When mental illness and substance abuse coexist in a patient, they are said to be co-occurring or dual diagnosis. Serious research began in the 1970s when doctors and scientists observed a strong correlation between substance abuse and mental illness in their own practices and clinical settings. The correlation between depression and substance abuse was the first relationship that was flagged and thus became the first subject of studies related to these illnesses occurring simultaneously. A decade or so later, the subject opened up further when researchers were able to determine that it was not only depression that was heavily linked to substance abuse, but many other mental illnesses as well. In the 1980s and 1990s, clinicians were reporting staggering numbers of co-occurrence, with substance abuse facilities reporting that 50-75 percent of their patients were also suffering from a mental illness. Mental health clinics reported that 20-50 percent of patients also faced substance abuse challenges. With the numbers so high with regard to co-occurrence, it is clear that there need to be systems in place to come to the aid of those suffering with them.
Nestled in the mid-Atlantic region of the United States, Delaware is home to over 900,000 people. Delaware is not without instances of mental health issues and substance abuse, teens and the youth of Delaware have not escaped the reach of such issues. The Substance Abuse and Mental Health Services Administration (SAMHSA) reported that for the years 2013 and 2014 an estimated 7000 adolescents between the ages of 12 and 17 used illicit drugs within the month prior to being asked. This number makes up about 10% of all adolescents in Delaware. SAMHSA also reported that roughly 15,000 teens and youth between the ages of 12 and 20 reported episodes of binge drinking within the month prior to being asked. This would be about 14% of all people between the ages of 12 and 20 in Delaware. Concurrently, about 10% of adolescents reported experiencing a major depressive episode in 2013 and 2014. Of these youth who reported the illness, about 46% received treatment for their depression. The adult population of Delaware were also asked to report their experiences with mental illness. According to SAMHSA, about 28,000 adults above the age of 18 reported having a serious mental illness in 2013 and 2014. 47% of these individuals received treatment for their mental illnesses.
Delaware's state run mental health and substance abuse treatment is run by the Division of Substance Abuse and Mental Health (DSAMH). This organization provides services to the public such as mental health treatment, counseling, support services, supportive housing, and mobile crisis intervention. For more serious illnesses the DSAMH provides psychiatric evaluation, diagnosis and inpatient treatment. With regard to substance abuse, treatment for co-occurring disorders is also available through the state. There is always room for improvement in any system and the DSAMH is no exception. With funding from the SAMSHA, the state plans to develop its programs even further to increase access and outreach in underserved communities.
Although causation has yet to be establish, research has been able to determine a definite relationship between these two types of disorders. These relationships become apparent when taking a look at the risk factors that are shared between mental health and substance abuse. Survey data has shown that those with mental illness are more likely to abuse drugs and alcohol while substance abusers tend to have a higher rate of mental illness. There are several reasons why this relationship exists. The first is related to mental illness that remains undiagnosed. Individuals who are suffering symptoms that are unpleasant and that they do not understand seek out relief in whatever form they may see fit. Many times this relief comes in the form of illicit drugs or alcohol. While the drug or drink relieves their symptoms in the moment, it is but a temporary respite. Soon, the person must reach out for the substance again to soothe themselves. This cycle very soon develops in to a dependency or addiction.
Secondly, substance abuse brings out mental illness in the genetically predisposed. For example, if an individual possesses the gene markers for schizophrenia, it may be that because they abused a drug or alcohol that illness developed as a result. It is possible for the genes related to schizophrenia to be present in DNA without the illness ever blossoming. Environmental factors absolutely affect genetics.
Lastly, one disorder exacerbates the other. One may not even know they are mentally ill until they pick up a drug or a drink and the illness becomes markedly worse. This intertwined relationship between mental health and substance abuse creates challenges across the spectrum of health care, from diagnosis to treatment.
There are challenges with identifying an individual with a dual diagnosis due to the interrelationship between the two. For instance, the side effects of using a drug may resemble symptoms of a mental illness. The reverse is true, in that symptoms of a mental illness may look like drug abuse to the untrained eye. The two disorders may even share the same symptoms. Teasing this out is not truly important for the lay person, once a person has sought out treatment, a trained medical professional will be able to untangle the web of symptoms and provide a plan for treatment. However, despite the challenges, there are some signs and symptoms that may be able to help identify that an individual may be suffering from one or more of these disorders:
If you or a loved one is experiencing any or all of these signs and symptoms, it is best to seek out help immediately. Leaving a potential mental illness or substance abuse problem unchecked can have devastating effects on one's life as well as their community.
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The effects that mental illness and substance abuse have on each other create definite challenges in diagnosis and treating co-occurring illness of these types. Legacy methods of treatment were falling short, and were not creating positive outcomes for patients. Clinics and clinicians for mental health and substance abuse were largely separate and so the illnesses would be treated separately. This disparity was wreaking havoc on the patients undergoing treatments and a source of frustration for clinicians who worked so hard to help these people. Medical professionals would find that once they were complete with one set of treatment, by the time the patient was ready for the next phase at a different facility, the progress that had been made was gone due to the co-occurring illness going untreated during that time. More recently, state and private run organizations have combined their mental health and substance abuse departments so that these individuals receive the best care and the most positive outcomes possible. Thus, it has been found that an integrative approach is the best way to treat co-occurring mental health and substance abuse disorders. Both illnesses will be treated at the same time, ideally with one unified staff of doctors, nurses, therapists and other staff.
Now that an integrative approach is understood, a treatment plan will be created on an individual basis. While there is no one path to recovery, there is a similar trajectory for these patients. If a patient needs to undergo a detoxification process because of acute withdrawal symptoms, they will be referred to a detoxification center. These centers are equipped to handle patients' harmful and often times painful withdrawal symptoms in a safe manner. After detox, if needed, one would begin treatment for their co-occurring disorders. Treatment options include Cognitive Behavioral Therapy (CBT), psychotherapy, art and alternative therapies, peer-to-peer counseling, peer run treatment centers, medication therapy and support groups. An individualized regimen will be determined and executed.
After undergoing rehabilitation, a lot of times patients will want to seek out transitional or half-way houses. This type of supportive housing allows a person to slowly integrate back into their daily lives in a safe and supported way. Research has shown that individuals who go into one of these housing communities have a better chance of maintaining their sobriety as well as their mental health than those who go directly back to their original situations.
Continuing care for co-occurring mental health and substance abuse disorders is required. For many of these patients, the road to recovery is a life-long journey. Self-help support groups are a great way for the patient to stay among like-minded folks who desire to maintain abstinence from drugs and alcohol as well as keep doing what is necessary to treat their mental illness. There is no cure for the majority of mental illnesses, but most can be effectively managed with proper care including continuing therapy, self-help, physical education, and medication.
References
https://www.census.gov/quickfacts/fact/table/DE/PST045219
https://www.samhsa.gov/data/sites/default/files/2015_Delaware_BHBarometer.pdf
https://www.ncbi.nlm.nih.gov/books/NBK64201/
https://dhss.delaware.gov/dhss/dsamh/mental_health.html
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