Mental Illness and Substance Abuse
Mental health problems are frequently complicated by substance abuse, putting patients in need of special care.
"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.
"There is a relatively small window of opportunity in which
to get the mental health problem under control before the patient ends up right
back into substance abuse," says Frye.
As such, many doctors are now turning to a dual treatment
approach -- a program that integrates detoxification of addictive substances
with simultaneous identification and treatment of any coexisting mental
"This approach can be particularly effective because even
if you get a clear history of a patient, even if you are certain that the
substance abuse led to the mental illness, or vice versa, treating the first
problem doesn't necessarily lead to the cessation of the second problem, "
Unfortunately, the dual approach is still considered somewhat
specialized, and frequently only available in pricey private hospitals. The
next best thing, say experts, is to integrate patient care among the
professionals dealing with each part of the illness.