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Bipolar Disorder Health Center

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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.


"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.

"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 health problems.

"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, " says Hayden.

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.

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