Mental Illness and Substance Abuse

Rep. Patrick Kennedy's release from drug rehab puts a spotlight on people who suffer from a trying combination of health problems: substance abuse and a mental health disorder.

Kennedy -- the son of Sen. Edward Kennedy -- checked into a rehab clinic in May 2006 after a car accident near the U.S. Capitol. The younger Kennedy says he has no memory of the incident; he admits he had taken medications usually prescribed for sleep problems and to control nausea.

After his release from rehab, Kennedy told reporters he suffers from addiction and bipolar disorder.

Doctors say they are increasingly seeing patients from all walks of life who suffer from a combination of substance abuse and mental health problems. Experts estimate that at least 60% of people battling one of these conditions are battling both.

"Mental health problems and substance abuse are often seen together because one makes you more vulnerable to the other," says Alan Manevitz, MD, a psychiatrist with New York-Presbyterian Hospital, Cornell University campus, in New York.

Mental health problems are common in the U.S. An estimated 1 in 5 adults in the U.S. suffers from a diagnosable mental disorder, according to the National Institute of Metal Health.

When there is a biological or genetic vulnerability to any type of mental health problem, regardless of how big or small, Manevitz says, substance use often triggers the onset of that problem.

"The substance is not really causing the mental health problem, but it can be a precipitating factor that causes the condition to manifest," Manevitz tells WebMD.

"In this respect, the mental health condition is already actively present when the substance abuse begins, but the patient just doesn't know it -- the problem is driving the addiction, it just hasn't yet been recognized or diagnosed," Manevitz tells WebMD.

It is, in fact, the increasing awareness of this dual diagnosis that has opened the door to a whole new line of thinking about both substance abuse and mental health problems. Indeed, some researchers contend that certain forms of mental illness and some addictions may, in fact, be a single disease.

Among the areas where this research is most prominent is a condition known as bipolar disorder -- a disease characterized by cycles of extreme mood swings between deep depression and high elation, or mania. During periods of mania, patients show extreme irritability, racing thoughts, little need for sleep, poor judgment, distractibility, abuse of drugs, and denial that anything is wrong. Depressive periods are associated with feelings of hopelessness, guilt, too much sleep, and thoughts of death or suicide.

"What we have found is that people with bipolar disorder, particularly women, have an enormously high rate of alcoholism -- up to seven times that of the general population," says Mark Frye, MD, director of the UCLA Bipolar Disorder Research Program in Los Angeles.