Substance Abuse and Mental Health in California

Despite the palm trees and practically year-round sunny days, Californians face mental health and substance abuse problems with some significant frequency. When these types of disorders are present in an individual at the same time, this is referred to as a dual diagnosis or they are referred to as co-occurring.

One study done by the Health and Human Services Agency Behavioral Health Division showed that teens and youth with a dual diagnosis in California were more likely to be male and of Hispanic descent when compared to youth without a co-occurring illness. In turn, adults who were treated for co-occurring disorders in California were more likely to be male and of European descent when compared to patients without co-occurring disorders. Adults with a dual diagnosis were most likely to have a primary diagnosis of schizophrenia or bipolar disorders as opposed to depressive or anxiety disorders.

Topography of Mental Illness in California

Since 1995, the population in California has increased by about seven million but the available options for psychiatric treatment have actually decreased. This poses a major issue in light of California's current mental health climate. According to the California Health Care Almanac, mental health disorders are one of the most common health conditions faced by Californians. 1 in 6 California adults face a mental health issue of some kind, while 1 in 24 are suffering from a serious mental illness (SMI). The numbers are not any more forgiving for teens and young adults. 1 in 13 of California's teens and young adults were reported to have disruptive emotional issues affecting their lives at school and at home.

Public and private organizations have poured substantial amounts of money and other resources to provide access to care, improve integration of mental health care with mainstream care and reduce the stigma that mental illness currently carries within society. Although these efforts have been valiant, many Californians are not receiving proper treatment for the mental health issues and rates of occurrence continue to increase. Despite these efforts, the incidence of some mental illnesses continues to rise, many Californians still fail to receive treatment for their mental health needs, and many are experiences poor overall health outcomes due to their mental illness going untreated.

Why do mental health issues and substance abuse co-occur?

Mental health issues tend to co-occur with substance abuse disorders due to the inter-relatedness of these types of disorders. Those with mental health issues tend to abuse substances and those with substance abuse issues tend to develop a mental illness. Many genetic risk factors for substance abuse coincide with those for mental illness. This means that the same set of genes that are connected with mental health disorders are also connected with substance abuse issues. The circumstances which would trigger co-occurring disorders include genetic predisposition, environmental triggers, brain damage, and exposure to drugs and alcohol at a young age. For those with a genetic predisposition to mental illness, it is likely that if this person abuses drugs they will see that illness manifest in their lives. In terms of environmental triggers, these include external stressors and traumatic events that may push one over the edge to develop a mental illness and/or a substance addiction. The part of the brain that controls rewards and stress is affected by mental illness as well as substance abuse. If this area becomes damaged through drug use, it is likely that these issues will be compounded. The brain can also be adversely affected if a person begins abusing drugs and alcohol at a young age while the brain is still developing. This effectively hinders personal development and makes an individual more likely to have a lifetime prevalence of substance abuse.

Co-occurring mental health issues and substance abuse disorders are challenging for clinicians. Based on the Epidemiologic Catchment Area Study, the prevalence of a substance abuse issues among mental health patients is about 30%. That number is even higher when looking at patients with specific illnesses such as schizophrenia, bipolar disorder and antisocial personality disorder; the percentages are 47%, 61% and 84% respectively. It is glaringly apparent that these numbers show that the mentally ill are more likely to have a substance abuse issue that not.

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What are the signs and symptoms of a dual diagnosis case?

It is tough to tease out symptoms of substance abuse or withdrawal versus symptoms of an underlying psychiatric disorder, especially if symptoms persist after the drug has worn off. There are also confounding environmental factors which cause anxiety or depressive disorders to flare, such as a breakup or loss of employment. This is what makes diagnosing these illnesses when they co-occur so challenging. The symptoms of a mental illness can look like substance abuse or withdrawal, while the reverse is also true. Symptoms of substance abuse or withdrawal can look like a mental illness.

In light of the diagnostic issues noted, there are some signs that a person is facing co-occurring mental health and substance abuse disorders. These include the following:

These signs and symptoms are helpful in determining if someone may be suffering from co-occurring disorders, but it is always best left to the professionals to make a final diagnosis. Medical professionals are highly trained to see what the untrained eye may not.

What are the treatment options for co-occurring mental health and substance abuse disorders?

Based on research regarding patient outcomes, the main ideas of dual-diagnosis treatment include the importance of integrated and simultaneous treatment. Integrated treatments are preferred over parallel and sequential treatments. This means that patients will be treated for both illnesses at the same time as opposed to treating one illness then treating the other. The ideal treatment plan would include an interdisciplinary team of medical and psychiatric professionals. They would ideally concert their efforts and focus on treating the co-occurring disorders simultaneously. Addiction therapy including motivational interviewing, cognitive-behavioral therapy, relapse prevention, contingency management, skills training, and/or case management, are absolutely a requirement to ensure positive outcomes for patients. These can be utilized alongside medication therapies which address substance abuse as well as mental illness.

Treating patients with co-occurring disorders using integrated dual-disorder treatment models may seem simple. The plain fact is that clinicians face difficulty with implementing the treatments due to some of the personality traits common to those with substance abuse and mental illness issues. Some individuals may be avoidant to treatment or they lack motivation to help themselves and they may not even have access to these programs. If a patient does have access to programs, these treatments would likely be delivered in an inpatient rehabilitation center. Patients will go through an intake process where they will be fully assessed by a professional. This professional will determine if the patient needs to be referred to a detoxification center prior to starting treatment. There are cases where it is not safe for the individual to stop taking a substance without tapering off under medical supervision. These are handled by detox centers who will monitor the patient 24/7 to ensure that their body is able to handle withdrawal and also ease some of the nastier withdrawal symptoms which can be quite painful.

After detoxification, the next step in recovery would be to check into an inpatient rehabilitation center. Within these walls is where the journey to recovery truly begins. 24/7 monitoring continues so that an individual receives the optimum level of support. Inpatient rehabs offer a variety of therapies that have been clinically proven effective in treating substance abuse and mental health issues. These methods include group, individual and art therapy as well as psychopharmaceutic therapies appropriate for each case. These therapies as well as time sober will do wonders for someone on the road to recovery.

Once a rehabilitation program is completed, many patients elect to move into transitional housing as opposed to returning to their normal lives straightaway. Transitional housing provides structured and supported living conducive to keeping the sobriety and mental health breakthroughs one achieved in rehab. Homes of this type have trained staff that continue to monitor patients and help them through coping with triggers and stressors. This supervised practice will prepare a person for when they are living completely on their own. They will be better equipped to handle life's stresses. While in transitional living, patients will also be connected in with others who are going through the same struggles and will come to form a new and healthy support network of peers. Having a peer support network in place is essential to maintaining a healthy lifestyle.

Beyond a peer support network, one may also wish to seek out formal support groups for those who wish to walk the path to recovery. There are many and varied types of support groups available for almost any preference including women's only groups. Some may wish to keep their support groups of like gender to remove complications. Joining a support group also can provide a person with responsibilities should they wish to become heavily involved in the group. This also creates a new level of accountability, further removing temptations to relapse.


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