Individuals with a mental disorder often have a co-existing condition, such as depression, anxiety, or often, a substance use disorder. Alcohol or drugs are frequently used to medicate the symptoms of a mental disorder. But the presence of a substance use disorder can make treatment more complicated and can delay the reduction in symptoms.

Altered Mismatch Negativity

In an article appearing in Clinical Psychiatry News, researchers in Australia examined the impact of risky alcohol consumption among those with bipolar disorder, as compared with nondrinkers. The study found that there was a phenomenon known as “altered mismatch negativity” on electroencephalography (EEG) exams among those with risky drinking histories.

According to the article, mismatch negativity is the brain’s automatic electrical activity that responds to auditory stimulation when there is a change in sounds. When there is a reduction in mismatch negativity, it indicates an impairment of NMDA-receptor activation. The NMDA receptors were already thought to be impacted by both alcohol use and in patients with bipolar disorder.

To measure the mismatch negativity in individuals with risky alcohol use and bipolar disorder, the researchers recruited 42 bipolar disorder patients and 34 control subjects. The participants were between the ages of 16 and 30. The participants were subjected to EEG exams with auditory stimuli.

Among the participants, 16 bipolar patients engaged in risky alcohol-related behaviors, as well as 14 of the control subjects. Of the remaining patients, 26 of the bipolar subjects and 20 of the control subjects did not engage in risky drinking.

Misuse Of Alcohol In Those Who Are Bipolar

The researchers found that the misuse of alcohol was a strong predictor of attenuations in mismatch negativity. The effect was significantly more profound among those diagnosed with bipolar disorder. The researchers believe that the alcohol may play an antagonistic role on the NMDA/glutamatergic system. This is consistent with the growing use of glutamatergic agents to treat bipolar disorder. Limiting alcohol consumption may be an important step when beginning treatment with glutamatergic agents.

The article notes recent studies showing that bipolar males between the ages of 20 and 30 have the highest weekly substance use. In more general terms, those who are diagnosed with bipolar disorder before adulthood have lifetime alcohol use rates of up to 70 percent.

The researchers note multiple potential limitations on their findings. For instance, the youths included in the study are not able to legally buy alcohol in Australia, so the underage drinkers may have had incentive to understate drinking behavior.

The study adds to the body of evidence that shows that bipolar disorder patients are particularly susceptible to the dangers of risky alcohol consumption.

Discover Why Integrating Medical And Mental Health Treatment Is Crucial

Depression can be a very serious mental health condition. People struggle with depression to varying degrees. For some it is a lifelong battle, while for others it comes on as the result of life situations but is temporary. In any type of depression, self-medication is common but ill advised. Self-medication is the use of drugs or alcohol to mitigate symptoms. It is a dangerous and destructive practice, but not everyone who does it realizes the harm they are causing. If you or someone you love struggles with depression, look out for and avoid self-medicating.

Depression And Substance Abuse

Self-medicating is particularly common for depression. It mostly occurs in people who have not been diagnosed and are not getting professional treatment for depression. If you feel depressed, it is natural to turn to something that will either make you feel better, or that will at least numb that bad feeling. Most people reach for alcohol, but prescription drugs and illegal drugs are used as well for the self-medication of depression. The rates of substance abuse among people with either depression or anxiety are as high as 20 percent.

The Dangers Of Self-Medicating

Self-medicating feelings of depression often work in the short term. It’s why so many people resort to it as a strategy for feeling better. Over a long period of time, however, doing so only causes more problems. Not least of these problems is the possibility of addiction. A dual diagnosis of depression and addiction is not uncommon. Relying on alcohol or drugs to make you feel better is a habit that leads to dependence. Your body will get used to the substance and you will find it difficult to quit.

Another problem with self-medicating is that it never allows you to confront and deal with your depression. Drinking or using drugs is like a quick fix, but one that doesn’t last. It is not a permanent solution to your problems. Only treatment by health care professionals using therapy in combination with appropriate medication will provide you with lasting relief. In fact, research into teenage depression has found that self-medication can actually make a mental illness more serious.

How Can I Tell If Someone Is Self-Medicating?

