Common Comorbidity with Substance Use Disorders 2018

 

Comorbidity is the occurrence of more than two disorders in an individual, occurring once or following one another. When two disorders in an individual interact, health conditions worsen and increase human suffering. In modern days, comorbid mental illness and substance use disorder is prevalent. Adolescents and young adults addicted to different drugs develop mental illness. Addiction usually alters the normal functioning of the brain and increases an individual’s desire to seek and abuse drugs. Drug abusers have compulsive behaviors that ruin the ability of a person to control impulses. Substance use disorder is common to individuals with mental illnesses. At least 50% of US citizens with substance use disorder suffer from mental illnesses (NIDA, 2018). Comorbid substance use disorders co-occur because of common risk factors like genes, trauma, and excess stress. Also, mental illnesses intensify the behavior of substance and drug abuse. Dangerous drugs are prioritized by the majority of people with mental illnesses as self-medication. Although most people think substance and drug abuse help limit some mental illness conditions, excessive use of addictive drugs drain brain cells and predispose an individual to exceed the habit of drug and substance abuse. The factsheet considers the interests of human services addictions interns.

The comorbid substance use disorders include post-traumatic stress disorder, anxiety disorder and panic disorder. Analysis of data from a large national sample indicates that US citizens diagnosed with mental, personality and drug abuse illnesses were vulnerable to abuse of opioids and other drugs. Comorbid disorders may attack an individual at any time in life since mental illness conditions develop in an individual slowly after getting introduced to hard drugs which are addictive.  Between 2009 and 2015 in the US, researchers identified that comorbid substance use disorders increased among the population of people identified and diagnosed with mental illnesses (NIDA, 2018). A higher percentage was witnessed in US people with substance use disorders (SUD) who developed mental illness from 20114 to 2015.

Figure 1: Interaction between Mental Illness and Substance use disorder.

In the treatment of people with substance use disorder at a federal level, health practitioners consider their mental illness conditions. Among US youths, attention-deficit hyperactivity disorder develops when they abuse drugs and other substances without limits. Severe mental illness results in intense substance and drug abuse among adolescents and youths in the US (NIDA, 2018). A mental disorder affecting an adolescent may increase chances of drug and substance abuse disorders in adulthood. Drug problems are prevalent in children with untreated attention-deficit hyperactivity.

Reasons for Comorbidity between mental illnesses and substance use disorders

The common risk factors, substance use and mental illnesses are pathways involved in comorbidity. Common risk factors influence mental illness and addiction resulting from substance use. Genetic vulnerabilities is amongst common risk factors contributing to morbidity in substance use disorders and mental illnesses. Genetics contributes the highest percentage on a person’s vulnerability to a particular substance use disorder. Complex interactions in multiple genes provide an active region for substance use comorbidity (NIDA, 2018). Products of genes in an individual behave like proteins influencing an individual’s response to a particular drug. For instance, cigarette smoking and alcohol dependence generate specific genes predisposing an individual’s mental illness conditions.

Epigenetic influences resulting from gene regulation activities and environmental factors influence comorbidity of substance abuse disorder in adolescents and young adults. Neural circuits function differently after modifications are made to encoding proteins in a human body(Druss & Walker, 2011). Therefore, the developmental stage of an individual experiences high risks of mental illnesses, especially when adolescents are involved in substance abuse behavior. Substance abusers increase their rate of developing mental illness as they mature as illustrated in the figure below:

Figure 2: Percentage of individuals with mental disorders

The figure above illustrates that drug administration begins in adulthood, and as individuals mature, the substance use disorders intensify affecting their health mostly while in adulthood. Epigenetic influences to comorbidity of substance abuse disorders integrate genetic and environmental factors like drug exposure, chronic stress and trauma.

Comorbidity occurs between mental illnesses and substance use disorders because of brain region involvement. The human brain is fragile to substance use disorders as well as mental illnesses. A brain possesses circuits that influence an individual’s decision making, help in impulse control and regulate emotions (NIDA, 2018). When addiction results in depression, psychiatric disorders and schizophrenia, some of the brain’s circuits stop functioning normally, hence comorbidity between substances use disorders and disturbing mental illnesses. Stress and trauma also influence comorbidity among addicts. More so, mental illnesses influence addiction and morbidity when drugs are used by mentally-ill people as a form of self-medication, lack of control results in abuse and later addiction.

Some of the substances commonly abused include heroin, nicotine, opioid, alcohol and Marijuana.

