Substance Abuse and Mental Health in Hawaii

The state of Hawaii consists of an archipelago of 137 islands, 8 of which are inhabited. There are approximately 1.7 million people living on the lush Hawaiian Islands. The serene beauty of Hawaii does not shield its many residents from mental illness and substance abuse, unfortunately. When these two types of disorders are present in an individual at the same time, this is referred to as dual diagnosis or that the disorders are co-occurring. The trouble of co-occurring substance use and mental disorders is more prevalent than people may believe. 44 million adults in the United States are dealing with a mental illness. 19 million others are facing a substance use disorder. Of these 63.7 million people, 8.2 million have co-occurring mental illness and a substance use disorder, or dual diagnosis. In other words, more than 40 percent of people with a drug or alcohol problem also have a mental disorder.

As of today, the largest study of, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), found that approximately 20% of those in the United States that are facing a substance use disorder had at least one mood disorder, and 18% had at least one completely independent anxiety related illness. When these types of illnesses are co-occurring, a complicating factor is created with regard to the treatment of each disorder in addition to complicating any general health care that is needed.

Topography of Mental Illness and Substance Abuse in Hawaii

The most commonly abused drug in Hawaii is methamphetamine. According to a study done by Hawaii state government, 69% of those who were surveyed identified methamphetamine abuse as the number one issue Hawaii faces and that it should be treated as a top priority. One study outlined the devastating effect that the drug is having on the islands, with multiple generations of families being impacted by the rampant use of the drug. These people were also presenting with mental illnesses at an alarming rate. The youth in Hawaii is particularly susceptible to addiction to meth, and the treatment of teens was shown to be further complicated by their involvement with more institutions and organizations than adults.

The most common mental illnesses to co-occur with substance abuse are depression, PTSD, personality disorders, anxiety disorders and bipolar disorders. Depression is one of the most common psychological disorders in the United States, so it makes sense that it would be the number one disorder that co-occurs with substance abuse. While people may think their drinking or drug use is helping them get out, it is actually pushing them down further into depression. PTSD is another common dual diagnosis disorder. PTSD is the result of experiencing a traumatic event in one's life and manifests itself differently among different people. The pain of PTSD can be severe, driving a person to pick up that drink or drug to numb themselves. The cause of personality disorders has yet to be determined, but these types of disorders are life-long illnesses that affect every facet of an individual's life, especially interpersonal relationships. Emotional pain usually drives someone with a personality disorder to substance abuse. Those with anxiety disorders experience unwarranted fear, stress, and internal angst in everyday situations. This constant state of agitation does take its toll, people are driven to use drugs and alcohol to try to escape from this pain. This short term gain is not worth the devastation it causes in the long run.

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

Co-occurring mental health and substance use disorder are extremely common. According to SAMHSA's 2018 National Survey on Drug Use and Health (NSDUH), approximately 41.2% of those with a substance abuse disorder also had a diagnosis of a psychological, behavioral, or emotional issue within the past year. As shown by the recent survey, those who face substance abuse also develop a mental health illness like anxiety, depression, or bipolar disorder. The onset of mental illness is often triggered by the chemical and neurological variance caused by the psychoactive properties of harmful substances, as well as the destructive effect that drug and alcohol use has on the psyche. There are also cases in which addition to drugs or alcohol form when those with an undiagnosed mental illness try to self-medicate. Some of the common illness that cause a person to self-medicate are anxiety, panic disorder, major depression, eating disorders, and personality disorders.

Common mental illness diagnoses are:

Signs and Symptoms of Co-Occurring Disorders

It does not matter how an addiction begins in a person potentially facing multiple diagnoses. Highly specialized care is required in a dual diagnosis program. Research shows that when underlying mental health conditions are left untreated, the relapse risk is much higher. There is a complicated relationship between these two types of disorders. Symptoms of one may look like symptom of the other. Withdrawal symptoms of a drug may appear to be a symptom of a mental illness. These are some signs and symptoms of co-occurring disorders:

Symptoms can vary greatly from person to person, but any marked changes in behavior and personality should be flagged.

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

When treating co-occurring mental health and substance abuse disorders, both are now considered primary disorders. Up until the 1990s, mental health disorders such as anxiety attacks, depression, bipolar disorder, and ADHD were treated separately from an addiction. Meaningful treatment for a psychological disorder could not start until a patient was able to maintain abstinence from the addictive substance. The difficulty with this was that often time patients with a mental illness face even tougher obstacles to sobriety. These patients are markedly harder to deal with, according to providers. Patients tend to be more dishonest about substance abuse and were more likely to be non-compliant than those without a mental illness. Therein was the complication with these cases. Clinicians soon realized that the only way to improve outcomes for these patients was to integrate mental health and substance abuse treatment systems on a broad scope.

Armed with knowledge and research, treatment providers who specialize in the treatment of addiction are able to be trained in handing co-occurring cases. Within this new integrated system, a multi-disciplinary team of professionals will create individualized treatment plans for these patients. The plans vary with the many different combinations of disorders that patients present with. The plans include detoxification for certain patients, residential or outpatient rehabilitation, supportive housing and continuing self-help and care.

A patient must detox in a safe environment if their addiction has caused them to experience withdrawal symptoms. These symptoms must be eased with medication or even a tapering dose of the drug. After detox, if needed, patients then embark on the rehabilitation journey. Residential treatment programs that specialize in co-occurring disorders are essential. There are also some outpatient options for those who are thought to thrive in such environments. The therapies used in treatment programs include psychotherapy and medication. There are also facilities which utilize more alternative methods of treatment such as acupuncture, massage, art and animal therapy.

After treatment, the road to recovery does not end. It is only beginning. Those who have found themselves in a rehabilitation center have shown that they need a certain level of support. Pushing that person out into the world, back to their lives is not the wisest choice. The best outcomes happen when patients move from rehabilitation to transitional housing. Transitional housing provides a level of support that living on one's own cannot provide. Mental health services are provided as well as occupational services.

Recovery is a life-long journey that requires patients to seek out support of their peers. There are many such support groups available, and patients are often connected to these groups while living in supportive housing. Contusing care is also essential for recovery. Patients are highly encouraged to continue to attend therapy and to pursue other forms of self-help. There are many programs and schools of thought to help a person in recovery stay sober and mentally healthy. It is also absolutely necessary for patients to be able to have access to health care and obtain the medications they need to thrive.


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