Substance Abuse and Mental Health in Connecticut

Substance abuse is viewed as a mental health issue by the medical community. Although this is true, there is a disparity between how each type of illness is perceived. While getting treatment for mental illness is largely accepted and encouraged by society, treatment for substance abuse carries a negative stigma. This stigma is particularly destructive because of the large number of people who are facing these types of issues. A large percentage of the population is affected negatively by this stigma.

When substance abuse and mental illness are present at the same time within an individual the disorders are said to be co-occurring. Substance abuse co-occurs with mental illness quite often in America, with SAMHSA reporting that 4 million people in the last year experienced a co-occurrence of this nature in their lifetimes.

Connecticut's branch that oversees assessment and treatment of patients with co-occurring disorders is the Department of Mental Health and Addiction Services (DMHAS). This state funded entity is considered one of the most successful in the nation.

Topography of Mental Illness and Substance Abuse in Connecticut

According to a report by the SAMHSA, nearly 29,000 of Connecticut's young people, 10% of adolescents, per year in 2009-2013 reported using illicit drugs within the month prior to being surveyed. About 88,000 individuals between the ages of 12 and 20, 20% of all people in this age group, per year in 2009-2013 reported binge drinking within the month prior to being surveyed. Binge drinking is defined as drinking that raises the level of alcohol in the blood to over .08 grams.

In conjunction with this drug and alcohol use, the state also saw quite a few instances of mental illness. SAMSHA reports that 7% of all adolescents within the state per year in 2009-2013 experienced at least one disordered mental episode within the year prior to being surveyed.

Although Connecticut's mental health system is superior to most in the United States, it still struggles to keep up with the increasing need for care. Cuts to funding has recently caused the waitlist to be at least 10 days in some community based facilities.

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

Researchers are not yet sure why these types of disorders co-occur. It has been shown that those with mental health disorders are more likely to have substance abuse issues that people that do not have the primary condition. The flip side is also true in that those with substance abuse issues as their primary diagnosis tend to have mental health problems. While causation cannot be determined in a patient who is presenting with both types of disorders, there are risk factors that may help to explain why they are co-occurring. First, mental illness and substance abuse share many of the same genes. That is to say that the genes that control whether or not a person develops a mental illness is also connected to the gene that may govern addiction.

Suffering from symptoms of a mental illness drives some people to attempt to alleviate symptoms through self-medication. This self-medication often takes the form of ingesting/using illicit drugs or abusing alcohol. While this behavior may provide relief in the moment, this is only temporary and will almost certainly lead to a dependency. People who have a mental health disorder are more likely to have a substance abuse disorder when compared to those with no mental illness. At the same time, those with substance abuse disorders have a higher rate of mental illness than people who do not use drugs or abuse alcohol.

Certain mental illnesses are more highly correlated with instances of substance abuse than others. These illnesses include mood disorders, schizophrenia, anxiety disorders, depression, and bipolar I and II. It is still unclear at this point the exact reasons these more commonly co-occur with substance abuse; however, the connection has been soundly made.

Signs and Symptoms of Co-Occurring Mental Health and Substance Abuse Disorders

Suffering from co-occurring disorders can take a toll on a person mentally and physically. While this is painful for the person going through it, these symptoms can leave a trail for loved ones to follow to hopefully identify what the issue actually is. It can be difficult to discern which symptoms stem from which disorder. Understanding the origin of the symptoms is not important for the lay person and is best left to the medical professionals. The most important thing at this point is that the symptoms are recognized and flagged; doing so could save someone's life. Although causation cannot be established, there are indicators to watch for that point to co-occurring disorders. Any one or a combination of the following symptoms should be considered:

If these symptoms are present within yourself or a loved one, this may indicate a serious condition and should not be brushed aside. The safest action to take would be to enlist the help of a medical profession as quickly as possible. While these types of disorders certainly pose a challenge in overcoming and may seem daunting, recovery is very possible and should be sought out immediately. The first step is often time the most difficult.

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

In Connecticut, the DMHAS adheres to specific guidelines with regard to treating co-occurring mental illness and substance abuse disorders. The organization also reports that great strides have been made of late in this area. The state was able to provide increase their capacity to provide effective, comprehensive, integrated and evidence-based care to adults with co-occurring disorders. To achieve this, the state combined several agencies into a single department so that both disorders are addressed within the same authority. This newly integrated system is better able to provide the integrated care that these individuals require. The state strives to identify all mental health and substance abuse disorders that coexist within an individual and then deliver treatment such that all disorders are addressed simultaneously.

Connecticut is shifting away from exclusively using inpatient rehabilitation for treating co-occurring disorders. Research has shown that community based care can be more effective than inpatient rehabilitation for those with mental health and substance abuse issues specifically. The initiative to move away from institution began in the 1960s, but has recently found to be effective in certain populations because community based care allows a person to remain in their own communities and support networks.

Prior to beginning any course of treatment, an assessment needs to be performed. The accuracy of the assessment is critical to formulating a treatment plan. The diagnoses need to be correct to help ensure a positive outcome. If a patient is ready to stop using a substance and they will potentially have acute withdrawal symptoms, they will be referred to an inpatient detoxification center. There are certain withdrawal symptoms that can be very harmful or even fatal if the detox process is not done properly. Detox centers are fully staffed with medical professionals trained to handle these delicate cases. Patients will be monitored at all times to ensure they are safely coming off of the harmful drug or drink. Barring these acute and dangerous symptoms, mental illness and substance abuse should be treated at the same time.

Cognitive Behavioral Therapy (CBT) is an effective method for treating co-occurring mental health and substance abuse disorders. CBT is defined as a short-term and goal-oriented therapy that helps people change the way they think and subsequently change their behaviors. Some CBT techniques include journaling, questioning one's own beliefs, practicing mindfulness, mediation/relaxation, and thinking exercises.

Psychotherapy has also been found to be very effective in treating dual diagnosis patients. A psychotherapist is trained in talk therapy and is able to bring healing to traumas living within a person's psyche. Untold damage is done when trauma is left unaddressed. When patients are able to face their demons, they are able to heal a part of themselves that may be driving them to use substances.

Treatment for co-occurring mental health and substance abuse disorders may be ongoing long term for most patients. Once a person is able to reach a level of health to where they are ready to take on their lives, it is best that they do so slowly. Transitional housing is an invaluable to tool to achieve this easing in. Within these community's patients are able to find a level of support that is unsurpassed elsewhere. Individuals are provided with vocational, psychiatric, emotional and financial support within these housing options.

Self-help and other types of support groups are the most popular option for continuing care. As stated earlier, the path to healing and recovery may be life-long. Continuing care makes it possible for people to stay on the best path for them to continue to recover and stay sober.


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