Mental Illness and Drug of Choice: Is there a direct connection

Mental Illness and Drug of Choice: Is there a direct connection?

The purpose of this paper is to determine whether or a not a person’s drug of choice is specific to their type of mental illness.  It would be very useful within the field of addictions to know if an individual’s mental illness type determined the substance they are most likely to use/abuse.  A connection between mental illnesses and preferred abused substances would help current and future individuals with co-occurring disorders (COD) obtain proper treatment.  It would also greatly benefit the professionals who create treatment plans for those with COD.  A Proper treatment plan is the foundation for successful recovery. If such a connection exists, I would imagine there would be new educational requirements and learning opportunities for students entering this area of study.  
The original research question was: Is there a direct connection between mental illness and drug of choice?  There is a large variety of research on COD.  Within the findings are sections pertaining to common substances used/abuse by individuals with different forms of mental illness.  However, finding one directed specifically towards substances being mental illness specific, is a difficult task.  There are multiple treatment options available for mental illness, addiction, and COD (both).  These treatments could be more catered towards specific combinations if the connection could be confirmed.
It is quite common for individuals who suffer from mental illnesses to also suffer from alcohol or other substance abuse/addiction.  Such individuals may use alcohol or other drugs in order to self-medicate to relieve or drown out the symptoms of their mental illness.  This creates a risk of substance abuse, which could lead to addiction, for those who have mental illnesses.  Finding relationships between drug of choice and mental illnesses will help addiction specialists to create more personalized treatment plans which can improve recovery success rates.

A Few Statistics
Between 25%-90% of clients in treatment for alcohol and other drugs (AOD) also have a COD. On the other side of this, around 35%-90% of those receiving mental health treatments have a COD. It is estimated that of the first episode psychotic breaks, half of them involve substance use (Porteus, 2008). According to Porteus (2008):
43% receiving mental health services had been diagnosed with a co-occurring Substance-use Disorder (SUD).
13% of adolescents with significant emotional and behavior problems
reported substance dependence.
62% of males and 82% of females entering SUD treatment had a co-occurring
psychiatric disorder.
75-80 % of adolescents receiving inpatient substance abuse treatment have a coexisting mental disorder. (p. 5-6).

The common belief within this field of study is that having a mental health issue is, in itself, a risk factor for substance abuse/addiction.  This is understandable considering many people with mental illnesses go undiagnosed leaving them to self-medicate their symptoms.

General Relationships
It is common knowledge that many mental health issues result from a chemical imbalance of the brain. When alcohol or other drugs are used/abused, the chemicals within the brain are altered which is similar to the imbalance associated with mental illnesses. Many substances of abuse can cause a person to experience symptoms similar to those of mental illnesses. Some believe mental illnesses are a direct result of using/abusing AOD. Most co-occurring disorder cases do not support this (Drugabuse.com, 2013).
Mental illnesses which are typically associated with co-occurring substance abuse disorders include anxiety and depression disorders, along with antisocial personality disorder (ASPD). The disorder which has the strongest association with abuse or dependence of drugs is ASPD. Anxiety disorders, ASPD, and mood disorders have shown the strongest association to dependence to tranquilizers, sedatives, and opioids (Conway, Montoya, & Compton, 2007). The National Epidemio- logic Survey on Alcohol and Related Conditions (NESARC), according to Conway, Montoya, & Compton (2007), reported the following results:
Results show that although nearly every specific mental disorder is positively and significantly associated with each specific drug use disorder, the magnitude of the associations is inversely related to the prevalence of the specific drug use disorder. That is, marijuana use disorder is by far the most prevalent drug use disorder, followed by cocaine use disorder, yet these drug use disorders generally show the weakest associations with mood, anxiety, and antisocial personality disorders. Conversely, low-prevalence drug use disorders (eg, sedative, opioid, and tranquilizer abuse or dependence) are more strongly associated with those mental disorders. (p. 2).

Specific Relationships
It is not a far stretch to assume that mental health patients have an addiction problem from using specific substances which would mimic a prescribed mental health medication. There have been links between some mental health disorders and their most commonly abused substances.

