It is very common for mental health problems and substance abuse to go together. In many cases, this results in a dual diagnosis. There are many reasons as to why this happens. Firstly, many people who have a mental health disorder are more susceptible to substance abuse, as they may self-medicate or they may lack a sense of self-protection. Secondly, using drugs can lead to mental illness, for instance due to changes in the chemical composition of the brain. Lastly, the effects of certain drugs can be experienced as a mental health problem, which is known as a substance induced disorder.
It is known that one in four adults who currently have a serious mental health problem also struggles with substance abuse. Certain mental health conditions, mainly anxiety disorders, depression, personality disorders and schizophrenia, regularly lead to substance abuse.
The DSM-V is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The American Psychiatric Association has developed this manual in order to have clarity on the various symptoms, names and diagnostic features of every mental illness known to man, of which addiction is one. The fifth edition was published in May 2013, which was the first update in nearly 20 years.
According to the DSM-V, ten different classes of drugs are involved in substance related disorders. These are:
- Hallucinogens (arylcyclohexylamines such as phencyclidine)
- Other types of hallucinogens (like LSD)
- Other unknown substances (which currently includes synthetic drugs)
According to the DSM-V, when people take drugs, the brain’s reward system is activated. In some people, the feeling of reward is so strong that people are no longer interested in any of their daily activities, choosing the drug instead. Every class of drug has a different pharmacological mechanism, but all substances use the same reward system. This is what is referred to as a “high” and describes the feeling of euphoria and pleasure.
There is also a clear recognition in the DSM-V that not every person is equally or automatically vulnerable to spiraling into a substance related disorder. Additionally, some people do not have sufficient self-control to not develop problems, which is also related to the natural chemicals in the brain. Because of this, the DSM-V recognizes that there are two types of disorders relating to substance abuse, being substance use disorders on the one hand and substance induced disorders on the other.
Substance Use Disorders
A substance use disorder occurs when an individual is aware of the problems that the drug is causing them (in any degree) and continues to take it. A pattern of symptoms is involved with this. Eleven criteria have been set in order to recognize this disorder. These are:
- Taking the substance of choice in an above average amount and for a period that is longer than was intended.
- Wanting to stop taking the drug, but failing to do so.
- Urges and cravings to use a substance.
- Struggling to manage social, educational or employment responsibilities due to using the substance.
- Choosing to use the substance even if relationships start to suffer.
- Giving up activities on a social, recreational or occupational level.
- Continuously using substances, even if this places your life at risk.
- Continuing using the substance, even if the patient knows they have psychological or physical problems that are potentially affected by the substance.
- Building up tolerance to the substance.
- Experiencing withdrawal, which are removed when more of the substance is taken.
Thanks to the DSM-V, clinicians are able to identify the severity of the substance use disorder, depending on how many of the 11 criteria are present. If only three are present, the disorder is mild, five equates to moderate and six or above is classed as a severe disorder.
Substance Induced Disorders
There are various substance induced disorders, ranging from something as mild as intoxication to as severe as substance induced psychosis and everything in between. The identified disorders include:
- Substance induced persisting dementia
- Substance induced delirium
- Substance induced psychotic disorder
- Substance induced persisting amnestic disorder
- Substance induced anxiety disorder
- Substance induced psychotic disorder
- Substance induced sleep disorder
- Substance induced sexual dysfunction
- Hallucinogen persisting perceptual disorder
These disorders are separate to the co-occurring mental health problems, as these symptoms are a direct result of using a certain substance. This does not mean that they preclude any mental health or psychological disorder that the patient may have, but rather that these symptoms are experienced because of using a substance. In many cases, patients experience both a mental health disorder and a substance induced disorder as well.
In most cases, the symptoms of these disorders are the exact opposite of those experienced will taking the drug. This is often described as the “high” and the “crash”. In many cases, the crash is of a temporary nature, but if the substance is taken for longer periods of time or in higher quantities, a psychotic state can be achieved, leading to permanent problems.
Everybody experiences intoxication and withdrawal in a unique way, which means that exposure to a certain substance does not guarantee certain symptoms. Furthermore, many substance users mix different drugs together. At Creative Care, our goal is to ensure we continuously evaluate the psychiatric state of our residents and identify whether there is a relationship with abstinence. Usually, once the patient has detoxed, the symptoms also start to improve. However, if psychotic symptoms are experience due to prolonged use of amphetamine, or if dementia problems (problem solving, concentration, memory) are experienced, this can be a permanent feature. Dementia problems are most often caused by inhalants, alcohol and amphetamines.
If you suspect you or a loved one has a substance abuse problem and is experiencing a substance abuse disorder or a substance induced disorder, it is very important to seek drug and alcohol rehab help straight away. At Creative Care, we are focused on offering a dual diagnosis when it is there and in providing suitable treatment, addressing not just the substance addiction, but also the mental health problems that lead to the substance abuse, or that were caused by takin substances.