“Mental illness and alcoholism or drug abuse interact in a complex dance,” said Dr. James Garbutt, professor of psychiatry at the University of North Carolina at Chapel Hill and research scientist at Bowels Center for Alcohol Studies. “Mental illnesses can increase the risk for alcoholism or drug abuse, sometimes because of self-medicating. On the other hand alcohol and drug abuse can lead to significant anxiety and depression that may appear indistinguishable from a mental illness. Finally, one disorder can be worse than the other.”
The popular mindset is that alcoholism and drug abuse are viewed as a strange beast, somehow outside of the category of mental illness. Addiction has long been seen as a moral failing, a matter of choice and an issue of lack of discipline.
The national institute of Drug Abuse states that drug addiction qualifies as a mental illness because “addiction” changes the brain, changing a person’s normal thinking patterns of needs and desires and a substituting of new priorities connected with procuring and using the drug of choice.
As a consequence, compulsive behaviors dominate the addict and actions are taken and then repeated without appropriate regard for consequences. According to the National Alliance on Mental Illness nearly one third of those with mental illness also have substance abuse problems. The figure increases to fifty% where the underlying mental illness is severe as in bipolar and schizophrenia.
According to Dr. Stephen Gilman, an addiction psychiatrist at New York University, “Alcoholism and drug abuse addictions and other psychiatric disorders often occur at the same time. However they are distinct disorders that must be treated as such in order to get a good outcome for the patient.”
Compared to the general population, individuals with drug use disorders are twice as likely to suffer from mood or anxiety disorder. Similarly, the person with a mood or anxiety disorder are twice as likely to suffer from a drug use disorder.
Fifty percent of those with an addictive disorder will also have a psychiatric disorder. That number is even higher with certain mental conditions such as post traumatic stress disorder, antisocial personality disorder (characterized by a lack of empathy toward other people), anxiety, sleep disorders or depression, may increase the risk of addiction. Those with the highest risk of addiction are bipolar or schizophrenic.
Researchers do not know exactly why people with either of these particular disorders are at an increased risk for addiction, but alcoholism and drug abuse can cause changes in the brain, sometimes leading to changes in personality and mental disorders.
“It is very important, but often difficult, to distinguish which symptoms are psychiatric and which are addictive,” according to Dr. Gilman. “A person must be substance-free for at least two weeks in order to tease apart the various symptoms.”
Drs. Garbutt and Gilman both believe that treating an addiction and a mental illness at the same time is possible, and when you treat them together you can begin the process of unraveling the underlying causes of each.
“Clinically speaking you have to treat the addiction and the psychological symptoms at the same time. Misdiagnosis, and therefore under-treatment, is common, such when alcohol addiction is masking bipolar disorder,” Dr. Garbutt said.
People with co-occurring (mental illness and addiction) disorders are best served through integrated treatment. With integrated treatment, practitioners can address mental and substance use disorders at the same time, often lowering costs and creating better outcomes by increasing awareness. Substance Abuse and Mental Health Services and Administration.
Many people in the criminal justice system have co-occurring disorders. Providing integrated treatment to address mental and substance use disorders can lead to positive outcomes such as reduced substance use and fewer arrests. This would benefit not only the person with co-occurring disorder but everyone in law enforcement and the medical arena.
Addiction is the only prison where the locks are on the inside and it makes you blind to reality.
Overfield is an advocate for the National Alliance on Mental Illness of Park County. (307) 587-5873