If you’re worried that someone you care about may be struggling with depression and is self-medicating, act immediately. Be there for your loved one and offer your help. People often don’t realize that they are depressed. It is usually easier for others to see the signs.

First look for signs of depression:

• Feelings of hopelessness or loneliness
• Apathy
• Changes in sleeping habits
• Weight loss or gain
• Irritability or irrational anger
• Difficulty concentrating
• Reckless behaviors
• Unexplained aches and pains

If, in addition to seeing these signs in someone, you also see them using drugs or alcohol frequently or to excess, he or she is probably self-medicating for depression. Your loved one may try to hide drug use or drinking, which is another clear sign. Confront this person as soon as you can, but do so in a loving and compassionate manner and offer your help.

Depression is a complex mental illness. It afflicts many people, who often turn to substances for relief. Instead of drugging the problem, get help for yourself or your loved one. The care and treatment given by professionals is the right solution to coping with and living with depression. Self-medicating may feel right initially, but the good feeling won’t last. It will only make the condition and symptoms worse.

Learn More About Dual Diagnosis

If You Or Someone You Love Is Struggling With Mental Illness and/or Addiction – Call Us Now To Speak To A Recovery Advisor! We Are Here To Help!

Mental illness and substance abuse often occur together. One of the most common types of mental illness, anxiety disorder, is sometimes a cause of substance abuse and addiction, and in some cases follows a substance abuse problem. Nearly 20 percent of all people who struggle with a mood disorder, which includes anxiety disorder, also have a problem with alcohol or drug abuse. Coping with both issues can be a challenge, but experts are always developing new ways to treat co-occurring disorders. There is hope for anyone struggling with both anxiety and substance abuse.

Which Comes First: Addiction Or Anxiety?

The statistics work both ways. Twenty percent of people with anxiety disorder also struggle with substance abuse, and 20 percent of people who abuse substances have symptoms of an anxiety disorder. So, which develops first? It is possible that the symptoms of anxiety disorders can lead someone to drink or abuse drugs. If you have anxiety and you don’t get treatment for it, using substances can make you feel as if you are alleviating your symptoms. This is called self-medicating. Social anxiety disorder, in particular, commonly leads to substance abuse because using drugs or alcohol can make you feel more comfortable when around people.

On the other hand, if you have not struggled with anxiety until after you started abusing alcohol or drugs, it can be the substance abuse that initiated your feelings of anxiousness. Drugs and alcohol have a powerful impact on the brain and how it works. When you abuse these substances you risk making changes to the brain’s chemistry and that can lead to any number of mental illnesses, including anxiety disorders.

Treating Addiction And Anxiety Disorder

It is important to recognize both problems in order to heal from an addiction and an anxiety disorder. By ignoring one and only treating the other, both issues are likely to reappear. Often it is the addiction that becomes obvious first. If you realize you have a problem with drugs or alcohol, start looking for treatment programs, a drug counselor or a support group. A good treatment program for addiction should also screen you for mental illness. If you suspect you have other issues beyond your substance abuse, see a specialist for an accurate diagnosis.

Once you know what you have, you can begin getting treatment for addiction and anxiety. Many experts would agree that it is most important to treat and get addiction under control first and then include treatment for the anxiety disorder. A growing number of treatment facilities treat both issues simultaneously. Keep in mind that your treatment professionals should create a personalized treatment plan that will address both addiction and anxiety.

When you have a handle on your addiction, seek targeted treatment for your anxiety disorder. Therapy may be your best option. Although many people take prescription medications for anxiety, and find relief using them, drugs may not be a good choice for you. Some of these medications are habit-forming and if addiction is a problem for you, it may be best to avoid them. That choice is one for you and your therapist to make together.

As you work toward healing from both addiction and mental illness, be sure to rely on your loved ones for support. Having a strong support network is important to help maintain sobriety and control anxiety. Let them guide you into new activities and hobbies that will help you reduce anxiety without resorting to drugs and alcohol. With professional care and the help of loved ones, you can overcome your co-occurring problems.

Call Us Now – We Are Here To Help You With Mental Health Issues And Addiction!

