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Mental Illness and Substance Abuse

Mental health problems are frequently complicated by substance abuse, putting patients in need of special care.

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This is also true, says Frye, when both male and female bipolar patients are compared to those with other forms of mental illness.

And while the reason remains unclear, Frye tells WebMD that there is at least some evidence that the two conditions share many similarities.

Indeed, as the age of "brain science" continues to mature, a number of researchers have begun to note some startling similarities within the brain chemistry patterns of various types of mental health problems and substance abuse. Some of the more interesting discoveries had to do with animal models of addiction.

"Research on rats showed us that there were certain pleasure centers of the brain that, when stimulated, elicited such a powerful response, the animal would opt for stimulation over food," says Francis Hayden, MD, associate director of the division of Alcohol and Substance Abuse at Bellvue Hospital in New York.

This discovery, he says, led many researchers to question whether there was something different about the brains of substance abusers that "causes them to kind of feel not quite right -- so that when they happen upon a substance, it kind of normalizes them in a way," says Hayden.

That feeling of "not quite right," he says, may be the mental health problem at work.

Another indication that they may be one disease: Studies that show that when one condition worsens, the other is soon to follow suit.

"In someone who has both a mental illness and a substance abuse problem, almost without exception, an addiction relapse will worsen the mental health problem, and when the mental health problem goes untreated, or declines, it makes them more susceptible to renewing addictive behaviors," says Kenneth Skodnek, MD, chairman of the department of psychiatry and psychology and director of the addiction service at Nassau University Medical Center in East Meadow, N.Y.

In addition, says Skodnek, it's very clear that activation of one problem frequently activates the other in those who are susceptible.

Finding the Treatment That Works

Whether the mental health problem -- or the drug use -- came first, doctors say that good mental health can't prevail until both problems are treated. The best way to accomplish this, however, remains a matter of some debate.

"When the two disorders coexist, you frequently have to address the substance abuse issue right away because if someone is intoxicated, they need to be detoxed," Frye tells WebMD. Without that component in place, he says, starting therapy can be very difficult.

Though this approach looks good on paper, he says, the reality isn't always easy to achieve. The very process of detoxification, says Frye, can often leave an addict feeling so raw and vulnerable, their mental health situation rapidly declines -- which in turn can easily cause the substance abuse problem to quickly recur as well.

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