At the section of the Oscars where they mourn those who have passed away in the last year, the topic of conversation turned to the tragic passing of Philip Seymour Hoffman. One woman said, "He did it to himself." I couldn't help but to respond that drug addiction is a mental illness. He no more wanted to do that to himself (fatally overdose himself on a toxic combination of drugs), but he couldn't help NOT doing that to himself.
Is drug addiction a mental illness? Yes, it is. Habitual drug use leads to addiction, in that the drug changes the brain in fundamental ways. A person's normal hierarchy of needs and desires is disrupted, as the brain substitutes new priorities connected with obtaining and using the drug. The resulting compulsive behavior weakens the brain's ability to control impulses, even despite negative consequences. These are the same behaviors that are the hallmark of other mental illnesses.
When my son received a "dual diagnosis," (now referred to as a Co-occurring Disorder) I wasn't exactly sure what that meant. Soon, I came to understand that meant he was suffering from two mental disorders at the same time. In my sons case, he suffers from a major depressive disorder, and a drug use disorder. He also has a complex partial seizure disorder, Marfan's Syndrome, and a host of other problems due to the Terbutaline he was exposed to while in utero. But, the main focus of my concern today is the dual diagnosis, and how the depressive disorder and drug use disorder affect each other.
Comorbidity, (which by the way, is a terrible name. Couldn't they have chosen a less disturbing root word than 'morbid'?) is a term used to describe two or more disorders or illnesses occurring in the same person at the same time. They can occur at the same time, or one after the other. Comorbidity implies there are interactions between the illnesses that can worsen the course of both. For my son, this is a lethal situation. Though he knows he struggles with drug seeking behavior, and understands he has a depressive disorder, his brain is wired to seek the drug, even at the risk of his own demise. So, apparently, "comorbidity" is the perfect way to describe such a condition.
Although drug use disorders commonly occur with other mental illnesses, this does not mean that one caused the other, even if one appeared first. It is often difficult to distinguish which came first. Research shows that abusing drugs may bring about symptoms of another mental illness. Increased risk of psychosis in vulnerable marijuana users suggest this possibility. It may be that a person suffering from a depressive or other disorder seeks to self-medicate with drugs to temporarily relieve their symptoms, and their brain is quickly rewired towards addiction in the process. There are also shared risk factors such as predisposed genetic vulnerabilities that may make a person susceptible to both addiction and other mental disorders, or having a greater risk of a second disorder once the first appears.
There is also the concern that drug use disorders and other mental illnesses are developmental disorders. That means that they often begin in the teen years or even younger - periods where the brain experiences dramatic developmental changes. Early exposure to drugs of abuse may change the brain in ways that increase the risk for mental disorders. And, early symptoms for a mental disorder may indicate an increased risk for later drug use.
How does one treat this type of comorbidity? Treatment calls for a comprehensive approach that identifies and evaluates both disorders. Anyone seeking treatment for drug abuse/addiction or another mental disorder should be checked for both and treated accordingly. Several behavioral therapies have shown promise for treating comorbid conditions. These approaches can be tailored to patients according to age, specific drug abuses, and other factors. Some therapies have proved more effective for adolescents, while others have shown greater effectiveness for adults. Some are designed for families, and groups, others for individuals. Make sure to check with your health care professional to make sure they are familiar with treating addictive disorders.
Much of my information in this post came from NIDA (National Institute on Drug Abuse) Information and Facts, which I learned in a Family to Family class I'm taking offered by NAMI (National Alliance on Mental Illness). For more information on these and other facts having to do with Comorbidity, addiction, and other mental disorders, please visit the NIDA web page by clicking here.