A dual diagnosis means that you have a substance abuse problem, or an addiction, and you also have been diagnosed as having a mental illness. The co-occurrence of addiction and mental illness is not uncommon. If you receive a dual diagnosis, rest assured that you are not alone, but also know that you need to be treated for both issues. There are plenty of rehab facilities and caring, trained professionals who can help you work through both and help guide you through recovery.

How Many People Receive A Dual Diagnosis?

A dual diagnosis is a fairly common occurrence. According to statistics from the National Alliance on Mental Illness, around half of all people with a severe mental illness also struggle with substance abuse. On the flipside, over one-third of people who abuse alcohol, and more than half of people who abuse drugs, are affected by mental illness. Some of the more common mental illnesses that are diagnosed with substance abuse include depression, anxiety disorder, schizophrenia, and bipolar disorder.

Why Do Substance Abuse And Mental Illness Co-Occur?

There are several possible reasons it is so common to have both a mental illness and an addiction. The relationship is complicated and can be caused by different factors depending on the individual. If you have a mental illness, especially if you are not seeking treatment for it, you may find that you turn to drugs or alcohol as a way of self-medicating. By getting high, you may be able to momentarily push away the pain and bad feelings associated with your mental illness.

Another factor in dual diagnosis is the possibility that substance abuse triggers or worsens a mental illness. Some people use drugs or alcohol and then begin to experience the onset of mental illness symptoms for the first time. If you have an undiagnosed mental illness, like depression, and abuse drugs, you can make it worse.

Why Is It Important To Treat Both Mental Illness And Addiction?

If you receive a dual diagnosis, you must treat both conditions in order to have a chance at being well. If you get into recovery for your addiction, but ignore your mental illness, you are likely to go back to using. On the other hand, if you get help for your mental illness and fail to address your substance abuse problem, you can expect to experience relapsing symptoms of your disorder.

How Are Mental Illness And Addiction Treated Together?

Experts agree that an integrated approach to treatment is the best option for a dual diagnosis. This means that mental health professionals and addiction specialists work together with you in the same place. For instance, you might enter into a rehab facility that specializes in diagnosing and treating mental disorders along with substance abuse problems. By targeting both issues, at the same time and in the same place, you will have the best odds of success. The two problems are intertwined and to get at one, you must address the other.

Effective integrated treatment for a dual diagnosis includes several components. Care is given in stages, beginning with developing a relationship with your caregivers. Interventions that motivate you to stop using are important. Counseling for both mental illness and substance abuse should be included. Finally, having social support, whether that means working with peers or with family, is essential for good care.

If you have been surprised with a dual diagnosis, take time to learn about your options. Make sure that you get help from professionals who understand your particular needs and who will approach your care by addressing both of your issues.

See How Mental Illness And Substance Abuse Are Leading Causes of Non-Fatal Disease

Studies reveal that anti-smoking and anti-drinking campaigns are working. Smoking rates in the U.S. have fallen dramatically. But not everyone is being helped with their substance abuse problems.

Dr. Sarah M. Hartz, an assistant professor of psychiatry at Washington University School of Medicine in St. Louis, is the author of a new study done in conjunction with the University of Southern California that shows individuals with severe mental illness have higher rates of substance abuse.

Unique Treatment For Substance Abuse And Mental Illnesses

The National Alliance on Mental Illness says health professionals estimate that half of the individuals who suffer from a psychiatric disorder also abuse alcohol, tobacco or drugs. Trying to manage a mental illness becomes twice as difficult when it is coupled with trying to also manage a substance abuse problem. Each illness demands its own treatment and must be treated individually for the person to heal completely.

Higher Percentages For Drinking And Smoking

Half of the 20,000 participants in Hartz’s study were diagnosed with bipolar disorder, schizophrenia or schizoaffective disorder. When the psychiatric patients were compared with individuals from the general public, the psychiatric patients had higher rates of using alcohol, smoking tobacco, smoking marijuana and other drug use.

While 75 percent of the mental illness participants were tobacco smokers, only 33 percent of other participants smoked. Thirty percent of mental illness participants were binge drinkers compared to eight percent of other participants. Fifty percent of the mental illness participants used marijuana regularly compared to 18 percent of the other participants. Fifty percent also used other illicit drugs compared to only 12 percent of the mentally healthy participants.

