Tons of research has been done recently into the arena of mental health and substance abuse. Ranging in focus from genetics and stress to developmental and environmental indicators and predictors. Regardless of the origins and the debatable elements of whether or not one condition precedes or predisposes an individual to the other, current research shows that the incidences of people who suffer from both is as high as 65-74% (some numbers I have seen were even higher).
That is to say, of the population of folks who suffer from a substance abuse disorder, the majority of them also struggle with a mental health issue. The lexicon of treatment jargon has historically referred to this doubly unfortunate group by using terms like “dual diagnosed, co morbid, MICA, MISA, SMI” and the politically correct term at present is “co occurring disorder”. The question that seems to drive a good bit of the research is which happens first? Is one a depressed individual because one drinks, or does one drink because they are a depressed individual?
Theories abound and as noted above have several proponents and logical reasons to substantiate their claims. Genetically speaking, several regions of the human genome have been linked to increased risk of both drug use disorders and mental illness. To pinpoint a single gene has been impossible as such a predisposition seems to come from a combination of many genes, their interaction with environmental milieu and the nature in which these interface when chemicals are introduced in the brain. The influence of genetics gets even muddier when one considers the fact that there are indirect influences as well as direct influences at play. For example, how an individual responds to stress can have a significant impact on the mental health of that person as well as what chemicals will interact in a given way with their biochemistry.
What I will collectively call “overlap theory” is based on the fact that specific regions of the brain are affected by both substance abuse and mental health disorders. Consider the fact that dopamine (an integral neurotransmitter) issues are known to cause depression, but are also disrupted by drug and alcohol use. Flooding the brain with chemically induced dopamine will cause the bodies normal supply to stop being produced, creating a shortage when the drug is withdrawn leaving the individual highly susceptible to depression, anguish and pain. The reverse can also be true. That is to say if an individual suffers from low dopamine levels due to a mental illness, flooding the synaptic gap with dopamine due to illicit drug use makes this individual feel better than they ever have and therefore creates a desire to self medicate. In this example, it’s easy to see how one hand washes the other when it comes to substance abuse and mental health.
The bottom line is an entire series can be dedicated to this topic alone (and probably should be), but it boils down to a couple of key take aways. The first is that psychological disorders are exceedingly common among those who are living with drug and alcohol addiction and may include depression, anxiety, bipolar disorder, and schizophrenia. Secondly, because the effects of one often mask the other, mistakes can be made depending on when (and by whom) a diagnosis is given. That is to say that someone who is in detox for a year long heroin bender is going to be depressed, anxious and irritable and that is to be expected. It does not necessarily mean they suffer from MDD or GAD.
And lastly, it’s not what caused which or which came first that matters in helping these folks. It’s being able to accurately diagnose and treat an accompanying mental health issue that may be present in someone who abuses drugs and alcohol. The biggest threat to a newly recovering person’s sobriety that has a co occurring disorder may in fact be the neglect of addressing their mental health needs (medications, therapy etc.). The biggest threat to a newly recovering person who does not have a co occurring disorder may be the very same medications that are often used to treat such disorders (sedative hypnotics). There is a fine line between over medicating someone and not helping someone who needs it and deciphering which is which is where the research should be focused.