Substance Abuse

Substance use disorders — the repeated misuse of alcohol and/or drugs — often occur simultaneously in individuals with mental illness, usually to cope with overwhelming symptoms. The combination of these two illnesses has its own term: dual diagnosis, or co-occurring disorders. Either disorder (substance use or mental illness) can develop first.

 

According to the National Survey on Drug Use and Health, 9.2 million U.S. adults experienced both mental illness and a substance use disorder in 2018. 

Symptoms

Because many combinations of dual diagnosis can occur, symptoms vary widely. Mental health clinics are starting to use alcohol and drug screening tools to identify people at risk. Symptoms of substance use disorder may include:

  • Withdrawal from friends and family

  • Sudden changes in behavior

  • Engaging in risky behaviors

  • Developing a high tolerance and withdrawal symptoms

  • Feeling like you need a drug to be able to function

 

Symptoms of a mental health condition can also vary greatly. Warnings signs, such as extreme mood changes, confused thinking or problems concentrating, avoiding friends and social activities and thoughts of suicide, may be reasons to seek help.

 

Treatment

The best treatment for dual diagnosis is integrated intervention, when a person receives care for both their diagnosed mental illness and substance use disorder. The idea that “I cannot treat your depression because you are also drinking” is outdated — current thinking requires both issues be addressed.

You and your treatment provider should understand the ways each condition affects the other and how your treatment can be most effective. Treatment planning will not be the same for everyone, but here are a few common elements:

Detoxification. The first major hurdle that people with a substance use disorder will have to pass is detoxification. Inpatient detoxification is generally more effective than outpatient for initial sobriety and safety. During inpatient detoxification, trained medical staff monitor a person 24/7 for up to seven days. The staff may administer tapering amounts of the substance or its medical alternative to wean a person off and lessen the effects of withdrawal.

Inpatient Rehabilitation. A person experiencing a mental illness and dependent patterns of substance use may benefit from an inpatient rehabilitation center where they can receive medical and mental health care 24/7. These treatment centers provide therapy, support, medication and health services to treat the substance use disorder and its underlying causes. 

Psychotherapy is usually a large part of an effective treatment plan. In particular, cognitive behavioral therapy (CBT) helps people with dual diagnosis learn how to cope and change ineffective patterns of thinking, which may increase the risk of substance use. 

Medications are useful for treating mental illness. Certain medications can also help people experiencing substance use disorders ease withdrawal symptoms during the detoxification process. 

 

Supportive Housing, like group homes or sober houses, are residential treatment centers that may help people who are newly sober or trying to avoid relapse. Sober homes have been criticized for offering varying levels of quality care because licensed professionals do not typically run them. Please do some research before making a selection. 

Self-Help and Support Groups. Dealing with a dual diagnosis can feel challenging and isolating. Support groups allow members to share frustrations, celebrate successes, find referrals for specialists, find the best community resources and swap recovery tips. They also provide a space for forming healthy friendships filled with encouragement to stay clean. 

 

Co-Occurring

Mental Illness

A co-occurring disorder refers to when one person has two or more mental health disorders or medical illnesses. These co-occurring disorders may overlap and begin at the same time, or one may appear before or after the other.

Bipolar Disorder & Co-Occurring Substance Abuse

The coexistence of both a mental health and a substance use disorder is referred to as co-occurring disorders, the National Institute for Mental Health’s Mental Health Information page has information about specific conditions and disorders as well as their symptoms.

 

SAMHSA works to prevent and treat mental and substance use disorders and provide supports for people seeking or already in recovery

 

Medication

Guide

(Prescription & Experimental)

Alcohol Use Disorder Medications​

  • Acamprosate - is for people in recovery, who are no longer drinking alcohol and want to avoid drinking. It works to prevent people from drinking alcohol, but it does not prevent withdrawal symptoms after people drink alcohol. It has not been shown to work in people who continue drinking alcohol, consume illicit drugs, and/or engage in prescription drug misuse and abuse. The use of acamprosate typically begins on the fifth day of abstinence, reaching full effectiveness in five to eight days. It is offered in tablet form and taken three times a day, preferably at the same time every day. The medication’s side effects may include diarrhea, upset stomach, appetite loss, anxiety, dizziness, and difficulty sleeping.

  • Disulfiram - treats chronic alcoholism and is most effective in people who have already gone through detoxification or are in the initial stage of abstinence. Offered in a tablet form and taken once a day, disulfiram should never be taken while intoxicated and it should not be taken for at least 12 hours after drinking alcohol. Unpleasant side effects (nausea, headache, vomiting, chest pains, difficulty breathing) can occur as soon as ten minutes after drinking even a small amount of alcohol and can last for an hour or more.

  • Naltrexone - blocks the euphoric effects and feelings of intoxication and allows people with alcohol use disorders to reduce alcohol use and to remain motivated to continue to take the medication, stay in treatment, and avoid relapses.

Opioid Dependency Medications

  • Methadone- Clinic-based opioid agonist that does not block other narcotics while preventing withdrawal while taking it; daily liquid dispensed only in specialty regulated opioid treatment clinics

  • Buprenorphine- Office-based opioid agonist/antagonist that blocks other narcotics while reducing withdrawal risk; daily dissolving tablet, cheek film, or 6-month implant under the skin.

The Facts about Buprenorphine for Treatment of Opioid Addiction

  • Naltrexone-Office-based non-addictive opioid antagonist that blocks the effects of other narcotics; daily pill or monthly injection.

An Introduction to Extended-Release Injectable Naltrexone for the Treatment of People with Opioid Dependence

Experimental

Although in the early stages of testing, experimental procedures and substances have shown promising results towards helping those with mental health. Please consult with your doctor before moving forward with any new or experimental medicine. 

  • Psychedelics - Scientists are rediscovering what many see as the substances’ astonishing therapeutic potential for a vast range of issues, from depression to drug addiction and acceptance of mortality. Early results have been promising and seem poised to keep the research on a roll.

  • LSD, Peyote, Ibogaine, and Ayahuasca -  There are a number of studies which suggest that these substances have potential applications in the treatment of addictions.

 
 

Sleep, Diet and Exercise for Better Mental Health

 

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