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Substance abuse and mental health

Substance Abuse and Mental Health

Substance abuse remains to be one of the most significant issues in the world. There has been a notable increase in their consumption and availability, which makes it necessary to look for new response strategies at the national and international level, to curb the impact on health problems that directly link to the abuse of such harmful substances.

The association between drug use and mental disorders is frequent. Since on many occasions, people with addiction problems present other complications related to mental health. This process is called comorbidity. It is a concept used to describe the diseases or disorders that affect a person and are related to each other.

The term “comorbidity” applies when a person suffers from two or more disorders or diseases, which can happen at the same time or one after the other. Comorbidity also implies some interaction between the diseases, which can make both worse.

Mental health problems and substance use disorders.

Sometimes mental health problems and substance use disorders coexist. It is because:

  • Certain illegal drugs can cause addiction in people who experience one or more symptoms of a mental health problem
  • Mental health problems sometimes lead to drug or alcohol use, as some people with a mental health problem may abuse these substances as a form of self-medication
  • Substance use and mental disorders share some underlying causes, such as changes in brain composition, genetic vulnerabilities, and early contact with stress or trauma.
  • Probably every two in five adults with a severe mental health problem also have a substance abuse problem.

Substance use problems more frequently happen in association with certain mental health problems, including:

  • Personality disorders
  • Anxiety disorders
  • Depression
  • Schizophrenia
  • Substance use disorders (it can refer to substance use or dependence.)

Symptoms of these disorders include:

Changes in behavior, for example:

  • Decrease attendance and performance in school
  • Getting into trouble frequently (illegal activities, accidents, and fights, etc.)
  • Using substances in circumstances that pose a physical hazard, for example, while operating a machine or driving.
  • Acting secretly or suspiciously
  • Manifest changes in appetite or sleep patterns
  • Exhibiting unexplained changes in personality or attitude
  • Show mood swings, irritability, or outbursts of anger
  • Going through unusual periods of hyperactivity, agitation, or lightheadedness
  • Have no motivation
  • Appearing fearful, paranoid, or anxious, for no reason

Physical changes, for example:

  • Bloodshot eyes and abnormal-sized pupils
  • Sudden weight loss or gain
  • Deterioration of physical appearance
  • Unusual smells on your breath, body, or clothing
  • Tremors, inarticulate speech, or impaired coordination

Social changes, for example:

  • Sudden change in hobbies, favorite hangouts, and friends
  • Legal issues related to substance use
  • Unexplained need for money or financial problems
  • Use of substances even though they create problems in relationships

Is drug addiction a mental illness?

Yes. Addiction affects the brain in fundamental ways, changing a person’s regular needs and wants and replacing them with new priorities related to seeking and using drugs. It causes compulsive behaviors that weaken the ability to control impulses despite adverse consequences. These behaviors are similar to the characteristics of other mental disorders.

How do drugs affect our brains?

The reward system, beneficial for our vital functions, is based on the secretion of a hormone, dopamine. Addictions introduce a distortion in that system. The expert explains that there are people “with a tendency to seek the immediacy of satisfaction.” 

Well, when there is an addiction, the reward system consistently satisfies the person, who feels great and requires more dopamine to retain that well-being.

The dilemma is that most drugs act on brain areas altered in mental disorders. Is there a causal relationship? “In practice, it is difficult to establish what causes what, especially with an acute condition. However, the information provided by the family is key. It can be difficult for patients to recognize addiction and a mental disorder.

How common is a comorbidity of drug use disorders and other mental illnesses?

Many people with drug use disorder can also have other mental illnesses. In the same way that people who are diagnosed with a mental disorder are often also diagnosed with a drug use disorder. For example, about half of people with mental illness will also suffer from a drug use disorder at some point in their lives. There are a few studies of comorbidity in children, and they show that young people with a substance use disorder also have high rates of mental illness, such as depression or anxiety, at the same time.

Why is it common for these disorders to occur at the same time?

Although substance use disorders usually occur with other mental disorders that does not mean that one causes the other. Even if one appeared before the other, it could not be easy to establish which one came first and why. However, studies suggest three possibilities for this common comorbidity:

Some general risk factors can contribute to both mental illness and drug use disorder. Research indicates that many genes can contribute to the risk of drug use disorders and mental illness. For example, some people have a particular gene that puts them at higher risk for mental illness in adulthood if they used marijuana frequently in childhood or adolescence. A gene can also affect how a person responds to a drug (whether taking it makes them feel good or not).

Environmental factors, such as trauma or stress, can cause hereditary changes that are passed from generation to generation and can contribute to mental illness or drug use disorder.

Certain mental health states are known as risk factors for drug use disorder. For example, some studies suggest that people with mental illness may use drugs or alcohol as a way to self-medicate. 

Although some drugs can help with symptoms of mental illness, they can sometimes also make symptoms worse. Also, when a person begins to suffer from a mental illness, changes in the brain can increase the rewarding effect of drugs, and therefore, the person is predisposed to continue using the drug.

Drug use and drug addiction can contribute to mental illness. Drug use can change the brain so that a person is more prone to mental illness.

How are these comorbidities diagnosed and treated?

The high ratio of comorbidity between drug use disorder and other mental illnesses requires a comprehensive strategy that identifies and evaluates both problems. Therefore, people seeking help for drug use or abuse and drug addiction or mental illness should assess their problems and offer appropriate treatment.

Several behavioral therapies have shown promising results in treating comorbid conditions. We can also tailor these strategies to patients based on age, the specific drug they have used, and other factors. They can be used independently or along with other medications. Some of the behavioral therapies used to treat these comorbid conditions include:

  • Cognitive-behavioral therapy, which helps change harmful beliefs and behaviors.
  • Dialectical behavior therapy, specifically designed to reduce self-injurious behaviors, such as cutting yourself, using drugs, or having suicidal attempts, thoughts, or impulses.
  • Assertive community treatment, which emphasizes outreach to the community and individualized treatment strategies.
  • Therapeutic communities, which are conventional long-term residential treatment modalities that focus on the “re-socialization” of the person.

However, recovery is not easy because it is necessary to maintain a drug-free life, but the effects of the drug remain on the mind and body. Even if the treatment seems to stop the use of the drug, flashback may occur and then restart.

Drug use and mental disorders.

With every passing year, we can see the growing significance and recognition of psychological aspects in the processes of health, disease, well-being, and quality of life. This fact derives from the knowledge of the complex and multifactorial nature of health, disease, and the procedures of healing and getting sick.

This multifactorial nature requires giving due importance to the entire set of cognitive, affective, attitudinal, motivational, physiological, behavioral, and psychosocial aspects. It must be combined in the promotion of health and the prevention and treatment of disease.

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