Drug / Alcohol Addictions and Mental Illness: Co-occurring Disorders

    Donna Lilly, MS, LCSW, LCAC, Chemical Dependency Coordinator, Deaconess Cross Pointe

    Co-occurring disorders are very common and are characterized by a co-existing mental disorder and a chemical dependency/addiction. There are numerous possible combinations of mental and chemical dependency disorders. Below are the most common.

    • Anxiety and chemical dependency
    • Depression and chemical dependency
    • Bipolar disorder and chemical dependency
    • Chronic pain and chemical dependency

    In all these cases, chemical dependency could include:
    • Alcohol
    • Prescription pain medication
    • Prescription sedatives
    • Various stimulants—prescription and non-prescription, sometimes illegal
    • Cannabis (marijuana)
       
    In some cases, the mental health issue pre-dated the chemical dependency, and the person struggling found that abusing chemical substances appeared to “help” with their issue. In other cases, the chemical dependency started, and mental health issues arose.

    Anxiety and co-occurring addiction

    Anxiety disorders are characterized by feelings of restlessness, of being “on edge,” difficulty concentrating, and sleep disturbances. These symptoms have to be occurring over a period of time, and truly start interfering with life (rather than just occasional annoyances) to be considered a true anxiety disorder.

    What often happens is people begin to use alcohol (most commonly) to put themselves at ease. And it actually does work, as alcohol is a depressant and can be relaxing.

    Sometimes, when experiencing anxiety symptoms over time, people will go to the doctor and receive a prescription for sedatives, such as Klonopin, Xanax, or Ativan (benzodiazepines). Those work quite well, but are not meant to be used over a long period of time.

    In both cases—alcohol and sedatives—the body can develop a tolerance, which means more and more is needed for the same effect. This can lead to a dependency and addiction.

    Sometimes people also feel that marijuana helps relieve anxiety. In the case of marijuana, the effects begin to wear off and the person experiences a “rebound.” Over time, this cycle leads to the anxiety getting worse and worse.


    Depression and chemical dependency

    There is a strong link between depression and chemical dependency. In fact, about half of all people who struggle with addiction also have depression. Interestingly, it’s often hard to determine which issue came first. In some cases, people are self-medicating depression; in other cases, the brain chemistry is affected by substance use, which can lead to depression. The effects of substance addiction can also lead to so many bad outcomes in life (job loss, family disruption, etc.) that depression—or worsening depression—can also result.

    Depression is more than feeling sad. It’s a persistent feeling of loss of hope; loss of pleasure in activities that used to be fun; sleep disruption (too much, too little); change in appetite; decreased energy and overall feeling of emptiness. These feelings are all bad, and so it’s understandable that someone would want to numb them or at least “escape” them for a little while. What happens is that this can become a chronic habit, and the chemical balance of the brain is disrupted—both by the depression and the abuse of the substances—which can result in a vicious cycle.

    And those with depression seem to be all across the board in terms of which substance is abused—alcohol, sedatives, stimulants, etc.


    Bipolar disorder and substance abuse

    Bipolar disorder is characterized by extreme mood swings over long periods of time. It’s more than feeling “moody” occasionally or having mood swings over the course of a day.
    These swings may be long periods of depression followed by periods of euphoria and high energy—like a manic mood. Each phase could last weeks or even months. It cycles back-and-forth, and people can even be in the healthy, in-between phase for long periods of time. Triggers can lead to a reoccurrence of symptoms.

    Bipolar disorder and substance abuse is a very common combination. Sadly, substance abuse can cause more intensified symptoms, such as lower/worsening depression and higher/exacerbated manias. Often those with bipolar disorders attempt to use alcohol or drugs to try to “stay in the middle.” Others say they don’t like the effects of the prescription medication they are supposed to take, so they try to self-manage with other substances.

    Bipolar disorder is very difficult to diagnose, and often people who think they may be bipolar are actually experiencing the side effects of their substance abuse.


    Chronic pain and chemical dependency

    Chronic pain is not a mental health disorder, but it can certainly lead to some—particularly depression. People in pain can find themselves in a slippery slope. When you’re in pain, sometimes pain medication doesn’t entirely take away all discomfort, but people will reason that “if I take a little more,” or “If I add a drink to this” it will work better. Then they end up needing more…and more…and more to have any effect on their pain, which leads to an addiction.

    On top of that, chronic pain is a major cause of depression, as it can lead to isolation, loss of connections with work/family/friends, etc. So when someone is not handling their pain medication well, it can alter their brain chemistry, leading to worsening depression.


    Marijuana (cannabis/pot) and mental illness

    We have become jaded in our society to think that nothing is wrong with pot, and many have come to believe that it is a safe “medicine.” And some with chronic pain have decided that using marijuana is the answer to their problem.

    In addition, some people with anxiety disorders feel that pot helps them more/better than prescription medications. With anxiety, there is a lessening of the symptoms, but there is a rebound in that when the effects of the marijuana wear off, the anxiety symptoms return—and are slightly worse than they were originally. This takes place over time, but is real. The end result is that if you carry this out over months, the anxiety symptoms actually get much worse, and the only way to lessen those is to smoke more pot and the problem goes round and round. Those with anxiety are actually doing themselves a great disservice by trying to medicate themselves with pot.

    Another problem with pot is that it’s not regulated, so what you’re getting today and getting tomorrow can be totally different. Other substances are sometimes added in that can create other issues—such as other illegal drugs like K2 or heroin.


    How to get help

    So what do you do if you realize that you or someone you love likely has a co-occurring disorder like the ones we’ve talked about?

    First of all, you have to recognize that substance use has become a problem—it’s interfering with life and causing numerous problems. Discontinuing the drug/alcohol use needs to be priority. Addictions are hard to overcome by yourself, so seeking help at an addiction treatment program (such as Deaconess Cross Pointe) or attending groups such as Narcotics Anonymous (NA) or Alcoholics Anonymous (AA) can help.

    If a person truly has a co-occurring disorder, both disorders need to be treated at the same time. So managing depression, anxiety, bipolar disorder or chronic pain—at the same time as working through the addiction—is critical.

    For more information about these services here at Deaconess Cross Pointe, visit http://www.deaconess.com/DeaconessCrossPointe.aspx
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