The relationship between mental illness and addiction is complex, but evidence suggests that those suffering from existing mental or behavioural disorders are more likely to develop addictions as a result. The following guide provides guidance on a number of different disorders and treatment options for dual diagnosis.
Co-occurring disorders (COD – also known as dual diagnosis, or occasionally dual pathology) is the condition of suffering from an addiction to drugs and/or alcohol whilst at the same time suffering from a mental illness. Dual diagnosis, understandably, makes treating an addiction significantly more complex as the therapeutic approach needs to factor in the constraints created by the mental illness (including any medication the addict takes to treat their mental disorder/s) and the latter may have been a significant factor in the emergence of the patient’s substance abuse problem originally (for example, if the person began taking substances of abuse to self-medicate their mental health condition).
The relationship between mental illness and addiction is complex; as well as sharing many symptoms with substance abuse, certain mental health issues can be either a driver of addiction or result from it. People with mental illnesses are more likely than the average to become addicted to drugs and/or alcohol, and those with co-occurring disorders often face an array of complex challenges over and above their substance addiction. They may find life extremely difficult to manage and could struggle with problems such as homelessness and financial disorder (including chronic unemployment) which impact severely their ability to live independent lives, as well as their capacity to obtain and sustain treatment; they also have higher-than-average rates of infection with diseases such as HIV and hepatitis C which further impact both the medical aspects of treating the addiction and their general psychological and emotional health (which impacts, in turn, can lead to continued substance abuse).
There are a huge range of mental illnesses and disorders which can be identified in addicts, some of which play a greater role than others in terms of both the development of an addiction and the complications resulting from it. Some of the most commonly occurring conditions are as follows…
Anxiety disorders are a range of conditions characterised by feelings of great anxiety, uncertainty and fear – relating to either current or future events and scenarios – which may be rational but taken to extremes, or entirely irrational. They may result in symptoms such as increased heart rate, shakiness, and even fainting, and can have a wide variety of causes including genetics and environmental factors. People with anxiety disorders have a greater-than-average risk of addiction because of the inclination to self-medicate (perhaps drinking or taking drugs to “calm the nerves”) and because anxiety can be treated by any of a number of medications which can themselves be habit-forming, including benzodiazepines.
Attention deficit hyperactivity disorder (ADHD) is a neuro-developmental disorder in which the sufferer finds it difficult to pay attention and remain focused for long periods; is likely to exhibit excessive activity (including fidgeting); and has problems controlling their behaviour, especially in a controlled environment such as school. ADHD normally manifests before adolescence and can result in impaired academic performance and numerous social issues. ADHD is linked with the development of addictions partly because of its primary symptom of impulsivity. Children with the condition can be prescribed habit-forming medications (such as Ritalin) and their condition can make them feel isolated or ostracised by their peers, leading to reduced self-esteem and a greater propensity to engage in substance abuse.
Bipolar disorder (traditionally known as manic depression, and frequently still referred to in that manner by people outside the medical community) is characterised by oscillating periods of depression and of abnormally elevated mood – mania – which can result in irrational behaviour. Those suffering from bipolar disorder are at a high risk of self-harm and even suicide during their depressive phases, whilst the manic phases can result in risky behaviour with potentially life-changing consequence. Substance abuse and subsequent addiction can develop from self-medication (especially during the depressive periods) or from engaging in hedonistic pursuits during manic phases; sufferers are also likely to be prescribed any of a range of medications, some of which can be addictive (and are much more likely than the average to consume higher dosages than are recommended by their doctors).
Personality disorders (PD) are a range of mental disorders characterised by behaviour which differs from social norms resulting from problems with cognition, impulse control and inner experience, which set sufferers apart from their peers and society but which may not be recognised by the sufferer as being negative or having potentially deleterious consequences for their relationships with others. Between 40% and 60% of all psychiatric patients are diagnosed as having personality disorders, making them the most frequently diagnosed mental disorders. People with personality disorders may engage in substance abuse (and subsequently develop addictions) for a host of reasons, including (but certainly not limited to) to cope with feelings of intense unhappiness and worthlessness; to fit in with an otherwise unaccepting peer group; in response to depression; as acts of rebellion. They may also encounter substances of abuse in a medical setting, especially if their disorder has meant a period of psychiatric treatment.
Depression is one of the leading contributors to substance abuse and addiction; it is a state of low mood and motivation which can be temporary (perhaps in response to significant distressing life events such as bereavement) but can also manifest in a mental disorder known as major depressive disorder (MDD) which can persist for months or years. Depression tends to be accompanied by low self-esteem, extreme pessimism, very low levels of energy and a disinclination to participate in even low-intensity activities, and is a factor in a high proportion of suicides (as well as leading to self-harm and other destructive behaviour). Many people suffering from depression self-medicate with alcohol (which as a depressant can significantly worsen the problem) and/or with other substances of abuse and can develop addictions thereto, as well as potentially being prescribed medications which can themselves be habit-forming. Depression can manifest itself as a result of withdrawal from many substances, increasing the risk of relapse in those suffering from it beforehand.
