Comorbidity : Substance Use Disorders and Other Mental Illnesses

Drug Effects

What is comorbidity?

Comorbidity describes two or more disorders or illnesses occurring in the same person. They can occur at the same time or one after the other. Comorbidity also implies interactions between the illnesses that can worsen the course of both.

Is drug addiction a mental illness?

Yes. Addiction changes the brain in fundamental ways, changing a person’s normal needs and desires and replacing them with new priorities connected with seeking and using the drug. This results in compulsive behaviors that weaken the ability to control impulses, despite the negative consequences, and are similar to hallmarks of other mental illnesses.

How common are comorbid substance use disorders and other mental illnesses?

Many people who have a substance use disorder also develop other mental illnesses, just as many people who are diagnosed with mental illness are often diagnosed with a substance use disorder. For example, about half of people who experience a mental illness will also experience a substance use disorder at some point in their lives and vice versa. Few studies have been done on comorbidity in children, but those that have been conducted suggest that youth with substance use disorders also have high rates of co-occurring mental illness, such as depression and anxiety.

Why do these disorders often co-occur?

Although substance use disorders commonly occur with other mental illnesses, this does not mean that one caused the other, even if one appeared first. In fact, establishing which came first or why can be difficult. However, research suggests three possibilities for this common co-occurrence:

  • Common risk factors can contribute to both mental illness and substance use disorders. Research suggests that there are many genes that can contribute to the risk of developing both a substance use disorder and a mental illness. For example, some people have a specific gene that can make them at increased risk of mental illness as an adult, if they frequently used marijuana as a child. A gene can also influence how a person responds to a drug – whether or not using the drug makes them feel good. Environmental factors, such as stress or trauma, can cause genetic changes that are passed down through generations and may contribute to the development of mental illnesses or a substance use disorder.
  • Mental illnesses can contribute to drug use and substance use disorders. Some mental health conditions have been identified as risk factors for developing a substance use disorder. For example, some research suggests that people with mental illness may use drugs or alcohol as a form of self-medication.Although some drugs may help with mental illness symptoms, sometimes this can also make the symptoms worse. Additionally, when a person develops a mental illness, brain changes may enhance the rewarding effects of substances, predisposing the person to continue using the substance.
  • Substance use and addiction can contribute to the development of mental illness. Substance use may change the brain in ways that make a person more likely to develop a mental illness.

How are these comorbid conditions diagnosed and treated?

The high rate of comorbidity between substance use disorders and other mental illnesses calls for a comprehensive approach that identifies and evaluates both. Accordingly, anyone seeking help for either substance use, misuse, or addiction or another mental disorder should be evaluated 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, the specific drug misused, and other factors. They can be used alone or in combinations with medications. Some effective behavioral therapies for treating comorbid conditions include:

  • Cognitive behavioral therapy (CBT) helps to change harmful beliefs and behaviors.
  • Dialectical behavioral therapy (DBT) was designed specifically to reduce self-harm behaviors including suicide attempts, thoughts, or urges; cutting; and drug use.
  • Assertive community treatment (ACT) emphasizes outreach to the community and an individualized approach to treatment.
  • Therapeutic communities (TC) are a common form of long-term residential treatment that focus on the “resocialization” of the person.
  • Contingency management (CM) gives vouchers or rewards to people who practice healthy behaviors.

Effective medications exist for treating opioid, alcohol, and nicotine addiction and for alleviating the symptoms of many other mental disorders, yet most have not been well studied in comorbid populations. Some medications may benefit multiple problems. For example, bupropion is approved for treating both depression (Wellbutrin®) and nicotine dependence (Zyban®). More research is needed, however, to better understand how these medications work, particularly when combined in patients with comorbidities.

Points to Remember

  • Comorbidity describes two or more conditions appearing in a person. The conditions can occur at the same time or one right after the other.
  • Comorbid substance use disorder and mental illnesses are common, with about half of people who have one condition also having the other.
  • Substance use disorders and mental illnesses have many of the same risk factors. Additionally, having a mental illness may predispose someone to develop a substance use disorder and vice versa.
  • Treatment for comorbid illnesses should focus on both mental illness and substance use disorders together, rather than one or the other.
  • Effective behavioral treatments and medication exist to treat mental illnesses and addiction.

