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| INVITED GUEST EDITORIAL |
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| Year : 2014 | Volume
: 1
| Issue : 2 | Page : 54-55 |
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Self-medicating in mental illness, substance abuse & addiction- The challenges of dual diagnosis
Gireesh Bembalkar
| Date of Web Publication | 4-Jul-2017 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None
How to cite this article:
Bembalkar G. Self-medicating in mental illness, substance abuse & addiction- The challenges of dual diagnosis. Acta Med Int 2014;1:54-5 |
Self-Medicating without a doctor's oversight to overcome and/or manage treatable Brain Disorders is common and risky. Can you imagine perspiring heavily for no obvious reason, having debilitating palpitations and mind racing in paranoia, while waiting in a checkout line at the local grocery store? Can you imagine going to the grocery store at 6 am or 9 pm in order to avoid the Panic and Social Anxiety, associated with being in a tight, long queue and held captive from running outside because of your silly trolley full of fresh groceries?
Imagine your mind, flashing from one thought to the next with lightning speed, without control; or imagine not being able to tell the difference between reality and hallucinations. Although you know in your mind that you have no physical problems, you feel like a slave in hell, physically, mentally, emotionally, and spiritually. How about considering suicide?
Conjure up feeling nothingness; no energy, no appetite, no strength. Your mind numb to any pleasure and feeling fragile in every possible manner.
These are just a few of the symptoms that accompany mental illnesses like panic disorder, bipolar disorder, schizophrenia, mood disorders, depression, addiction, and the rest.
Mental illness and drug addiction often occur together. This condition of dual diagnosis presents a challenge to physicians. The patient has two brain diseases that influence one another, and both of which need treatment.
“To effectively deal with dual diagnosis, we must treat the problems of mental illness and addiction together.” --Dr. Glen Hanson
“Substance abuse treatment centers are starting to recognize the critical need to treat patients for both addiction and mental illness.” --Pat Fleming
But why do mental illness and substance abuse so often occur together? Which happens first? Addiction or mental Illness? Can drug use cause mental illness? Are mental illness sufferers self-medicating with drugs to alleviate their painful symptoms?
Chicken and Egg…
Which came first, the mental illness or the drug addiction?
“Drug use fans the flames of mental illness.” --Dr. Glen Hanson
There is a clear link between Addiction and Mental Illness. It goes both ways, but definitely anyone can make himself or herself truly ADDICTED by sustained use of very easily accessible substance, like alcohol. It is like a flip switches in the brain... one day drinking alcoholically, the next day an Alcoholic.
Some say that certain drugs may indeed cause mental illness in individuals with a vulnerable genetic profile. Others say that drugs don't necessarily cause mental illness, but can worsen the symptoms. Many people use certain substances to not deal with their “voices” and thoughts about being and feeling so different than the “Norm.” However it is a fact that continued use of benzodiazepine, alcohol, and opioids will cause addiction regardless of how the use started and the choice to quit.
And regardless of which occurred first, understanding the underlying causes of dual diagnosis facilitates proper corrective treatment.
A teen who develops a mental illness begins to use drugs to alleviate his or her symptoms. As a result, symptoms of mental illness surface sooner than they would have, but worsen dramatically with prolonged drug use.
Some where between 35%-50% of people currently in rehab began using drugs of abuse as a form of self-medication. Drugs of abuse temporarily relieve many of the symptoms associated with mental illness, such as stress, anxiety, panic, social inhibitions, or depression. The foremost drugs of abuse falling into this category are alcohol, benzodiazepines, opioids, nicotine and cannabis.
According to the USA National Institute for Mental Health, 70% of schizophrenics smoke. Smoking a cigarette may help them experience calmness or a sense of well-being. It may help them think more clearly, more easily carry on a conversation, or diminish uncomfortable side effects of medications.
Stimulants such as cocaine can cause anxiety, panic attacks, mania, and sleep disorders. However, it can keep the individual focused enough on work to function and manage life temporarily. Methamphetamine addicts, bent on staying awake for endless hours, often report hearing voices and other types of hallucinations characteristic of certain mental disorders.
Depression can result from an underactive reward pathway that receives little pleasure from natural rewards. People with depression may turn to drugs to stimulate their reward pathways to more “normal” levels. Prolonged drug use can lead to a downward spiral of worsening mental illness and drug addiction, leaving people worse than with one initial illness.
Addiction and mental illness are both brain diseases. A person vulnerable to one type of brain disease may also be vulnerable to another. Addiction and mental illness involve the same pathways, molecules, and chemicals in the brain, and they share many similarities:
Increased dopamine activity is characteristic of both schizophrenia and many stimulants such as cocaine. A serotonin transporter is associated with both mood disorders and alcoholism. Cocaine users with schizophrenia have dysfunctional reward pathways with increased dopamine activity.
People with severe mental illness such as schizophrenia or bipolar disorder, or an elevated Panic Disorder, have a higher risk for substance use, especially cigarette smoking, alcoholism, sedatives, and stimulants, and “protective factors usually associated with lower rates of substance use do not exist in severe mental illness,” according to a new study funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.
“Estimates based on past studies suggest that people diagnosed with mood or anxiety disorders are about twice as likely as the general population to also suffer from a substance use disorder. Statistics from the 2012 National Survey on Drug Use and Health indicate close to 8.4 million External Web Site Policy adults in the United States have both a mental and substance use disorder. However, only 7.9 percent of people receive treatment for both conditions, and 53.7 percent receive no treatment at all,” the statistics External Web Site Policy indicate.
In another study by NIDA, “compared to control groups, people with severe mental illness were about 4 times more likely to be heavy alcohol users; 3.5 times more likely to use marijuana regularly; and 4.6 times more likely to use other drugs at least 10 times in their lives. The greatest increases were seen with tobacco, with patients with severe mental illness 5.1 times more likely to be daily smokers. This is of concern because smoking is the leading cause of preventable death in the United States.”
There is a tremendous cost to the person who suffers the most but also to the family, and the society at large. The cultural taboos are many, the ignorance and stigma associated with this illness widespread and the research and treatment facilities not enough.
Let us hope that the sufferers, will become openly honest on how they feel and think and share that information with a qualified healthcare professional and not be besieged with humiliating or stigmatized thoughts but rejoice in seeking Freedom from Darkness and not try to self-medicate.
Let us also hope that the medical professionals and the society, will listen with an open mind and empathy and continue the research and treatment efforts with greater vigor and resources.
This illness should be treated in the same way as any physical illness.
Thrive Vibrantly!
| Editor's Comments | |  |
Gireesh Bembalkar Senior Advisor/Chairman/Ambassador/ Rural Hillary Clinton Branding/Ready for Hillary PAC/ Global Clinton Promoter USA.
The views expressed here are totally of Gireesh Bembalkar. Editorial board of Acta Medica International does not cut/edit the guest editorial. Editorial board sincerely thanks Gireesh Bembalkar.
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