ADHD
According to Fassbender (2012), individuals with attention-deficit/hyperactivity disorder (ADHD) are high-risk for dependence upon substances. Those with ADHD run the particular risk of becoming dependent on methamphetamine. It is also said that these individuals find it very difficult to overcome such an addiction (Fassbender, 2012). This should not be surprising at all considering the most commonly prescribed medication for the disorder is amphetamine, or Adderall. Furthermore, in researching ADHD medical and nonmedical stimulant use, Poulin (2007) found:
The present study highlights a further issue of public health concern regarding ADHD; that is, that appropriate assessment and management of ADHD among male and female adolescents are essential to minimize the risk of the diversion of stimulant medication and the risk of substance use associated with unrecognized ADHD. (p. 750).
Research into this particular relationship is still ongoing.
Bipolar Disorder
In an article from the Foundations Recovery Network (2013), there are a few statistics related to bipolar disorder and commonly abused substances. These findings came from the American Journal of Managed Care. Apparently, over half of the individuals studied with bipolar disorder experienced AOD addiction. Almost half of them abused or were addicted to alcohol. Alcohol seems to be abused the most of any other substance by people suffering from bipolar disorder (Bipolar Disorder and Addiction, 2013).
Schizophrenia
Research suggests individuals who have schizophrenia are far more inclined than others to have an AOD problem. The substance most frequently abused by those with schizophrenia is nicotine. It seems as though they are strongly compelled to smoke. These individuals have a nicotine dependence which is much higher than that of others (Post traumatic stress disorder and addiction, 2013). People with schizophrenia often smoke marijuana as well. This is typically another way in which they try to relieve symptoms of depression. Depression among those with schizophrenia often a side effect of many medications prescribed to reduce the occurrence of hallucinations (Drugabuse.com, 2013).
Post Traumatic Stress Disorder
For sufferers of Post traumatic stress disorder (PTSD), the risk of addiction to alcohol or other substances is very high. The main reason for such a high risk has to do with the severity of the symptoms from PTSD. The symptoms of PTSD are intense and sometimes incredibly distressing. An individual with strong PTSD symptoms may attempt to self-medicate to numb the symptoms or to try and forget a traumatic event. It is estimated that over fifty percent of people with PTSD also have alcohol dependence (Post traumatic stress disorder and addiction, 2013).
Treatment
When an individual suffers from COD, each of their disorders (mental health & substance abuse) has their own individual symptoms. With the many different models of therapy, it may be challenging to decide on which to use in order to treat a co-occurring patient. However, according to Conway, Montoya, & Compton (2007), both disorders can be treated effectively with some forms of psychotherapy. They continue to explain in more detail:
Interventions such as motivational interviewing, motivational enhancement therapy, contingency management, and relapse prevention can help improve the mental condition as well as help initiate drug abstinence or prevent drug use relapse. Although abstinence may not be achieved quickly, it should be the ultimate treatment goal. In the meantime, the therapy may focus on developing a therapeutic alliance, promoting treatment adherence, developing family and social support, reducing drug use, preventing the consequences of drug use, and improving mental health status. (p. 3).
There are many other options for treating co-occurring disorders, but the symptoms of each disorder must be treated individually. Individuals with COD need to be treated for the symptoms of their specific mental illness(s), as well as those specific to their addiction. The bMental Illness and Drug of Choice: Is there a direct connection?
The purpose of this paper is to determine whether or a not a person’s drug of choice is specific to their type of mental illness. It would be very useful within the field of addictions to know if an individual’s mental illness type determined the substance they are most likely to use/abuse. A connection between mental illnesses and preferred abused substances would help current and future individuals with co-occurring disorders (COD) obtain proper treatment. It would also greatly benefit the professionals who create treatment plans for those with COD. A Proper treatment plan is the foundation for successful recovery. If such a connection exists, I would imagine there would be new educational requirements and learning opportunities for students entering this area of study.
The original research question was: Is there a direct connection between mental illness and drug of choice? There is a large variety of research on COD. Within the findings are sections pertaining to common substances used/abuse by individuals with different forms of mental illness. However, finding one directed specifically towards substances being mental illness specific, is a difficult task. There are multiple treatment options available for mental illness, addiction, and COD (both). These treatments could be more catered towards specific combinations if the connection could be confirmed.