Table 1: Comorbid SUD

The Approaches in Diagnosis of Comorbid Substance Abuse Disorder

Behavior therapies in regard to age, and drug misused are approaches prioritized in the diagnosis of comorbid substance use disorders. Diagnosis starts with the identification of common genetic, environmental and neural substrates of particular substance use disorders. Individuals with psychiatric illnesses are supposed to undergo screening to identify the symptoms of substance abuse disorders affecting their health. Over the years, it has been complicated to diagnose comorbid substance abuse disorder effectively. Clinical diagnosis of comorbidity involves evaluating the level of aspects like mood, psychotic, hyperactivity, anxiety and attention deficit developing in patients with comorbidity substance use disorder (NIDA, 2018). Clinical severity is impacted by psychiatric comorbidity; hence diagnosis help explain the psychosocial functioning of individuals with severe comorbidity of substance use and harmful mental health disorders. Optimal management of diagnosis by therapists involves a better understanding of efficacy, and side effects of comorbidity substance use disorders.

Treatment of comorbid conditions among patients involves different approaches. Cognitive behavioral therapy is prioritized when changing harmful behaviors in individuals like regular substance abuse, which may result in addiction and later severe mental illnesses. Also, dialectical behavior therapy is utilized as an approach in the treatment of comorbid conditions and the approach targets limiting self-harm behaviors like excess drug use and thoughts that may trigger suicide (NIDA, 2018). Assertive community treatment focus on community outreach urging individuals to undergo better treatment options whenever comorbidity substance use disorders strike. Other approaches in diagnosis and treatment of common comorbidities include therapeutic communities and contingency management. The co-occurring substance use disorders make an individual experience physical health conditions like heart disease, chronic pain and cancer. Limiting substance abuse reduces the risk of chronic pain. The high rate of tobacco use and opioid misuse results in macular degeneration, erectile dysfunction and impaired immune function.

In Europe, patients with comorbid substance use disorders and those suffering from mental illnesses utilize sequential model, parallel model and integrated model in the treatment of their comorbid conditions. The sequential model involves the treatment of psychiatric and substance use disorders with little communication between patients and healthcare providers(EMCDDA, 2016). Serious mental illnesses are treated first and before other common substance use disorders when the sequential model is implemented. Patients undergoing sequential treatment model may be passed through healthcare services, and risk of relapse intensifies, hence the model is not suitable for dual diagnosis patients. Also, a parallel model is used in the treatment of comorbid conditions whereby two or more comorbid disorders may be treated at the same time. Mental health services and use of prescription drugs concurrently treat patients with comorbidity substance abuse disorders when the parallel model is prioritized. A treatment plan mostly lacks overall coherence when the parallel model is used in the treatment of comorbid conditions in patients. Moreover, an integrated model is used in the treatment of comorbid disorders. The integrated model provides treatment options based on a special comorbidity program. Treatment options under integrated model constitute behavioral and motivational interventions for comorbidity substance use disorders. Also, the integrated model helps in relapse prevention when treating severe mental illnesses and substance abuse disorders.

Clinicians provide recommendations on effective treatment of comorbidity substance use disorders. For instance, the use of antipsychotic drugs should consider the type and level of substances abused. Records showing that a patient misuses heroin and marijuana should guide clinical officers to concentrate on an integrated treatment model when providing healthcare interventions to the patient(EMCDDA, 2016). Patients should be warned about the dangers of misusing substances while underprescribed medications. Integrating psychological and antipsychotic treatments improves the health of a patient with comorbid conditions.

 

 

 

 

 

 

References

Druss, B. G., & Walker, E. R. (2011). Mental disorders and medical comorbidity. Robert Wood Johnson Foundation. Retrieved from https://www.integration.samhsa.gov/workforce/mental_disorders_and_medical_comorbidity.pdf

EMCDDA. (2016). Comorbidity of substance use and mental health disorders in Europe. Perspectives on Drugs. Retrieved from http://www.emcdda.europa.eu/system/files/attachments/2639/Comorbidity_POD2016.pdf

NIDA. (2018, February 27). Common Comorbidities with Substance Use Disorders. Retrieved from https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders on 2019, January 3

Figure 1. Retrieved from SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Mental Health, Detailed Tables.Available at: https://www.samhsa.gov/data/population-data-nsduh

Figure 2. Adapted from National Comorbidity Survey, retrieved from https://www.integration.samhsa.gov/workforce/mental_disorders_and_medical_comorbidity.pdf

Table 1. Retrieved from https://www.drugabuse.gov/longdesc/table-1-comorbid-substance-use-disorders

 


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