Substance abuse is the addiction and dependence of people on alcohol and drugs that comes about because of the confluence of psychological, social and medical problems (Connors, Donovan & DiClemente, 2001). This means that there is no absolute cause for substance abuse implying that treatment should be based on the individual context of patients. Substance abuse constitutes an illness that involves long-term and continuous treatment because of the need to address not only the medical aspect but also the psychological and social aspects that led to dependence on alcohol and drugs.
Since substance abuse has a psychological or mental aspect, substance abuse among patients with mental illness became the subject of studies for purposes of accurate diagnosis and responsive treatment. As such diagnosis and treatment of substance abuse and mental illness considers the possibility of comorbidity. Prevalence of Substance Abuse among Mentally Ill Patients The U. S. Department of Health and Human Services (2007) reported that substance abuse remains high 16.7 percent of the population using illicit drugs, marijuana, or psychotherapeutic drugs for non-medical reasons in 2005 while 51. 8 percent of the population consumes alcohol, out of which 22. 7 percent are binge drinkers and 6. 6 percent are heavy alcohol drinkers.
The National Institute of Mental Health (2008) reported that one in four Americans eighteen years old and above has a diagnosed mental disorder. This translates to 26. 2 percent of the entire American population or 57. 7 million Americans. Of this number, nearly 50 percent suffer from at least two mental disorders.
The high percentage of substance use and the corresponding high probability of substance abuse and a significant percentage of people with mental disorders when considered together with the common reasons for substances abuse and mental disorder, which are psychological, social and medical support comorbity. The National Alliance on Mental Illness (2003) reported that around 50 percent of people with mental disorders also engage in substance abuse. In addition, 37 percent of people involved in alcohol abuse and 53 percent of those engaged in drug abuse having one or more mental disorders.
Moreover, out of the individuals diagnosed with a mental illness, 29 percent engage in alcohol and/or drug abuse. Comorbidity of Substance Abuse and Mental Illness RachBeisel, Scott and Dixon (1999) found that routine screening of people with mental illness showed significant incidence of substance abuse. Fisher et al. (2007) explained that many patients with mental illness engaged in substance abuse even prior to admission while Sinclair, Latifi and Latifi (2008) explained that mental patients with shorter hospital treatment tended to develop substance abuse.
Substance abuse and mental illness co-occur because of a number of compelling reasons. One, the reasons behind substance abuse could also be the cause of mental illness and vice versa. Peer pressure is a social factor that could influence people to abuse alcohol and drugs and this could also trigger mental disorders such an anxiety and depression when the pressure is difficult to handle and expectations of peers are unmet. Medical and psychological factors could drive individuals to abuse alcohol and drugs or trigger mental disorder.
Another reason is that alcohol and drug abuse could trigger mental disorder while mental illness can result to alcohol and drug abuse. One constitutes vulnerability for the other so that it is not unlikely for individuals having one to have the other. (Fisher et al. , 2007; Sinclair et al. , 2008) Diagnosis and Treatment Options Dual diagnosis has received recognition as the appropriate diagnostic procedure in handling substance abuse and mental disorder.
Currently, both are diagnosed and treated separately but through the recognition of the probability of comorbidity, dual diagnosis emerged as the effective means of determining whether a mentally ill patient also has an alcohol and/or drug addition or whether a patient seeking treatment for alcohol or drug abuse has a mental disorder. Medical workers treating patients with mental disorder or substance abuse should consider the possibility of co-occurrence, which means testing for both.
Many treatments emerged for the different mental disorders as well as alcohol and drug abuse but treatment for alcohol and drug abuse in patients also with mental illness necessarily involve an integrated approach to address both problems (Ley et al. , 2000). RachBeisel et al. (1999) explained that an integrated approach integrates components such as harm reduction strategies, stage-based treatment, motivational counseling, cognitive-behavioral intervention, group therapy, and other treatment that target both conditions simultaneously.
An integrated approach targets all the causes of the co-occurring conditions. Alverson, Alverson and Drake (2000) found that improvement in the quality of life of mentally ill patients also engaged in substance abuse significantly influenced efforts of these patients to abstain from substance abuse. This targets the social and psychological causes of the co-occurring condition. Sinclair et al. (2008) suggested that including substance abuse in the treatment of mentally ill patients by including rehabilitative therapy with the treatment for mental illness targets both conditions.
Conclusion Comorbidity of substance abuse with mental illness is a real problem that requires practice solutions. Understanding the causes of the co-occurrence leads to effective diagnosis and treatment. Currently, dual diagnosis and integrated treatment appears to be the viable means of addressing substance abuse among patients with mental illness.
References
Alverson, H. , Alverson, M. , & Drake, R. (2000). An ethnographic study of the longitudinal course of substance abuse among people with severe mental illness. Community Mental Health Journal, 36(6), 557-569.