mentally self-medicate (see above.)
According to a 2001 article published in Advances in Psychiatric Treatment, nearly half (48%) of opiate users have experienced lifetime depression.
Over time, heroin users can incur a form of brain damage which alters areas in the brain responsible for signaling pleasure. Thus, they become less and less capable of experiencing happiness without the drug.
When users try to wean themselves off or stop altogether, they often experience extreme depression and anxiety, and relapse is incredibly uncommon.
In fact, the National Alliance on Mental Illness states that the effects of heroin in persons with psychiatric disorders are more likely to be negative. Moreover, heroin may worsen depressive symptoms such as negative mood, low energy, social isolation, and suicidal thoughts.
It’s interesting to see how the most commonly occurring disorders tend to negatively compliment each other. That is, when someone has a propensity for substance abuse, they often do so because of negative thoughts and feelings. Then, over time the substance abuse makes those thoughts and feelings worse, thus exacerbating existing mental illness.
Treatment for co-occurring disorders usually needs to address both substance abuse and mental illness in order to be effective. For those who originally sought out substances as a means to self-medicate, the abuse itself is more likely to be a symptom of the original mental illness. Thus, treating addiction alone does nothing to assuage the underlying condition.
Conversely, those who have developed or exacerbated symptoms of mental illness due to substance abuse may find their symptoms reduced if they cease using and recover from the addiction.
~ G. Nathalee Serrels, M.A, Psychology