How Race Plays A Role In Substance Use

In other studies on alcohol and drug abuse, race and ethnicity sometimes determines the prevalence of their use. Some groups are more susceptible to use than others. In this study, all races and ethnicities were susceptible if they had a severe mental illness.

Turning To Substances To Escape Negative Emotions Causing Hidden Problems

When mental illness affects thoughts and emotions, individuals sometimes turn to substance use to escape. Tobacco and alcohol use over the years can cause heart disease, cancer, liver failure and other physiological problems that can ultimately end their life. Dr. Hartz sees these physiological problems as the hidden problems.

People with a mental illness may be carefully watched for any signs of suicidal thoughts but not watched as carefully for emphysema. Because loved ones may be so concerned about immediate tragic events like a drug overdose or suicide, they may miss seeing long-term threats from tobacco, alcohol or other substances.

Hartz notes that mental illness patients have a shorter life span by one to two decades than the average person. This isn’t because of immediate tragedy spurred by their mental illness. Most of the causes are ones like cancer and heart disease that were developing in their body over the years.

Finding A Way To Help, Holistically

Mental health specialists look holistically at their patients. They seek and address all of the problems that are affecting the mind and body of a person with mental illness. Hartz believes that if all specialists were to ask their patients about their tobacco, drug and alcohol use that more patients could be led to a happier and healthier life. Through initial screenings and periodic follow-ups, patients could be monitored for any previous substance use or any new substance use that may develop during their treatment.

Trying the tried and true strategies of smoking and drug intervention doesn’t often work for mental health patients, cautions Hartz. Through her studies she has noticed that mental health patients need their own style of intervention in order to heal. As new strategies arise to combat alcohol and drug abuse specifically in people with mental illness, holistic healing can begin.

Read More About Holistic Rehab Therapy!

When it comes to clinical depression, it’s typical to think of it as a disorder that largely affects women. However, men suffer from depression too, and it has the same profound impact on their mood, energy levels, and quality of life. Just as with women, it’s common for men with depression to abuse substances – particularly marijuana, stimulants and alcohol abuse – as a means of coping and alleviating symptoms.

While women are more likely than men to suffer from clinical depression [1], as many as six million American men experience symptoms every year [2]. Symptoms of depression in men sometimes don’t mirror those found in women. Research indicates that males may not always struggle with overwhelming sadness or excessive guilt. Instead, their symptoms more commonly include fatigue, anger, irritability, and sleep disturbances [3].

The Depression And Substance Abuse Connection

Depression and substance abuse frequently occur together. For example, it’s estimated that 40% of all people with depression struggle with alcohol abuse [4] – that’s a staggering statistic.  Depressed men may also smoke marijuana, which can elicit feelings of relaxation and numb overwhelming negative emotions, like irritability.

While alcohol and marijuana are commonly abused, some depressed men abuse stimulants, like cocaine, speed, or prescription medications used to treat ADHD and narcolepsy. These drugs can produce a pleasurable high that can offset symptoms. For instance, a depressed man may take a stimulant medication, like Adderall or Ritalin, in order to find the energy to go to work.

In some cases, depression symptoms appear before a substance abuse problem. Feelings of helplessness or worthlessness lead some individuals to self-medicate with substances. Initially, doing so seems to numb or relieve symptoms. However, in reality, many substances negatively affect brain chemicals linked to mood regulation. Many men drink or use drugs to feel better, sadly end up feeling worse.  Rather than stop, he continues to drink or use in order to get high.

This vicious cycle can also start with substance abuse. In particular, depressant substances, such as alcohol, lower levels of serotonin.  Serotonin is one of the chemicals in the brain that helps keeps mood stable.  Over time, the alcohol abuse may actually trigger or contribute to symptoms of depression. Chronic stimulant use is also linked to depression. An addicted male will suffer withdrawal, usually marked by a range of uncomfortable symptoms which include depression.