It is quite common for individuals who suffer from mental illnesses to also suffer from alcohol or other substance abuse/addiction. Such individuals may use alcohol or other drugs in order to self-medicate to relieve or drown out the symptoms of their mental illness. This creates a risk of substance abuse, which could lead to addiction, for those who have mental illnesses. Finding relationships between drug of choice and mental illnesses will help addiction specialists to create more personalized treatment plans which can improve recovery success rates.

Risk Potential
People who suffer from mental illness have a higher risk of becoming dependent on alcohol or other drugs. If their mental illness goes undiagnosed or untreated, said individual may turn to substances as a coping mechanism, or to self-medicate (Drugabuse.com, 2013). This would be their way of treating the negative symptoms which accompany the mental illness. Regular, continuous use of alcohol or other drugs can lead to addiction. When a person with a mental health problem abuses substances, they are considered to have dual diagnoses, or co-occurring disorder (COD). If substance abuse increases, the mental health issue also increases (Saisan, Smith, Segal, 2013).
A Few Statistics
Between 25%-90% of clients in treatment for alcohol and other drugs (AOD) also have a COD. On the other side of this, around 35%-90% of those receiving mental health treatments have a COD. It is estimated that of the first episode psychotic breaks, half of them involve substance use (Porteus, 2008). According to Porteus (2008):
43% receiving mental health services had been diagnosed with a co-occurring Substance-use Disorder (SUD).
13% of adolescents with significant emotional and behavior problems
reported substance dependence.
62% of males and 82% of females entering SUD treatment had a co-occurring
psychiatric disorder.
75-80 % of adolescents receiving inpatient substance abuse treatment have a coexisting mental disorder. (p. 5-6).
The common belief within this field of study is that having a mental health issue is, in itself, a risk factor for substance abuse/addiction. This is understandable considering many people with mental illnesses go undiagnosed leaving them to self-medicate their symptoms.
General Relationships
It is common knowledge that many mental health issues result from a chemical imbalance of the brain. When alcohol or other drugs are used/abused, the chemicals within the brain are altered which is similar to the imbalance associated with mental illnesses. Many substances of abuse can cause a person to experience symptoms similar to those of mental illnesses. Some believe mental illnesses are a direct result of using/abusing AOD. Most co-occurring disorder cases do not support this (Drugabuse.com, 2013).
Mental illnesses which are typically associated with co-occurring substance abuse disorders include anxiety and depression disorders, along with antisocial personality disorder (ASPD). The disorder which has the strongest association with abuse or dependence of drugs is ASPD. Anxiety disorders, ASPD, and mood disorders have shown the strongest association to dependence to tranquilizers, sedatives, and opioids (Conway, Montoya, & Compton, 2007). The National Epidemio- logic Survey on Alcohol and Related Conditions (NESARC), according to Conway, Montoya, & Compton (2007), reported the following results:
Results show that although nearly every specific mental disorder is positively and significantly associated with each specific drug use disorder, the magnitude of the associations is inversely related to the prevalence of the specific drug use disorder. That is, marijuana use disorder is by far the most prevalent drug use disorder, followed by cocaine use disorder, yet these drug use disorders generally show the weakest associations with mood, anxiety, and antisocial personality disorders. Conversely, low-prevalence drug use disorders (eg, sedative, opioid, and tranquilizer abuse or dependence) are more strongly associated with those mental disorders. (p. 2).
Specific Relationships
It is not a far stretch to assume that mental health patients have an addiction problem from using specific substances which would mimic a prescribed mental health medication. There have been links between some mental health disorders and their most commonly abused substances.
