Abstract:
According to the statistic from Substance Abuse and Mental Health Services Administration(SAMHSA), 9 million people have co-occurring mental health issues, such as anxiety disorder, panic disorder, depression, bipolar disorder, attention-deficit hyperactivity disorder, psychotic illness, borderline personality disorder, antisocial personality disorder, and post-traumatic stress disorder. Among these nine million people, only 7 percent get treatment; at the same time, 60 percent did not receive any treatment. People who did not receive any treatment would choose to binge drink, smoke tobacco, take drugs, et cetera, to release their pressure and uncomfortableness; this is also known as substance use disorder(SUD). In other words, mental illness is one of the main factors developing the patients' SUD risk. Additionally, SUD is characterized by health problems, disability, and failure to meet major responsibilities at work, school, or home, which causes the recurrent use of alcohol or other drugs(SAMHSA).
Data and Statistics:
The data from the National Institute on Drug Abuse(NIDA) and SAMHSA demonstrates patients with serious mental illness(SMI) have a higher rate of alcohol, tobacco, and drug use disorder. Approximately 1 in 4 individuals with SMI have a SUD(NIDA, 2020).
Moreover, in a survey conducted by SAMHSA in 2020, 28.3 million people aged 12 years and older had SUD in alcohol, and 18.4 million people aged 12 years and older had SUD in illicit drugs. Among adolescents between the age of 12 and 17, 1.6 million adolescents had SUD. In fact, many of the patients also suffered from significant depression: 2.7 percent, or 644,000, adolescents aged 12 to 17 in 2020 had both SUD and MDE. Simultaneously, among adults above 18 years old, 6.7 percent, 17 million people, had SUD and any mental illness(AMI).
What Caused SUD?
Genetic and epigenetic and SUD are strongly connected. SUD, similar to other mental health disorders, is caused by genetic and epigenetic vulnerability issues in the brain. Reference to the paper from Elizabeth C. Prom-Wormley from the Department of Family Medicine and Population Health of Virginia Commonwealth University mentioned that the data from family studies illustrated SUD clusters within families, which indirectly proved the influences of genetics on SUD. Besides, research by Joseph D. Deak from the Department of Psychiatry of Yale School of Medicine and Emma C. Johnson of the Department of Psychiatry of Washington University of School of Medicine has demonstrated that around 40 to 60 percent of vulnerability to SUD is dependent on genetics. Dopamine is a neurotransmitter in the brain that allows you to feel good, satistification, and pleasure. In other words, it is the brain’s reward center. Surprisingly, it is a key character that makes genetics and SUD to be connected. The levels of dopamine determine the possibility of SUD. Each substance(drug) increases the activity of the reward pathway by increasing dopamine transmission; the large amount of dopamine produced can fuel poor impulse control to affect someone to have an addiction.
Nevertheless, apart from the genetic’s impact, the environment is another factor contributing to SUD. Accessibility to a substance affects the risk of SUD. “A substantial body of research indicates that the presence of, proximity to, and density of alcohol outlets[...] is associated with increased alcohol-related mortality and alcohol consumption among teenagers, college students, and adults” (Mennis et al., 2016). Namely, the higher availability and exposure to substances drive SUD. As per the survey mentioned above, many teenagers have SUD. The cause of SUD among adolescents is peer pressure. Peer pressure can have both positive and negative effects simultaneously. For example, a person’s friend would encourage them not to smoke or take drugs. Conversely, a person’s friend could also encourage them to use drugs. Peer pressure encourages people to alter their behavior, especially in late childhood when children build their identity and need high recognition from friends. Lastly, traumatic stress affects SUD. The National Child Traumatic Stress Network(NCTSN) states that people who encourage problematic substance use are more likely to experience traumatic events and develop mental health issues than those who do not use substances.
Why do SUD and Mental Disorder Co-Occur?
The previous section discussed SUD factors, but why do SUD and mental illness co-occur? People may have SUD and mental illness co-occur because SUD changes the brain structure and function, making a person more likely to develop a mental illness. NIDA claims substance used leads to changes in the same brain areas that are disrupted in other mental disorders, including schizophrenia, anxiety, mood, and impulse-control disorder. Next, some people use substances for self-medication. Substances like nicotine in tobacco and alcohol can lessen certain symptoms of mental illnesses; however, consider it the long term, they can also exacerbate symptoms and make people rely on substance use.
Youth Substance Abuse:
As mentioned, 644,000 adolescents aged 12 to 17 in 2020 had both SUD and MDE. Frequent adolescent substance use is linked to genetic vulnerability, psychosocial experiences, and environment. “Although drug use and addiction can happen at any time during a person’s life, drug use typically starts in adolescence[...]”(NIDA, 2020). Adolescence is a period when the body continues developing, as well as the brain. As a result, people should pay more attention to substance use for teenagers. Adolescents who persistently have SUD often experience in problems with academic performance, health-related issues, poor peer relationships, and involvement with the juvenile justice system. A cite research conducted by Kawkins et al. in 1992 demonstrated the correlation between a low commitment to education and adolescents’ SUD. Youth substance use results in the consequence of mental health problems, including depression, apathy, anxiety, developmental lags, et cetera. A bad mental status raises the sucicide rate. Furthermore, a substance like marijuana has consequences like short-term memory, learning, and psychomotor skills that impact brain development and brain damage.