Why Men Don’t Seek Treatment For Depression As Often As Women

In the U.S., women are diagnosed with depression as anywhere from two to four times more frequently than men [5]. This gap may stem from several factors, including:

Traditional ideas about men – Traditionally, emotional expression hasn’t been highly valued among males. Expressing sadness, frustration, or helplessness can be – and often is – seen as a sign of weakness or lack of discipline. A man may hesitate or refuse to seek depression and substance abuse treatment because he worries it will damage his masculinity. Preconceived ideas about men and substance use can play a role as well. For instance, having a few beers after work every night may not only seem normal, but also expected, especially if a man’s father or grandfather did the same.

Lack of knowledge – It’s likely that some men don’t seek treatment for depression or substance abuse because they’re simply not aware they have a problem. It can be easy to write off negative feelings as a temporary setback or a normal reaction to severe stress or a major loss. A man may believe that if he just keeps pushing forward his emotions will eventually stabilize.

Substance abuse can be hard to recognize as well.  This is particularly true if he’s abusing prescription drugs. He may take them with the belief (or rationale) that they’re much safer than street drugs or okay to use just because they’ve been prescribed by a physician. Likewise, a depressed substance abuser may not realize that seemingly harmless and more acceptable substances like marijuana and alcohol can alter the brain over time and lead to an addiction.

Lack of motivation – Experiencing a lack of motivation is one of the many symptoms of depression. A person can feel as though he has no energy, making it a challenge to get off the sofa – much less seek professional help.

Stigma – Sometimes men won’t seek treatment because they want to avoid the stigma of having a “mental illness”. There’s stigma linked to substance abuse as well. It’s hard to ask for help when a man believes others will be quick to label him as an addict. Drug abuse, in particular, carries a strong stigma that potentially affects relationships and work.

The Importance Of Mental Health Treatment

Psychiatric disorders, like depression and substance abuse, require treatment just like any medical condition such as heart disease, diabetes, or cancer.  Mental health conditions are complex disorders that have a number of causes, some of them biological in nature. Although it can be difficult to reach out for depression and substance abuse treatment, professional help is crucial and can be highly beneficial.

Co-occurring conditions have a significant negative impact on your life. For example, your relationships are probably suffering. There may be frequent conflicts with those you love. You may be unable to be the father you want to be to your children. Additionally, depression and drug or alcohol abuse affect sexual performance, which can further strain your relationship with a significant other or spouse.

Work performance is likely suffering, too. Substance abuse combined with depression may make you more prone to calling in late or sick. Frequent absences can have serious consequences.  It can also be harder to perform assigned tasks and complete important projects, leaving them undone or forcing colleagues to pick up the slack. When workplace performance suffers, you’re less likely to hold onto a job and may have trouble finding a new one.

Depression and drug or alcohol abuse also adversely impact your physical and emotional health. For example, depression has been linked to a higher risk of heart disease in men [6]. Research suggests that men with heart failure who had moderate to severe depression were nearly four times more likely to die than those who weren’t depressed [7]. In addition, depression and substance abuse are both connected to a higher risk of suicide. It’s estimated that, overall, men are four to five times more likely to complete suicide than women [5].  This is largely due to the fact that males are more likely to use more lethal methods, such as shooting themselves.

Depression And Substance Abuse Treatment

If you have symptoms of depression and abuse substances, you need treatment. Contact a mental health professional or drug treatment facility that offers “dual diagnosis” treatment. If you’re not sure where to start, ask your primary care physician for a referral. Once you’re working with a mental health professional, be open about all symptoms and fully disclose your substance abuse habits. He or she will diagnose you and develop a treatment plan that may include residential or outpatient therapy, support groups, and, if necessary, medication.

Don’t let life fall apart because of your symptoms. Help is available. Reach out now for depression and substance abuse treatment to reclaim your physical and emotional health.

Read More About Depression And Drug Treatment

References:

[1] http://www.nimh.nih.gov/statistics/1mdd_adult.shtml

[2] http://www.apa.org/research/action/men.aspx

[3] http://www.apa.org/research/action/men.aspx

[4] http://www.niaaa.nih.gov/news-events/news-releases/national-survey-sharpens-picture-major-depression-among-us-adults

[5] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140791/#!po=4.16667

[6]   http://circ.ahajournals.org/content/early/2013/10/30/CIRCULATIONAHA.113.002065.abstract.html?ijkey=xgzTuA4JxivZbxO&keytype=ref

[7] http://newsroom.heart.org/news/depression-in-heart-failure-patients-233191

According to psychiatric literature, as many as five percent of the American population deals with attention deficit hyperactivity disorder (ADHD), and half of those people may also have a problem with substance abuse. That’s because the two conditions frequently appear together, a relationship referred to as comorbidity. Because both stem from dysfunction in the reward system, it can be hard to untangle and treat the conditions simultaneously.