ADHD
According to Fassbender (2012), individuals with attention-deficit/hyperactivity disorder (ADHD) are high-risk for dependence upon substances. Those with ADHD run the particular risk of becoming dependent on methamphetamine. It is also said that these individuals find it very difficult to overcome such an addiction (Fassbender, 2012). This should not be surprising at all considering the most commonly prescribed medication for the disorder is amphetamine, or Adderall. Furthermore, in researching ADHD medical and nonmedical stimulant use, Poulin (2007) found:
The present study highlights a further issue of public health concern regarding ADHD; that is, that appropriate assessment and management of ADHD among male and female adolescents are essential to minimize the risk of the diversion of stimulant medication and the risk of substance use associated with unrecognized ADHD. (p. 750).
Research into this particular relationship is still ongoing.
Bipolar Disorder
In an article from the Foundations Recovery Network (2013), there are a few statistics related to bipolar disorder and commonly abused substances. These findings came from the American Journal of Managed Care. Apparently, over half of the individuals studied with bipolar disorder experienced AOD addiction. Almost half of them abused or were addicted to alcohol. Alcohol seems to be abused the most of any other substance by people suffering from bipolar disorder (Bipolar Disorder and Addiction, 2013).
Schizophrenia
Research suggests individuals who have schizophrenia are far more inclined than others to have an AOD problem. The substance most frequently abused by those with schizophrenia is nicotine. It seems as though they are strongly compelled to smoke. These individuals have a nicotine dependence which is much higher than that of others (Post traumatic stress disorder and addiction, 2013). People with schizophrenia often smoke marijuana as well. This is typically another way in which they try to relieve symptoms of depression. Depression among those with schizophrenia often a side effect of many medications prescribed to reduce the occurrence of hallucinations (Drugabuse.com, 2013).
Post Traumatic Stress Disorder
For sufferers of Post traumatic stress disorder (PTSD), the risk of addiction to alcohol or other substances is very high. The main reason for such a high risk has to do with the severity of the symptoms from PTSD. The symptoms of PTSD are intense and sometimes incredibly distressing. An individual with strong PTSD symptoms may attempt to self-medicate to numb the symptoms or to try and forget a traumatic event. It is estimated that over fifty percent of people with PTSD also have alcohol dependence (Post traumatic stress disorder and addiction, 2013).
Treatment
When an individual suffers from COD, each of their disorders (mental health & substance abuse) has their own individual symptoms. With the many different models of therapy, it may be challenging to decide on which to use in order to treat a co-occurring patient. However, according to Conway, Montoya, & Compton (2007), both disorders can be treated effectively with some forms of psychotherapy. They continue to explain in more detail:
Interventions such as motivational interviewing, motivational enhancement therapy, contingency management, and relapse prevention can help improve the mental condition as well as help initiate drug abstinence or prevent drug use relapse. Although abstinence may not be achieved quickly, it should be the ultimate treatment goal. In the meantime, the therapy may focus on developing a therapeutic alliance, promoting treatment adherence, developing family and social support, reducing drug use, preventing the consequences of drug use, and improving mental health status. (p. 3).
There are many other options for treating co-occurring disorders, but the symptoms of each disorder must be treated individually. Individuals with COD need to be treated for the symptoms of their specific mental illness(s), as well as those specific to their addiction. The best treatment approach for COD is integrated, treating both the mental illness and addiction simultaneously (Saisan, Smith, & Segal, 2013). This is a common agreement throughout the fields of addiction and mental health. Sellman (2010) states: “The more a treatment plan addresses the individualized broad-based needs of a person the more effective it is” (p. 10).
Treatment professionals need to be aware of how new behavioral patterns can develop from the combination of the patient’s co-occurring disorders. Each of the disorders can also, separately, create new emotional manifestations which can interfere with treatment and recovery. Many abused substances can cause symptoms similar to mental illnesses; as some mental illness symptoms can be mistaken for drug use. This is a good reason why all mental health and substance abuse disorder patients should be thoroughly assessed for all disorders. It is highly recommended that co-occurring disorder patients have a treatment plan designed to manage each of their disorders and the interactions between them (Conway, Montoya, & Compton, 2007).
Conclusion
Whether or not someone with COD seeks out their drug of choice based on which mental illness they have is still inconclusive. This area of study has many variations to consider such involving pairing each mental illness with a specific substance, or substances. The ability to predict, somewhat, which substance(s) an individual would likely pursue just by knowing their mental illness could very possibly help to prevent the development of dependence/addiction for many people. This knowledge could also aid in creating various forms of therapy, treatment planning, and possibly even expand upon our current understanding of co-occurring mental health and addiction disorders.
