What is substance abuse comorbidity?
In the field of mental health, substance abuse comorbidity occurs when someone has both lived experience of a mental health condition and lived experience of a substance use disorder, often including addiction.
Experiencing a substance abuse disorder along with a mental health condition is relatively common; it has been suggested that over 60 percent of adolescents in community-based substance use disorder treatment programs also meet diagnostic criteria for another mental illness . Common mental health issues include anxiety disorders, such as generalized anxiety disorder, panic disorder and post-traumatic stress disorder. Substance abuse disorders can also co-occur with mental health issues such as depression and bipolar disorder, attention-deficit hyperactivity disorder, psychotic illness and borderline personality disorder. Youth can be a vulnerable time for people to develop substance abuse and mental health issue comorbidity.
Three main pathways have been identified for the development if comorbidity. These include common risk factors for both mental health issues and substance abuse; mental illness that may contribute to substance abuse; and substance abuse that can contribute mental health issues. Causative factors behind these three pathways can be very complex, and may include genetic and epigenetic influences, activation of various brain regions, environmental influences, stress, and trauma and other adverse childhood experiences.
Comorbidity is important to study and respond to for many reasons. Perhaps the most important of these is the damage comorbidity can do; particularly to young people. Unfortunately, both diagnosis and treatment of comorbidity can be very difficult. This may be because symptoms of either condition may overlap and reinforce one another. Successful treatment may be more difficult than for people with only one type of these challenges in their life. People with comorbidity may also face the challenge of “silo-ed” services – services that either treat only mental health issues or only substance abuse issues.
Research and experience in the field suggests that people with mental health issues and substance abuse should be diagnosed concurrently and treated in an integrated way for their own specific constellation of symptoms and challenges. It has been suggested that people entering drug treatment programs should be observed for a period after abstinence for ongoing symptoms of mental health issues; this may result in more accurate diagnoses and allows for better-targeted treatment. Relatively effective pharmaceutical interventions exist for many mental health issues. Psychosocial interventions also exist for many mental health issues and substance abuse issues. Psychosocial interventions include, but are not limited to, cognitive behavioural therapy, dialectical behaviour therapy, assertive community treatment and exposure therapy (for some anxiety disorders). Further, people with comorbidity may face challenges around housing, domestic violence, physical health and legal problems. These all call for practical, supportive intervention.
Perhaps it should also be emphasised that there are risk factors pre-disposing people towards mental health issues and substance abuse. These may include poverty, homelessness, availability of dangerous substances and a history of trauma. Effective treatment of comorbidity should address these factors in a preventative and harm-minimising fashion.
Dr. Richard Schweizer, Policy Officer at One Door Mental Health richard.schweizer@onedoor.org.au.
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Dr Richard Schweizer
[1] https://nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness