|
SitesAlcoholism RecoveryThe Art of HealingBig BookCenter for On-Line
|
|
|
| advertisement |
As anyone touched by substance abuse or dependence knows, recovery is not a simple process. People on the cusp of recovery and even those who have been "clean" for years sometimes slip back under the influence of cocaine or alcohol or prescription drugs. More and more research is now showing that one reason many substance abusers have so many setbacks is that they also have an untreated, co-occurring psychiatric illness. In fact, approximately 21 percent of the American adults living with a serious mental illness abused or were dependent upon alcohol or an illicit substance, compared to 7.9 percent of adults without a serious mental illness, according to the 2003 National Survey on Drug Use and Health.
Someone is said to be a substance abuser when they use drugs or alcohol in ways that interfere with school, work or relationships. Likewise, people with a psychiatric disorder may experience mood changes or other symptoms that interfere with their lives. "Clearly, people with substance abuse are significantly more likely to have a psychiatric disorder and vice versa," says Roger Weiss, MD, a professor of psychiatry at Harvard Medical School and clinical director of the Alcohol and Drug Abuse Treatment Program at McLean Hospital in Belmont, Mass.
Dr. Weiss has investigated what is known as dual diagnosis for many years, focusing largely on substance abuse and bipolar disorder, which is a mood disorder that causes cycles of depression and mania, or an abnormally elevated mood, or hypomania, which is a less severe form of mania. Below, Dr. Weiss explains why both conditions must be treated in order to achieve recovery.
Are there certain disorders that are particularly likely to be linked to substance abuse? Bipolar disorder is the psychiatric disorder that puts people at highest risk for having a substance abuse problem. People with bipolar disorder are much more likely to have a substance abuse problem than people without bipolar disorder. But other disorders, such as major depressive disorders, schizophrenia, panic disorder and posttraumatic stress disorder, all have a higher rate of substance abuse.
Is that because people with these illnesses are trying to relieve their symptoms? Part of it is that. Some people initially find some sort of symptom relief when they use drugs or alcohol, although, as they continue using drugs and alcohol, ultimately the substances of abuse often make their symptoms worse than they were before.
Are particular substances linked to certain psychiatric illnesses? I think that, very often, the choice of a particular drug that people use is governed more by the availability of that drug than the specific pharmacologic properties of the drug. But for some people the pharmacologic properties can be important, so people who have anxiety disorders may use drugs that help them to calm down. They may be prescribed drugs like benzodiazepines, which are anti-anxiety drugs, but they may abuse them.
What substances are favored by people with bipolar disorder? When people with bipolar disorder are hypomanic or manic they may be somewhat euphoric, they may talk fast, feel a little bit grandiose, very powerful. Oftentimes, they have increased energy. They may be hypersexual. Some people in an early stage of hypomania or mania may find that pleasurable, so they may use drugs like cocaine to increase their symptoms. Other people may use drugs such as alcohol or marijuana that relieve unwanted symptoms. And sometimes people with bipolar disorder who are not in the hypomanic or manic phase try to recreate that feeling with drugs like cocaine.
Can substance abuse trigger a psychiatric disorder? Using drugs like cocaine can affect some of the same neurochemicals that are felt to be abnormal in bipolar disorder, so there are some people who believe that the use of cocaine may trigger an earlier onset of bipolar disorder in people who are otherwise vulnerable. It's also possible that the use of cocaine could trigger an exacerbation or a re-experiencing of a mood episode in patients with bipolar disorder.
For people who have major depressive disorder, chronic cocaine use can also exacerbate it, leaving people to use more and more: they move from feeling euphoric initially to being more depressed as they use cocaine and then, very often, paranoid.
Are most people who are treated for substance abuse evaluated for psychiatric illness? I think it's a common enough co-occurrence that it's important to evaluate people with substance abuse problems to see if they do have a psychiatric disorder. I think a number of people are being treated for a psychiatric illness, but I think it's also true that there are a lot of people who are getting treated for substance abuse who are not getting the psychiatric evaluation. Now, people who don't have coexisting psychiatric illness (and that's many of those people) can do fine without coexisting psychiatric treatment. It's just that the people who have a coexisting psychiatric disorder may not do well unless that is also treated. They will be more likely to relapse.
Are there particular treatment approaches that seem to work best for people who have that dual diagnosis? When you're talking about treatment, there are really two major types of treatment. There is use of medications and then there are psychological treatments. If you've got a substance abuse problem and a particular psychiatric disorder that might be responsive to medications, then the medications that are used are the medications that would ordinarily be used to treat that psychiatric disorder.
In terms of psychological treatments, there are a number of different models of dual diagnosis treatment and there has been a move in recent years toward what's called integrated treatment. This approach tries to deal with both disorders simultaneously rather than having people receive substance abuse treatment in one setting and their mental health treatment in an entirely different setting.
More often than not, these are outpatient programs. Inpatient programs are generally programs to help stabilize people. So they would help to stabilize psychiatric symptoms, to detoxify people and prepare people for the next step, which is a longer-term outpatient program.
Could you talk about some your research on the treatment of dual diagnosis? I've been involved in recent years in developing and testing a new group therapy for patients with bipolar disorder and substance dependence. It's called integrated group therapy, and the underlying foundation of integrated group therapy is that the same kinds of thoughts and behaviors that will facilitate the recovery from one disorder will also help you in the recovery from the other disorder. So we try to identify thoughts and behaviors that we call recovery behaviors and relapse behaviors that extend across both disorders. We look at the similarities between the two disorders and the interaction of the two disorders, and we essentially tell people that, rather than thinking of themselves as having two separate disorders, to think of themselves as having a single disorder: " bipolar substance abuse." The treatment that we're recommending for them (avoiding drugs and alcohol, taking medication as prescribed, monitoring moods, monitoring drug cravings, getting a good night's sleep, etc.) is good for both disorders and is good for recovery in general.
Do you think the earlier recognition of psychiatric illness could help prevent substance abuse? I think it could. People who have psychiatric illness with its onset, for example, in late teens or early adulthood, may use certain substances of abuse as an early attempt at self-medication. If they received treatment early on, that whole cycle might be less likely to occur.
What is your advice to people who think that they may have a dual diagnosis? If people think that they've got a substance abuse problem that's complicated by some psychiatric problems or vice versa, it's important to seek advice from somebody that's knowledgeable in dual diagnosis issues. They should try to realize that while this is a complicated issue, it's something that is clearly treatable, if recognized. Treatment will generally involve some combination of medications and psychological treatment, and people with these dual disorders could also benefit from self-help groups. With patience and with some work, people can really do quite well with these dual disorders.
|
Home to HealthyPlace.com Chat
Forums
Communities Healthyplace
Radio
Support
Groups © 2000 HealthyPlace.com, Inc. All rights reserved. Terms of Use Privacy Policy Disclaimer |