If the ongoing research ever confirms a direct connection between mental illness and drug of choice, the educational requirements for the addictions and mental health fields will likely be adjusted to include such information. Future addictions counselors and mental health professionals would be more prepared when dealing with clients who have COD. It is imperative for helping professionals to be empathetic with their clients in order to obtain a positive therapeutic relationship. This understanding of the specific relationship between mental health and addiction disorders would provide counselors with the ability to better empathize.
COD is a large topic of discussion within its field. Research studies and treatments are still in the process of discovering new information. There are so many individuals suffering with addiction with a mental illness they are not aware of. Many people go undiagnosed and untreated leaving them to follow the instinct to self-medicate. This behavior of AOD abuse can easily lead to dependence/addiction. The use/abuse of substances can aggravate their mental health symptoms causing even more problems. In general, mental health disorders create a high risk for substance use, abuse, and eventually, dependence. For those individuals, there has to be a way to improve upon diagnosing mental health issues.
All of the people who have an addiction, and want help have a difficult time progressing through treatment successfully due to mental health-like symptoms caused by the substance(s). These individuals may be misdiagnosed with a mental illness when they are simply experiencing the side effects of using alcohol/drugs or even withdrawal. The statistics showing that over half of men and women beginning treatment for a substance-use disorder also had a co-occurring mental health disorder is quite alarming; just fewer than half (43%) beginning mental health services were found to have a co-occurring substance-use disorder.
There have been some findings which link a few mental illnesses to their most commonly abused substances. Those who suffer from ASPD, mood and anxiety disorders tend to be associated with opioids, tranquilizers, and sedatives. Schizophrenia is commonly linked to nicotine and marijuana, bipolar disorder and PTSD are commonly associated with alcohol and ADHD with methamphetamines and other stimulants. Of each of these common connections, there is only one which has a significant difference from the others. It should not be surprising that people with ADHD self-medicate with methamphetamines seeing as how, in a clinic they would likely be prescribed Adderall or some other stimulant.
Recovery facilities with the ability to properly treat individuals with COD are available; however they are not as plentiful as those for mental healthcare or addiction. With the proper treatment plan to treat the unique symptoms of each disorder, COD patients can have effective, successful recovery. Professionals within this area are educated in diagnosing, and treating co-occurring disorders. This is very important since symptoms of each disorder are similar and interact with one another. With the continued research, there may one day be a more concrete answer as to the question of mental illness specific substance choices.

References
Center for Substance Abuse Treatment. (2011). Substance abuse treatment for persons with co-occurring disorders TIP 42. Rockville, MD: HHS . (Original work published 2005)
Conway, K. P., Montoya, I. D., & Compton, W. (2007, April 1). Lifetime psychiatric comorbidity of illicit drug use disorders [article]. Psychiatric Times, 1-3. Retrieved from http://www.psychiatrictimes.com/articles/lifetime-psychiatric-comorbidity-illicit-drug-use-disorders
Drugabuse.com (2013). Mental health and drug abuse, Coalition Against Drug Abuse Retrieved
from http://drugabuse.com/library/mental-health-and-drug-abuse/
Foundations Recovery Network. (2013). Bipolar Disorder and Addiction. Retrieved from
http://www.dualdiagnosis.org/bipolar-disorder-and-addiction/
Foundations Recovery Network. (2013). Post traumatic stress disorder and addiction. Retrieved
from http://www.dualdiagnosis.org/post-traumatic-stress-disorder-and-addiction/
National Institute of Mental Health. (2009), Schizophrenia, Retrieved from
http://www.nimh.nih.gov/health/publications/schizophrenia/index.shtml
Porteus, A. J. (2008, November). Co-Occurring Mental Health and Substance-use Disorders. In A. J. Porteus, . Symposium conducted at the NAMI, Yolo County. Retrieved from http://namisunflowers.org/porteus/20081105Porteus4perpage.pdf
Poulin, C. (2007), From attention-deficit/hyperactivity disorder to medical stimulant use to the
diversion of prescribed stimulants to non-medical stimulant use: connecting the dots. Addiction, 102: 740–751. doi: 10.1111/j.1360-0443.2007.01758.x
Saisan, J., Smith, M., & Segal, J. (2013, June). Substance abuse & mental health: Substance
abuse and co-occurring disorders. Retrieved from http://www.helpguide.org/mental/dual_diagnosis.htm
Sellman, D. (2010), The 10 most important things known about addiction. Addiction, 105: 6–13.