Effects of Cathinones Abuse

Drug Effects

Cathinone is an intoxicant found in khat, a plant grown in Yemen, Ethiopia, Somalia and other countries near the Horn of Africa. It is a mild and addictive stimulant that is released into the body when the leaves of this plant are chewed. The trafficking of this plant is very limited because the drug loses its stimulating qualities very quickly after harvesting.

But synthetic cathinones are a different matter. These are strong and dangerous stimulants invented in a laboratory. Chemically, they resemble the intoxicant in the khat plant. But unlike the plant, they have had deadly effects for too many people.

Drugs in this class include mephedrone, MDPV (3,4-methylenedioxypyrovalerone) and methylone. These are the primary chemicals that were originally found in the drugs that were labeled “bath salts.” Bath salts are not really substances for the bath, they are only labeled this way to circumvent certain laws. If a substance is not meant for human consumption, different laws apply to it. So sellers would label their drugs “not for human consumption” or “for a refreshing bath.” Or they would label the powder as some other non-consumable product, like jewelry cleaner, glass cleaner, plant food or research chemicals.

As adverse effects of cathinones began to show up, law enforcement personnel were powerless to stop the sale of the drugs because there was no law on the books that applied to them. It took many months for state legislatures to catch up, enabling local police to seize the products and so get them off the market.

The Most Adverse Effects Possible

People abusing these drugs hear that they will have more energy, be the life of the party, enjoy sex more – and that the substances will be undetectable by drug test. At one time, they were not detectable. Drug tests weren’t looking for those chemicals. This is no longer true – up to a point. Drug tests now can detect more than a dozen of these chemicals but there are many more of these drugs being added to the list every month.

Cathinones are included in the group of “designer drugs” – so called because all a chemist has to do to evade seizures by law enforcement is design a new molecule. Change the chemical structure in some tiny way and the seller can claim that this is a new drug. There are hundreds of synthetic drugs in this and similar classes that are being watched in Europe and the US to determine their dangers. In the US, the original cathinones have been banned by federal law and most states have followed suit.

The result of the utter immorality of cathinone chemists is that thousands of people have suffered dangerous or even deadly effects of cathinones. Many have lost their lives, sometimes at their own hands.

These drugs are said to be similar in effect to cocaine or methamphetamine. But whereas cocaine and methamphetamine use are not likely to result in hallucinations, delusions, psychosis and suicide, these effects are more likely when a person uses cathinones.

The Dangerous and Not-so-Dangerous Effects of Cathinones

  • Dizziness
  • Confusion
  • Aggression
  • Agitation
  • Overheating
  • Increased energy and alertness
  • Headache
  • Insomnia
  • Vomiting and nausea
  • Delusions
  • High blood pressure
  • Hallucinations
  • Palpitations
  • Liver failure
  • Kidney failure
  • Paranoia
  • Suicidal thoughts or actions

Rehab Can Save Lives

If a person is abusing drugs and has not yet started abusing cathinones, the family has a chance to get him (or her) into rehab and thereby prevent the serious effects of these drugs. If he has started abusing these drugs, as determined by the list of effects above, or by evidence such as empty packages with labeling as described above, then the family should waste no time. These drugs are highly addictive and once he starts, he may not be able to stop.

Losing a life due to drug abuse is a terrible waste. The Narconon drug and alcohol rehabilitation program has saved many lives from overdose or accidental death – or from jail. It is an eight to ten week program, on average, that gives a person who has lost everything a chance to rebuild. What most people find is that if they are willing to engage with the program and do their best, they can achieve the result of a lasting sobriety. They can regain the skills for making drug-free decisions, every day for the rest of their lives.

It takes most people eight to ten weeks to work through all the recovery, learning and repair steps of this program. Some people need more time to gain the ability and confidence to live drug-free. Graduation arrives when the lessons have been learned, when one’s self-respect has been restored, and when one knows how to repair the relationships that took such a beating.

Families say that they have their loved ones back again, as they graduate from program.

