Substance Abuse and Mental Health Connections

1
Substance Abuse and Mental Health Connections

• Carlo C. DiClemente
• Lippitz Professor of Arts, Humanities, and Social
  Sciences
• Psychology Department

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Overview

• Interactions between
• alcohol and/or substance use and
• emotional and psychological problems
• are many and varied.
• Epidemiology
• Types of interactions
• College connections

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Lifetime Prevalence - Psychiatric Substance
Abuse Disorders-2007

• Any Anxiety Disorder
• Any Mood Disorder
• Any Impulse Control Disorder
• Any Substance Disorder
• Any Disorder

• Males 25.4
• Females 36.4
• Males 17.5
• Females 24.9
• Males 28.6
• Females 21.6
• Males 41.8
• Females 29.6
• Males 58.4
• Females 56.5

National Household Survey on Drug Use
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12 Month Prevalence - 2007

• Any Disorder
• Any Substance Disorder (SUD)

• Males - 29.9
• Females - 34.7
• 18-29 - 43.8
• Males - 15.4
• Females 11.6
• 18-29 22

National Household Survey on Drug Use
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Models for Interactions

• A mental health problem increases the risk for
  substance use and dependence (secondary substance
  abuse model)
• A substance abuse problem increases the risk for
  mental health problems (secondary psychopathology
  model)
• Both are caused by a common underlying factor
  (common factor model)
• Whichever one comes first there is an interaction
  between them so that one influences the other
  which in turn impacts the first in a negative
  feedback loop (bi-directional model)
• Two independent events (independence model)

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Mental Health Substance Abuse

• 29 of mentally ill abuse either alcohol or drugs
  
• 47 of individuals with schizophrenia also have a
  substance abuse disorder (four times the general
  population)
• 61 of individuals with bipolar disorder also
  have a substance abuse disorder (five times the
  general population)

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Substance Abuse and Mental Illness

• 37 of alcohol abusers 53 of drug abusers have
  at least one serious mental illness
• Lifetime Substance Use Disorder doubles the odds
  for depression
• There are significant positive relationships
  between SUD and both mood and anxiety disorders

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Secondary PsychopathologySubstance Abuse
Causing Psychiatric Disorders

• Some substances have reactions that mimic or
  trigger serious psychiatric symptoms (paranoia,
  hallucinations)
• Some drugs can cause temporary organic brain
  syndromes (intoxication, blackouts, delirium)
• Some drugs can cause or trigger anxiety or
  depression episodes that last well beyond the
  drug use.

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Secondary Substance Abuse ModelManaging Life
Stress and Problems

• Many individuals try to self medicate
  psychological and emotional distress with
  prescription and illegal drug use
• Some use drugs to escape from reality
• Drugs and alcohol are used to cope with impulse
  and anger management and contribute to risky
  behaviors and violence
• Some use drugs to enhance performance to meet
  some difficult goal or to reach some
  (unattainable?) expectation

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Common Factors Model Preexisting Vulnerability
or Problems

• At times addictive behaviors and mental illness
  emerge from some common source
• Emotional, physical or sexual abuse
• Traumatic events
• Genetic vulnerability/family heritage
• Two elements of a more chaotic lifestyle related
  to a developing personality disorder

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Bi-Directional Models

• Psychiatric symptoms can more easily be explained
  when using drugs
• Stigma of psychiatric problem is relieved by
  hanging out with substance abusers which
  increases substance use which exacerbates
  psychiatric problem..
• Usually negative spiral of events ensues

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College Connections How is This Relevant to
College Students

• College students come to college with personal
  experiences with mental illness and substance
  abuse (direct or indirect)
• College is a transformational experience that
  produces growth and includes stressful
  experiences that challenge mental and physical
  health
• Family, friends, peers, mentors offer messages
  and models about psychological health and
  substance use that we struggle with

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How is This Relevant for College Mental Health

• Experimenting and exploring our thoughts and
  behaviors is normative
• Learning about strengths and weaknesses, how to
  cope successfully with failure and success, and
  what we can and cannot accomplish or tolerate is
  a critical part of this experience

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College, Substances, and Stress

• Late adolescence (18 26) is often a confusing
  time with unique stressors, significant
  challenges to our sense of identity belonging,
  and experimentation
• Substance use can complicate and distort these
  experiences
• Individuals experiencing psychological and
  emotional problems are at higher risk for abuse
  and dependence on alcohol and drugs and vice
  versa
• Alcohol and drugs become problems when they are
  used to cope with stress and manage college tasks

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Take Away Messages

• Be aware of the connections between substance
  abuse and psychiatric symptoms and syndromes
• Individuals who may be abusing substances
  (including alcohol) may also be experiencing
  serious emotional or psychological problems
• Seek help for yourself or others when the first
  signs of either or both types of problems emerge
• Early intervention is the best way to short
  circuit the negative interactions no matter which
  causative model is operative.