Connection Factors Between ADHD And Drug Addiction

Past studies of twins have shown a high comorbidity between ADHD and drug addiction. These studies point to shared genes which make a person more susceptible to both conditions. When a person has a genetic predisposition combined with environmental risk factors, the likelihood of the two conditions arising increases. To compound the problem, other studies reveal that people with ADHD are at greater risk for earlier onset of drug abuse, more serious abuse and a harder time remaining abstinent.

Diagnosing Adult ADHD

Both ADHD and substance abuse are diagnosed by using established tools which are essentially checklists of symptoms. In order to diagnose ADHD, a person must demonstrate a minimum of six symptoms of either hyperactivity or distractibility, but not necessarily symptoms in both categories. Doctors may be hesitant to diagnose adult ADHD, and even more so when a patient appears to be dealing with substance abuse as well, just because it requires a bit of detective work and a delicate balancing act in terms of treatment.

One way doctors can diagnose adult ADHD is by asking open-ended questions such as, “Why do you suspect that you may have ADHD?” this may result in symptoms being displayed without prodding. If this doesn’t happen right away, doctors can ask clarifying questions such as, “What does your work life look like?” or “Describe several of your closest relationships.” In terms of substance abuse, it is best to be forthright with questions such as, “Do you use any substances? “followed by, “Describe your substance use.”

A long-term picture will be the most accurate, so asking about grade school and high school experiences can be helpful. However, in some cases a parent may have performed the role of compensating presence – monitoring homework, ensuring the student was on time, helping them keep things organized, etc. – so with adult patients asking about college life or work life may actually provide the clearest idea of what symptoms are present. Whenever possible, having the added perspective of another person such as a spouse, parent or sibling is useful.

Symptoms Doctors Will Explore When Diagnosing ADHD

• Trouble focusing on a single task. The person has difficulty reading, leaves tasks unfinished, is not a good listener, engages in a lot of daydreaming and frequently loses things.
• Trouble staying focused. The person finds it hard to plan and organize. Time management is a problem issue. The person has difficult in recognizing potential consequences of actions.
• Trouble with motor control. The person exhibits restless, non-goal oriented movement and they can’t sit still for extended periods of time. It is important to note that the person who doodles and draws or who packs their daily schedule may also be showing signs of difficulty.
• Trouble with self-control. The person is impulsive, talking and acting without thinking. They frequently interrupt others and have little patience.

What These Brain-Function Symptoms Reveal

Each of these symptoms reveals sluggishness within the brain’s mesolimbic dopamine system, or reward pathway. Healthy people feel a certain amount of elation when they embrace another, hear beautiful music or engage in fun physical activity, and the reward circuitry in the brain is pre-set to respond positively to these things. When a person has an ill-functioning reward system, they may engage in riskier behaviors in order to stimulate or activate the reward response.

Treatment For ADHD And Substance Abuse

Drug use exacerbates this problem. Therefore, the best treatment will result from a multi-pronged approach. Persons with comorbid ADHD and substance abuse will probably require individual counseling, support group therapy, carefully monitored medication therapy and specific lifestyle changes.

Read More About Addiction And Mental Disorders

Daphne sat across the table from her husband and mouthed the words, “I hate you.” Then she painted a charming smile on her face and ordered a salad. She and Sam were out to dinner with his family, something they did only rarely because of what Sam’s mother referred to as “Daphne’s drinking problem.” What no one at the table knew was that Daphne had a gram of cocaine in her clutch and no plans to drink more than one cocktail. To everyone’s surprise, a single margarita is all she had that night.