Benzodiazepine effects (Valium, Xanax)

Drug Effects

Effects of Benzodiazepine Abuse

pouring pills into hand

People start abusing benzodiazepines (also called “benzos”) usually in one of two different ways. They may start taking them as prescribed, then progress to taking more than ordered. Or they may start out by getting them illicitly and then become addicted to them. As a person abuses this type of drug, they develop a tolerance and need more and more to produce the sedated, tranquilized effect that results from the drugs in this broad class.

There are fifteen benzodiazepines distributed in the US and another 20 sold elsewhere. They have a high potential for abuse and addiction. When used properly, they can be short-term solutions for sleep problems, anxiety, stress reactions like panic attacks and muscle spasms. In some contexts, they help prevent seizures (like during withdrawal from heavy alcohol abuse).

Primary Effects of Abusing Benzodiazepines

A person using benzos is likely to look drowsy and sleepy, lack coordination, and be hostile and irritable. He or she may have vivid and disturbing dreams. Of course, two of the main effects of abuse are the development of a tolerance and addiction.

A person may not manifest anxiety even if that reaction might be normal for a situation. As several benzodiazepines are used in hospital settings before surgery, the fact that they cause amnesia is considered a plus. So the person abusing benzodiazepines may have a poor memory and complete amnesia of some events.

When benzodiazepines are abused with other drugs, the effect can be coma or death. Hundreds of thousands of people go to US emergency rooms each year for problems with benzodiazepine abuse.

Cognitive Losses from Benzodiazepine Abuse

For quite some time, it was disputed that benzodiazepine use interfered with one’s ability to learn. In 2005, a study was published that stated that not only did the use of benzodiazepines interfere with visuospatial ability, speed of processing thoughts and perceptions and the ability to absorb verbal lessons, but also after a person withdrew from benzodiazepine use, these abilities did not fully return. Those who used benzodiazepines over a longer period of time were more impaired. It is interesting to note that while prescribing instructions specifically state that benzodiazepines should not be given for a long term, the participants in this study had been taking this type of drug for an average of nine years.

Driving and Pregnancy Dangers

Consistent with loss of visuospatial ability and speed of processing, it was found that benzodiazepine use was associated with driving problems like deviation from one’s lane. Those tested the day after taking benzodiazepines showed a similar loss of driving skills similar to a blood alcohol concentration of .05 to .10 (the federally mandated legal limit is .08).

In the elderly, these types of changes are reported to result in an increased number of falls. A woman who takes benzodiazepines during pregnancy risks having her baby develop a cleft in the mouth, withdrawal symptoms and floppy infant syndrome, a condition in which the baby lacks muscle tone and does not develop normally.

Withdrawing from Benzodiazepines

All central nervous system depressants (the category that benzodiazepines and other sedatives or sleep aids fall into) work by slowing the brain’s activity. When the person stops taking them, there is often a rebound effect that can mean seizures or other harmful consequences.

Withdrawal from benzodiazepines can be difficult and usually will need to be done in a medical detoxification program.

All of those going through benzodiazepine withdrawal experience:

  • Perceptual distortions
  • Paraesthesia, defined as abnormal skin sensations such as tingling, tickling, itching or burning
  • Difficult walking
  • Anxiety
  • Tension
  • Agitation
  • Restlessness
  • Sleep disturbance/insomnia

In addition, some people experienced:

  • Feelings of unreality
  • Extreme dysphoria (depression, unease, dissatisfaction with life)
  • Depersonalization (state in which a person feels that their feelings or thoughts belong to someone other than himself/herself; loss of sense of personal identity)
  • Feelings of persecution
  • Paranoid thoughts
  • Pain/headache
  • Seizures
  • Depression

Occasionally, those withdrawing experienced:

  • Psychosis
  • Confusional states
  • Fits

More extreme withdrawal symptoms are more likely for the person who has been abusing this drug for a long time or at a high dosage.