Treatment:
SUD and co-occurring conditions can be diagnosed through an assessment by a psychiatrist, a psychologist, or a licensed alcohol and drug counselor based on the Diagnostic and Statistical Manual of Mental Disorders(DSM-5). Likewise, lab tests, such as blood and urine tests, can be adapted to determine the level of drug use; besides, lab tests may be used to monitor recovery and treatment.
Treatment for SUD and co-occurring conditions must be treated at the same time. The treatment should be provided and designed by a healthcare provider. The patient’s disorders and symptoms, age, misuse of substances, specific mental illness, and medical history also make the treatment different. Behavioral therapy is common for individuals with co-occurring substance use and mental disorders, but be aware that there is a difference between adults and adolescents.
Behavior therapies for adults:
Cognitive behavioral therapy(CBT): A talking therapy with a psychotherapist. CBT helps people to manage their problems by changing their way of thinking and behaving.
Dialectical behavioral therapy(DBT): Another type of talking therapy. It is similar to CBT; however, DBT is for people with more intense emotions. DBT helps patients reduce self-destructive behaviors like suicide, self-harm, and drug use.
Assertive community treatment(ACT): A form of community-based mental healthcare for individuals that experience mental disorder that interferes with the ability to live in the community, attend appointments, et cetera.
Therapeutic communities(TC): A form of long-term residential treatment that aims to help people to build new and healthier values, attitudes, and behaviors.
Contingency management(CM): An application that encourages healthy behaviors by offering rewards for desirable behaviors.
Behavior therapies for adolescents(children):
Brief strategic family therapy(BSFT): A short-term family therapy that model and develop for youth to maintain SUD and co-occurring problem behaviors.
Multidimensional family therapy(MDFT): A family-centered treatment that addresses multiple and interacting youth behavior problems(SUD, mental disorders, and school problems).
Multisystemic therapy(MST): A family and community-based treatment that address severe antisocial behavior in children and adolescents with SUD.
Conclusion:
If people around you are experiencing SUD and mental illness, making a correct diagnosis and having proper treatment is necessary. Help from professionals can raise the chance for them to recover and return to normal life. Many people with SUD and mental illness are afraid to call for help because of social stigma. Hence, rising public awareness of SUD and mental health issues is significant to make the world happier.
Citations
(Cover Image Source: Recovery In Tune)
Addiction Center. "Peer Pressure and Substance Abuse." Addiction Center, www.addictioncenter.com/addiction/peer-pressure-substance-use/. Accessed 29 Mar. 2023.
Cleveland Clinic. "Is Addiction Hereditary?" Cleveland Clinic, 28 June 2022, health.clevelandclinic.org/is-addiction-genetic/.
Consequences of youth substance abuse. ojjdp.ojp.gov/sites/g/files/xyckuh176/files/pubs/drugid/ration-03.html#:~:text=Consequences%20of%20youth%20substance%20abuse&text=Young%20people%20who%20persistently%20abuse,with%20the%20juvenile%20justice%20system.
Deak, Joseph D., and Emma C. Johnson. "Genetics of substance use disorder: a review." National Library of Medicine, 21 Apr. 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC8477224/.
"Genes and Addiction." Learn.Genetics, learn.genetics.utah.edu/content/addiction/genes. Accessed 29 Mar. 2023.
Gordon, Sherri. "Why Mental Health Disorders Co-Exist With Substance Use." verywell mind, 16 July 2021, www.verywellmind.com/co-occurring-disorders-mental-health-and-addiction-4158280.
Mayo Clinic. "Drug addiction (substance use disorder)." Mayo Clinic, 4 Oct. 2022, www.mayoclinic.org/diseases-conditions/drug-addiction/diagnosis-treatment/drc-20365113#:~:text=Diagnosing%20drug%20addiction%20(substance%20use,a%20diagnostic%20test%20for%20addiction.
Mennis, Jeremy, et al. "Risky Substance Use Environments and Addiction: A New Frontier for Environmental Justice Research." National Library of Medicine, 13 June 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4924064/.
The National Child Traumatic Stress Network. "Trauma and Substance Use." The National Child Traumatic Stress Network, www.nctsn.org/what-is-child-trauma/populations-at-risk/trauma-and-substance-use. Accessed 29 Mar. 2023.
NIDA. "Part 1: The Connection Between Substance Use Disorders and Mental Illness." National Institute on Drug Abuse, 27 Sep. 2022, nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness Accessed 29 Mar. 2023.
NIDA. "Why is there comorbidity between substance use disorders and mental illnesses? ." National Institute on Drug Abuse, 13 Apr. 2021, nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/why-there-comorbidity-between-substance-use-disorders-mental-illnesses Accessed 29 Mar. 2023.
National Institute of Mental Health. "Substance Use and Co-Occurring Mental Disorders." National Institute of Mental Health, Mar. 2023, www.nimh.nih.gov/health/topics/substance-use-and-mental-health.
Prom-Wormley, Elizabeth C., et al. "The Genetic Epidemiology of Substance Use Disorder: A Review." National Library of Medicine, 22 Apr. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5911369/.
Villines, Zawn. "What to know about peer pressure and drugs." Medical News Today, 23 Feb. 2022, www.medicalnewstoday.com/articles/peer-pressure-drugs.
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