Eating disorders are conditions characterised by abnormal eating habits – typically, the consumption of either a greatly reduced or a greatly increased amount of food, which may or may not be accompanied by purging – which can have a very significant impact upon a person’s physical and psychological wellbeing, including upon feelings of self-worth. Eating disorders are strongly linked with anxiety disorders and depression, and often manifest in adolescents (though can strike at any age). Those suffering from eating disorders have a significantly enhanced risk of developing substance addictions; they may self-medicate to cope with depression and feelings of worthlessness and body dysmorphia, but are also prone to taking certain drugs (especially stimulants) which can suppress the appetite and/or assist with exercise designed to lose weight. They may also become addicted to prescription medication targeting one or more aspects of their disorder.
Post-traumatic stress disorder (PTSD) is a condition that can develop after a person is exposed to a traumatic event (for instance an assault, a serious accident, witnessing death or injury) and manifests in an array of symptoms including (but not limited to) persistent disturbing thoughts, depression, nightmares, obsessive behaviour and self-imposed isolation. Often misunderstood (with many more people self-diagnosing with the condition than genuinely suffering from it) PTSD is frequently treated with medication which can become habit-forming, while sufferers commonly self-medicate (especially with alcohol and hard drugs) in an attempt to hide from or bury the memories of the trauma. PTSD is especially prevalent amongst war veterans, many of whom are unable to return to normal life as a result of their experiences and as a result may suffer from homelessness which can further exacerbate any substance abuse disorder they may develop.
Schizophrenia is characterised by an inability to understand reality, often exacerbated by hallucinations (especially hearing voices), feelings of paranoia and delusions of persecution and/or grandeur, and false beliefs; other symptoms include disorganised thinking and speech, social disengagement, aggression, and a lack of attention to appearance and hygiene. Those with schizophrenia are often unable or unwilling to accept that they are mentally ill – especially if they are experiencing complex delusions which may include feelings of persecution and consequent mistrust of medical professionals. Approximately half of schizophrenics abuse alcohol and/or illegal drugs, and research suggests there may be a link between substance abuse and the onset of schizophrenia (though symptoms are very similar to those of stimulant psychosis and alcohol-related psychosis, which can lead to confusions in diagnosis and treatment). Drugs are often used as a coping mechanism to deal with the anxiety and depression which often result from schizophrenia.
For various reasons, treating dual diagnosis can be significantly more complicated than treating “simple” addiction. While the recommended treatment remains residential rehabilitation including detoxification and therapy, it’s vital to choose a treatment facility whose staff are highly experienced in dealing with co-occurring disorders and the particular constraints they impose.
Residential rehabilitation (“rehab”) provides addicts with treatment in pleasant, peaceful surroundings conducive to recovery, in which they have access to medical professionals highly experienced in dealing with all kinds of substance abuse disorders (and can be confident that patient confidentiality is a top priority). Initially patients go through a detoxification phase (with medical assistance) and subsequently move into therapy whilst being provided with dietary and fitness regimes aimed at improving their overall health.
Rehab can be attended on either an inpatient or outpatient basis; inpatient stays (typically of between 30 and 90 days) are usually recommended as patients can focus wholly on their recovery, but those who have obligations such as work or family which are incompatible with staying onsite for prolonged periods can opt for the outpatient option (which, however, does not remove the addict from the temptations of their daily life, thus increasing the chance of relapse).
Banbury Lodge provides a robust treatment programme for those suffering from addiction and mental health/behavioural disorders. Our programme entails a medical detox where appropriate, one to one counselling; a full psychiatric evaluation; medication and therapeutic programmes to help you deal with any underlining problems.
Medicines can play a very useful role in combating addiction; while there is no “magic bullet” pharmaceutical cure for addiction, various medications can be used to alleviate some of the more unpleasant symptoms of withdrawal, including antidepressants to cope with any substance-induced depression, and benzodiazepines to address anxiety, restlessness, insomnia and muscle spasms (and also to replace any drugs of the same class to which the patient may be addicted). In cases of dual diagnosis, in which an addict may already be on various medications (including one or more to which they may be addicted) the approach to pharmaceutical treatment can be extremely complex and some drugs may simply be unavailable to the addict because of the nature of the interactions they may create with other medication being consumed. As a result, it is vital that an addict with dual diagnosis does not attempt to self-medicate, as the consequences may be extremely damaging to their health. A doctor should always be consulted ahead of any attempt at detoxification as withdrawal from some substances can prove fatal without the correct treatment.
Therapy lies at the heart of addiction treatment and usually comprises the bulk of any such treatment. As a result of the sheer number of cases of addiction which have emerged in recent decades the weight of relevant psychiatric literature is now very substantial, and numerous therapeutic methodologies have been developed which have proven very effective in treating addiction and substance abuse disorders. While some common models such as cognitive behavioural therapy (CBT) and motivational therapy (MT) are known to be effective in many cases, and are typically offered as standard by rehabs, it may be that an addict will need to try a number of different models – both one-to-one and group – before settling on one or more which works for them. Support groups are also often an important element of recovery; organisations such as Narcotics Anonymous (NA) hold meetings across the UK and sufferers of dual diagnosis may find the peer support they provide vital in resisting relapse even years after completing treatment.