Recovering from Benzodiazepine Addiction

Despite the long list of withdrawal effects and the damage created by benzodiazepine abuse, it is possible to recover lasting sobriety after addiction to this drug. In the case of benzodiazepines, the first step for some people might be a medical detox to step down off high dosages. Once this is done, the Narconon program can take over providing sobriety. Early in the program, one phase of the overall recovery program addresses the residues left behind by these drugs. Using a sauna, a strict regimen of nutritional supplements and moderate daily exercise, the Narconon New Life Detoxification flushes out these residues and results in a resurgence of interest in life and clearer thinking.

Once this is done, each person proceeds to repair the damage done by addiction and learn or re-learn the life skills needed to stay sober.

Find out how the Narconon drug recovery program can help someone you care about who is addicted to benzodiazepines.

Effects of Barbiturates Abuse (Seconal, Nembutal)

Drug Effects ,

Barbiturate effects (Seconal, Nembutal)

The primary desirable effect of barbiturates – from a doctor’s viewpoint – is that they tend to induce sleep. For a person who is sleepless and anxious, these drugs offer a solution. But as long as doctors have prescribed barbiturates like Nembutal, Seconal, Amytal and others, there have been people abusing these drugs and becoming addicted to them. And just as long, there have been people who have been overdosing on these drugs and losing their lives.

One of the reasons that people lose their lives on barbiturates is that the dose that will kill a person is not that much more than the dose that will help them sleep.

When someone is using this drug recreationally, they are looking for the “drunkenness,” the lowered inhibitions, the euphoria that accompanies use of the drug, or they may just be seeking the sedated feeling they get.

There are other effects that also can tip off a person who is trying to understand changes in a person who has secretly started abusing these drugs:

  • Dulled, slow thinking
  • Emotional instability, swinging from laughter to tears easily
  • Irritation, antagonism
  • Slurring, stumbling speech
  • Lack of motor control that can cause a person to drop items
  • Poor physical coordination
  • Confusion

While a person in normal condition might be concerned with these changes, the sense of well-being and tranquility a person experiences because of the drug use may disable them from feeling this concern.

Unfortunately, if someone gets confused about how many pills they have taken, he (or she) may take more and unintentionally wind up with an overdose that kills him. Also, a person who is abusing barbiturates is also at greater risk of pneumonia or bronchitis as the drug affects the body’s normal ability to breathe.

Who Seeks the Effects of Abusing Barbiturates?

There are four different types of people seeking the effects of barbiturate abuse and they have different reasons for doing so.

  • Youth may abuse barbiturates so they can experience the drunken feelings that result. They are not very likely to understand that this can be a deadly drug.
  • An adult who abuses stimulants may look for a barbiturate to help them come down so they can rest or appear “normal” to others.
  • A person who is addicted to heroin or prescription opiates may seek barbiturates to give their dose of heroin more kick, or if they can’t get their hands on opiates at the moment.

And a person who has been taking these drugs as prescribed may find that they have to increase their dosage to get the desired effects. They may get their doctor to increase their dosage as they build up a tolerance and so need more of the drug to get the same effect. Or if there is any problem with their doctor giving them the drug, they may seek other doctors to get the drugs they feel they now need. This puts them into a category of prescription fraud through “doctor-shopping,” going from doctor to doctor, getting multiple prescriptions.

Coming off Barbiturates

anxiety from withdrawal

It’s not the easiest thing to come off this drug so a person can get sober. Many people will need the support of close physician supervision, medical detox, or if he (or she) has really come to rely on the drug to get through the day, a complete rehabilitation program.

A person trying to get clean will start to hit withdrawal within 24 hours of the last dose. The effects of withdrawal include anxiety, insomnia, tremors, even delirium and seizures among heavy users. Some people will need to taper off this drug.

When the drug has finally been discontinued, the best thing the addicted person can do is to get the help of a thorough rehabilitation program that enables him to once again get control of his life. This is the role of the Narconon drug and alcohol rehab program for thousands of people each year.

People come to Narconon for help with all kinds of drugs, from inhalants to alcohol to prescription drugs to club drugs and more. This is a thorough, eight to twelve-week program that never uses substitute drugs as part of treatment. It has been found that a person must learn to live a completely sober life for recovery to be lasting. Reliance on drugs like methadone, buprenorphine, suboxone or anti-drinking drugs do not really teach a person how to build a sober life. Nor do they allow him to learn what it feels like to be completely sober again.

