Substance Abuse and Co-occurring Disorders

According to the Journal of the American Medical Association, approximately 50 percent of individuals diagnosed with severe mental illness are affected by substance abuse. About 37 percent of individuals with alcoholism and 53 percent of individuals with drug addictions have at least one serious mental illness.

Individuals living with mental illness are sensitive to the effects of alcohol and other drugs. In some cases, a person diagnosed with mental illness uses drugs to self-medicate or manage certain symptoms. Self-medication is counterproductive in the long-term, even if the substance abuse helps a person change how they feel in the present.

It is sometimes hard to know which came first─the mental illness or the substance abuse. Historically, the substance abuse treatment system and the mental health care system have had difficulty helping people manage both problems at the same time. There are steps you can take to become your own medical self-advocate if coordinated care is lacking. Additionally, there is evidence of advocacy efforts, improved cultural policy and the design of clinical models to help the systems work better together.

Alcohol Abuse

Alcohol dependence is what people think of when they think of alcoholism. Alcoholism is a disease that occurs when a person has a strong need or urge to drink, the inability to stop drinking and/or physical dependence on the alcohol, including withdrawal symptoms or the need to drink greater amounts of alcohol to experience a high.

Recovered, or sober, individuals report that the craving an alcoholic feels for alcohol can be as strong as the need for food or water. An active alcoholic will drink despite serious family, health or legal problems.

Health Effects

Short-term:

• unintentional injuries, accidents and risk of domestic violence;
• risky sexual behaviors and impaired judgment;
• alcohol poisoning─which can lead to death;
• complex medication interactions; and
• fetal alcohol syndrome when pregnant.

Long-term:

• neurological problems including dementia, stroke and neuropathy;
• increased risk of high blood pressure, heart attack and other cardiovascular problems;
• cancer of the mouth, throat, esophagus, liver, colon and breast;
• liver diseases such as alcoholic hepatitis and cirrhosis;
• gastrointestinal problems, including pancreatitis and gastritis; and
• higher risk of premature death.

Alcohol use displaces healthier nutrition choices. With heavy use, alcohol uses up key vitamins and nutrients and medical problems may result. Beer or wine has 85-150 calories per serving and offers little nutritional value (often called an "empty calorie"). You should know the calorie content of an alcoholic beverage as you embrace healthy eating and wellness.

Getting Help

For most adults, moderate alcohol use─up to two drinks per day for men and one drink per day for women and older adults─causes few, if any, problems. Yet alcoholics cannot typically drink at all, even the socially acceptable amount. People who have cognitive limitations or women who are pregnant should avoid alcohol.

It is not uncommon for an individual to deny that they have a drinking problem. If you are not sure, ask yourself the following questions:

• Do you drink alone or in secret?
• Are you unable to limit the amount of alcohol you drink?
• Do you find yourself unable to remember conversations or commitments?
• Have you lost interest in activities or hobbies that you used to enjoy?
• Do you feel a need or compulsion to drink?
• Are you irritable when your usual drinking time nears, especially if alcohol is not available?
• Do you keep alcohol hidden in strange places around your home, at work or in your car?
• Have you built up a tolerance to that you need an increasing number of drinks to feel the effects you want?
• Do you need a drink as soon as you wake up in the morning?
• Do you feel guilty about your drinking?
• Do you think you need to cut back on your drinking?
• Are you annoyed when other people comment or criticize your drinking habits?

If you have answered yes to two or more of these questions, it is likely that you have a problem with alcohol. A confidential, online screening program may also help you decide if it may be time to seek help.

Drug Abuse

Drug abuse is the habitual use of illegal, prescription or over-the-counter drugs for purposes other than they were intended. Drug abuse may substantially injure the user and interfere with social, physical, emotional and job-related functioning.

Although initial drug use may be voluntary, drugs have been shown to alter brain chemistry, which interferes with an individual's ability to make decisions and can lead to compulsive craving, seeking and use. This then becomes a substance dependency.

Health Effects

The impact of drug abuse and dependence can be far-reaching, affecting almost every organ in the human body.

• Drugs can weaken the immune system, increasing susceptibility to infections.
• Drugs can cause cardiovascular conditions ranging from abnormal heart rate to heart attacks. Injected drugs can also lead to collapsed veins and infections of the blood vessels and heart valves.
• Drugs can cause nausea, vomiting and abdominal pain.
• Drugs can cause the liver to have to work harder, possibly causing significant damage or liver failure.
• Drugs can cause seizures, stroke and widespread brain damage that can impact all aspects of daily life by causing problems with memory, attention and decision-making.
• Many drugs produce global body changes such as dramatic fluctuations in appetite and increases in body temperature, which may impact a variety of health conditions.

More deaths, illnesses and disabilities stem from substance abuse than from any other preventable health condition. Today, one in four deaths is attributable to alcohol, tobacco and illicit drug use. People who live with under-treated or untreated mental illness and substance dependence have a higher risk of all bad outcomes including injuries, medical problems, incarceration and death.

A confidential, online screening program may help you decide if it may be time to seek help for your drug use.

Getting Help

There are many resources and supports available for conquering addiction. As you work to put a plan in place, educate yourself about pharmaceutical options, treatment facilities, outpatient behavioral treatment and community-based social support. There are many ways to get sober and no one right path. But recovery is a process that is often strengthened by self-help support.

The self-help recovery movement is strong in the substance-abuse community. Alcoholics Anonymous is a free, 12-step organization that has helped millions of individuals. Al-Anon is a program for families to help them learn detachment and to separate their responsibility from that of the addicted person. Al-Ateen is a program geared for adolescents who have addicted family members. Smart Recovery is also a sobriety support program that does not share the religious focus of AA, but is rooted is science. Double Trouble groups offer self-help support for individuals living with both mental illness and addiction.

Some self-help groups are sophisticated enough to help people achieve sobriety while accepting a psychiatric condition and the need for psychiatric medications. However, some AA groups have historically discouraged dually diagnosed persons from taking psychiatric medications. It can be useful to shop the meetings in your area to find one that best meets your individual needs. If you are taking medications for a mental illness and utilize AA support, be sure that your sponsor understands and respects your medication choices.

If you have health insurance, your best ally in identifying help may be your primary care provider. He or she can refer you to specialized care by recommending someone with additional addiction training or to a treatment facility. Medication and behavioral therapy are often included in a comprehensive treatment program. Treatment will likely begin with detoxification, focusing on the management of withdrawal symptoms, and proceed toward relapse prevention. Additional components of a treatment program may focus on managing stressors in daily life, medical and mental health services and a plan for follow-up care as necessary.

If you do not have health insurance, do not give up. Publicly funded treatment centers are available. For more information on these facilities in your state, please call (800) 662-HELP or visit www.findtreatment.samhsa.gov.