Mental Illness and Substance Abuse
Mental health problems are frequently complicated by substance abuse, putting patients in need of special care.
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
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
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,Â 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.