The Narconon drug recovery program takes the idea of being drug-free a step further. Each person on this program will go through a deep detoxification phase called the Narconon New Life Detoxification. This is a process that involves time in a sauna, nutritional supplements, and moderate daily exercise. This combination enables the body to start flushing out old drug toxins. Instead of each person carrying a burden of old drug residues, they can be flushed out on this program. The effect of this detox is clearer, brighter thinking, a better outlook on life and a greater ability to learn sober living skills.

At the end of this program, each graduate is much better prepared to create a new drug-free life to replace the one that was destroyed by addiction.

Find out more about this program that can help you bring someone back after barbiturate addiction or addiction to any drug.

Effects of Bath Salts Abuse

Drug Effects

Bath salts is the street name for a group of often changing synthetic drugs on the illicit market, so the full effects of using bath salts is not fully known. Medical personnel who come across someone who is in a full-blown delusion as a result of bath salts may not recognize the effects and may not know what to do. Even drug tests may not determine that bath salts were involved in a serious adverse effect since the newest tests only detect fourteen common chemicals used in these formulas. There are more than eighty chemicals that might be included in these small packets.

This group of drugs is referred to as “cathinones.” It is a class of stimulants that creates aggression and hallucinations. One or more of these substances are packaged in small foil packages and labeled “bath salts, for a soothing bath, not for human consumption.” The most common drugs to be included are mephedrone, methylone and methylenedioxypyrovalerone (MDPV).

Until very recently, bath salts were being sold in convenience stores and head shops. Federal laws banned the drugs many months ago but until states followed these laws with their own bans, it was hard to seize the drugs and prosecute. Now 31 US states have outlawed these drugs, and serious effects like trips to the emergency room have begun to drop as a result.

Short-Term Effects

Bath salts effects tend to last about three or four hours, but rapid heartbeat, increased blood pressure and other effects of a stimulant may last longer.

High doses have caused intense and extended panic attacks in some people. Since this drug is a stimulant, it tends to disrupt sleep. A person who takes the drug frequently may suffer from sleep-deprivation psychosis. Addiction is also a very likely effect.

Mental, Emotional and Physical Effects

anxiety caused by bath salts

Mentally, the user will experience euphoria, alertness, anxiety, and agitation. He will probably not feel hungry. He may have a headache, tense muscles, increased body temperature, nosebleeds and dilated pupils. He may also be dizzy and confused and may grind his teeth. But those are the milder effects.

The more serious effects include fits, hallucinations, aggression, suicidal thoughts or attempts and psychotic delusions. Physically, a person can experience liver failure, kidney failure, loss of bowel control and rhabdomyolysis, a spontaneous breakdown of muscle fiber that can lead to death.

Deaths and Injuries Due to Bath Salts

Tragically, one of the effects of bath salts abuse is death, either because of the direct effect of the drug or because of a person’s actions. In March 2011, a young man in New Jersey killed his girlfriend while he was under the influence of bath salts. A young woman who injected bath salts lost the arm the drugs were injected into, her shoulder, breast and other tissue after a flesh-eating bacteria destroyed the muscles in that part of her body. She survived.

A young man in Louisiana thought his house was surrounded by police and tried to cut his own throat. His family stopped him and the cut was stitched up, but he succeeded in shooting himself the next day. These are only a few of the many stories of self-destruction and harm resulting from bath salts consumption.

In 2010, there were 304 calls to poison control centers about this drug, but more than 6,000 in 2011. Since the drugs have been banned in 31 states, there have only been 2,250 in the first six months of 2012.

A Sober Person Does Not Run these Risks

Every drug of abuse is associated with harm—addiction, the decline of personal integrity and happiness, illness, incarceration, hallucinations, and delusions that can lead one to harm others—the list is almost endless. The only way to avoid these risks is to remain sober.

For some people, this is a choice they can’t make, as they are already addicted. Whether the addiction is to an opiate, alcohol, a stimulant like this one or any other substance, hope of lasting recovery is available at Narconon centers around the world.

Learn how a loved one can leave addiction behind and stay safely sober.

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