doi: 10.1111/j.1360-044
Treatment professionals need to be aware of how new behavioral patterns can develop from the combination of the patient’s co-occurring disorders. Each of the disorders can also, separately, create new emotional manifestations which can interfere with treatment and recovery. Many abused substances can cause symptoms similar to mental illnesses; as some mental illness symptoms can be mistaken for drug use. This is a good reason why all mental health and substance abuse disorder patients should be thoroughly assessed for all disorders. It is highly recommended that co-occurring disorder patients have a treatment plan designed to manage each of their disorders and the interactions between them (Conway, Montoya, & Compton, 2007).
Conclusion
Whether or not someone with COD seeks out their drug of choice based on which mental illness they have is still inconclusive. This area of study has many variations to consider such involving pairing each mental illness with a specific substance, or substances. The ability to predict, somewhat, which substance(s) an individual would likely pursue just by knowing their mental illness could very possibly help to prevent the development of dependence/addiction for many people. This knowledge could also aid in creating various forms of therapy, treatment planning, and possibly even expand upon our current understanding of co-occurring mental health and addiction disorders.
If the ongoing research ever confirms a direct connection between mental illness and drug of choice, the educational requirements for the addictions and mental health fields will likely be adjusted to include such information. Future addictions counselors and mental health professionals would be more prepared when dealing with clients who have COD. It is imperative for helping professionals to be empathetic with their clients in order to obtain a positive therapeutic relationship. This understanding of the specific relationship between mental health and addiction disorders would provide counselors with the ability to better empathize.
COD is a large topic of discussion within its field. Research studies and treatments are still in the process of discovering new information. There are so many individuals suffering with addiction with a mental illness they are not aware of. Many people go undiagnosed and untreated leaving them to follow the instinct to self-medicate. This behavior of AOD abuse can easily lead to dependence/addiction. The use/abuse of substances can aggravate their mental health symptoms causing even more problems. In general, mental health disorders create a high risk for substance use, abuse, and eventually, dependence. For those individuals, there has to be a way to improve upon diagnosing mental health issues.
All of the people who have an addiction, and want help have a difficult time progressing through treatment successfully due to mental health-like symptoms caused by the substance(s). These individuals may be misdiagnosed with a mental illness when they are simply experiencing the side effects of using alcohol/drugs or even withdrawal. The statistics showing that over half of men and women beginning treatment for a substance-use disorder also had a co-occurring mental health disorder is quite alarming; just fewer than half (43%) beginning mental health services were found to have a co-occurring substance-use disorder.
There have been some findings which link a few mental illnesses to their most commonly abused substances. Those who suffer from ASPD, mood and anxiety disorders tend to be associated with opioids, tranquilizers, and sedatives. Schizophrenia is commonly linked to nicotine and marijuana, bipolar disorder and PTSD are commonly associated with alcohol and ADHD with methamphetamines and other stimulants. Of each of these common connections, there is only one which has a significant difference from the others. It should not be surprising that people with ADHD self-medicate with methamphetamines seeing as how, in a clinic they would likely be prescribed Adderall or some other stimulant.
Recovery facilities with the ability to properly treat individuals with COD are available; however they are not as plentiful as those for mental healthcare or addiction. With the proper treatment plan to treat the unique symptoms of each disorder, COD patients can have effective, successful recovery. Professionals within this area are educated in diagnosing, and treating co-occurring disorders. This is very important since symptoms of each disorder are similar and interact with one another. With the continued research, there may one day be a more concrete answer as to the question of mental illness specific substance choices.