For the next four weeks, Daphne’s behavior was erratic. She didn’t find herself sneaking bottles of wine or vodka, passed out on the sofa in front of the television or lying in the floor of their shared walk-in closet, crying her eyes out over every conceivable wrong done to her in the past. Instead, she was scarce, hardly ever at home. When he did see her, she was wild with energy and ideas, frenetic to dress and shower and be off again. Her already thin frame appeared unusually slight. It didn’t look as though Daphne had been eating, or really doing anything but moving, fast.

Then on a Sunday afternoon, just like it had started, Daphne was suddenly home again—collapsed on the lawn, so drunk Sam could nearly smell the alcohol from the front door. Ever the co-dependent faithful partner, he walked to his wife and bent to scoop her into his arms. And just like clockwork, Daphne began to slur a litany of praise for her husband, how she could not live without him, how he was perfect in every way.

Days into Daphne’s return, however, she was threatening to stab herself with a kitchen knife if Sam didn’t give her access to all of her pain medication. Daphne received prescription opiates for a cracked cervical vertebra, and Sam sometimes hid them when Daphne’s drinking binges got especially bad. When she took the knife and started carving shallow cuts into the inside of her arm—something Daphne had done many times before, but always in private—Sam knew it was time to do what he had not yet done. He had his wife involuntarily hospitalized. An emergency hospital stay turned into a longer, voluntary in-patient psychiatric stay, and it was there that Daphne was formally diagnosed.

She was an alcoholic. She was a drug addict. She had anorexia. She had bipolar disorder. And she had borderline personality disorder. No one had expected this outcome, least of all Daphne.

Mental Disorders and Addiction

When a person has both a problem with addiction and a mental disorder, he or she is said to have a dual diagnosis (or comorbidity). Many times, substance abuse can mask the signs of mental illness. Traits or characteristics of mental illness, which may otherwise be quite noticeable to close family members and loved ones, cloak themselves in the depressed behavior brought on by excessive alcohol use (alcohol is itself a depressant), or the erratic behavior others exhibit whether using alcohol excessively or when high or seeking drugs.

People with certain mental disorders may seek to “self-medicate” the anxiety or depression that arises as a result of the disorder by consuming alcohol or using drugs, or a combination. One such disorder is bipolar disorder. About 56 percent of people with bipolar have experienced drug or alcohol addiction.  The personality disorders, such as borderline personality disorder (BPD), also share a high rate of dual diagnosis. According to the Center for Drug and Alcohol Programs at the Medical University of South Carolina, “Over 50 percent of drug abusers and almost 40 percent of alcoholics have at least one serious mental illness.”

Besides bipolar and BPD, depression, anxiety disorders, schizophrenia and other personality disorders frequently co-occur with substance abuse. Psychiatric issues can begin before or after the onset of substance abuse.

Treatment for the Dual Diagnosed

There is no question that adding disorders and substance issues to the mix significantly compounds an individual’s stress and further complicates treatment options. Those who have co-occurring mental disorders have a higher rate of relapse when it comes to getting sober. But even people with mental disorders and co-occurring substance abuse issues can begin to heal. What helps is an integrated therapeutic approach—where mental health treatment and addiction recovery are not thought of as separate, but fused into an integrated whole. Compartmentalizing too many areas of her life is often how an addict with mental health issues gets to the place in which she desperately needs recovery, so seeing her life as a working whole is important.

Thinking, “I cannot attend to my sobriety if I do not attend to my bipolar disorder” and vice versa is a good way to think about it. It’s quite true, in fact—not simply a bromide offered by practiced faces in the business of therapy.

While Daphne’s situation may seem extreme, it is likely that the deeper part of her issues are connected. When she begins to do the work to unravel what the deeply held beliefs and long-held stories that most affect her mental state are, she may begin to find herself experiencing better balance—and an ability to deal with the boat-rocking experience of finding herself with a half-dozen labels, all too frightening to think about in the beginning.

Becoming educated about the nature of addiction and the reality of mental illness is a good place to start. Choosing to look at one’s life carefully is the opposite of what addiction means. When you wrestle the hydra of addiction and mental illness, you know you’re only going to get more of the same. Better not to go in swinging but with clarity, a willingness to learn and possibly, maybe, a little bit of room for something like hope.