Substance abuse and mental illness

Dual diagnosis, co-occurring disorders, and co-morbidity refer to a condition in which a person has two brain diseases at the same time: one an addiction and one a mental disorder. Unfortunately, this condition is all too common. According to reports published in the Journal of American Medical Association (JAMA):

Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse.

Thirty-seven percent of alcohol abusers and 53 percent of drug abusers also have at least one mental illness.

Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.

Having a mental illness is rough on the person with the mental illness and their family members. It becomes even more complex and difficult if substance abuse is involved. The consequences are numerous and harsh. There is statistically greater propensity for violence, medication noncompliance, and failure to respond to treatment than a person with just substance abuse or a mental illness. In addition, having both conditions frequently leads to overall poorer functioning and a greater chance of relapse. They experience more episodes of psychosis. They are in and out of hospitals and treatment programs without lasting success.

Socially people with mental illnesses often are susceptible to co-occurring disorders due to “downward drift.” In other words, as a consequence of their mental illness they may find themselves living in marginal neighborhoods where drug use prevails. Having great difficulty developing social relationships, some people find themselves more easily accepted by groups whose social activity is based on drug use. Some may believe that an identity based on drug addiction is more acceptable than one based on mental illness.

People with co-occurring disorders are also much more likely to be homeless or jailed. An estimated 50 percent of homeless adults with serious mental illnesses have a co-occurring substance abuse disorder. Meanwhile, 16% of jail and prison inmates are estimated to have severe mental and substance abuse disorders. Among detainees with mental disorders, 72 percent also have a co-occurring substance abuse disorder.

Research has strongly indicated that to recover fully, a person with co-occurring disorder needs treatment for BOTH problems at the same time. Focusing on one does not ensure the other will go away. Dual diagnosis services integrate assistance for each condition, helping people recover from BOTH in ONE SETTING, AT THE SAME TIME.

In spite of research that supports its success, integrated treatment is still not made widely available. This is an idea that has been slow in coming. It involves a paradigm shift in philosophy and attitude. It necessitates changes in the programs and training for both substance abuse treatment and treatment for mental illness.

Families should protect their ill family member from being bounced back and forth between services for mental illness and those for substance abuse. With continued education on co-occurring disorders, hopefully, more treatments and better understanding are on the way.