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Mental Health Illness and how it leads to Substance Abuse

Introduction

Mental health illness or mental health disorder refers to abnormal psychological or behavioral pattern. Such abnormal psychological and behavioral pattern is characterized with distress or disability of performing well or normal. The understanding and recognition of mental health illness has changed over time and there are variations in the definition, classification and assessment of mental disorder. With the passage of time, different levels of assessment and treatment are observed and experimented for mental illness. The treatment of mental illness is associated with classification of disorder which is featured with particular drugs prescribed. Medical prescription for mental health illness is based on the severity and harm of the disorder.

This paper aims to identify some of the mental health disorders including bipolar, anxiety and depression while considering their causes, treatment and the way drugs treatment for these disorders lead to substance abuse. Studies have suggested that drug prescription given to mental health patient sometime results in substance abuse. Substance abuse refers to drug abuse and also defined as inadequate pattern of use of substance (Dennison, 2003). It is further defined as misuse of drugs as a result of prescription medications. Since number of drugs is medically prescribed for mental disorder, the report of Journal of the American Medical Association (JAMA) reveals that 50% of individuals with severe mental disorders are affected by substance abuse or dependence.

Classification of Mental Health Illness

Definition and classification of mental disorder is an important issue related to mental health. For most of mental health illness many international clinical documents have used the term mental disorder. With two widely established systems, mental disorder is classified and categorized, and provides the standardized criteria for diagnosis. Generally, mental disorders with reference to mental health illness are classified into three separate categories. According to this classification, mental disorders are of three kinds with their characteristics: learning disabilities or mental retardation. The next section of the paper discusses three mental health disorder including their symptoms, causes and treatment. Along with the discussion the main focus is on how these disorders lead to substance abuse with relation to use of drugs as treatment. The reason to examine how disorders lead to substance abuse is a significant issue with the fact that most mental disorders are treated with drugs and many patients even after recovery from illness continue the drug intake. 

Bipolar

Bipolar disorder is also called manic-depressive disorder and characterized with the mood disorders like the presence of one or more episodes of abnormally high energy levels, cognition, and mood with or without one or more depressive episodes. This disorder is psychiatric diagnosis and diagnosed with symptoms such as elevated moods and episodic depressions. The elevated moods are clinically recognized as mania, and hypomania. Individual who experiences manic episodes also experience depressive episodes with features of both mania and depression. The causes of bipolar disorder are associated with substantial genetic contribution and environmental effects. The diagnosis of bipolar disorder is conducted on the basis of abnormal behavior at first this abnormal behavior is observed and complaint by family, friends and co-workers and later assessed by a psychiatrist, nurse, or clinical psychologist or clinical assessment. To be diagnosed with bipolar disorder there is lists of criteria and this criteria is based on the presence and duration of particular symptoms.

After an individual is diagnosed with symptoms of bipolar disorder, the next step is to manage the disorder with medication and psychotherapy. Drugs are prescribed the most for the individuals with bipolar disorder for overcoming the symptoms. Mood stabilizers medications are used as basic medication for bipolar disorder and the most prescribed mood stabilizers are lithium carbonate or lamotrigine (Geddes, 2004). Besides, there are medication generally prescribed for bipolar disorder such as antipsychotic medications including quetiapine and olanzapine, antidepressants and anticonvulsant like topiramate. 

Anxiety

Anxiety is a physiological and psychological state with certain characteristics including emotional, behavioral  and cognitive factors (Rosenhan, 2000). With the disorder anxiety develops feelings of fear, restlessness, uneasiness and dread (Bouras& Holt, 2007). Anxiety is also considered as reaction to stress caused by difficult situation. When the state of anxiety reaches to extreme it falls within anxiety disorder. Anxiety is also considered as mood condition in which individual is characterized with fear, although the condition of fear in anxiety is different from the fear that appears in the result of an emotional response. The fear in anxiety is related to real life situation which is considered as out of control by the individual (Ohman, 2000). Another alternative approach defines anxiety as such mood state in which individual attempts to cope with upcoming negative events (Barlow, 2002). Thus anxiety is the difference between dangers and fear of future and present.

The cause of anxiety is related with neural circuitry involving the amygdala and hippocampus (Rosen& Schulkin, 1998). In most situations, individual shows the features of anxiety when he is exposed to unpleasant and potentially harmful stimuli and as result of this blood flow increases in amygdala causing anxiety. People with three characteristics are at the risk of having anxiety: biological vulnerability, psychological vulnerability, and specific psychological vulnerability. The most common treatment for anxiety disorder is anxiolytic also called antipanic or antianxiety (Jongsma, 2004). Anxiolytics have been proved to be effective in the treatment of anxiety disorders (Andrews, 2003). Different anxiolytic are benzodiazepines, SSRIs, Azapirones, Barbiturates, Hydroxyzine and Pregabalin (Barlow, 2004).

Depression

Depression is regarded as major depressive disorder or unipolar disorder. Depression is a clinically identified mental disorder characterized by low mood and low self-esteem with loss of interest and pleasure in normal life activities. The effects of disorder do not only rest on the individual with disorder but also affects the family, relatives and peers.  The cause of depression is associated with biological, psychological, and social factors. The diagnosis of disorder is based on the self report of personal behavior or family members and relative and after examined for mental status under the supervision of clinician. Individuals with depression symptoms are treated with antidepressant medication and psychotherapy.

Substance Abuse and Mental Health Illness

Many substances are used and abused; some can be acquired legally, while others are acquired illegally (Videbeck, 2010). This discussion aims to find how mental disorders such as bipolar disorder, anxiety and depression lead to substance abuse. According to Diagnostic and Statistical Manual of Mental Disorders, 4th edition which provides a list of substance abuse which includes alcohol, caffeine, cannabis, cocaine, amphetamines, inhalants, sedatives, Anxiolytics and opioids. It also includes the categorization of substance related disorders which is classified into two groups: one is the disorder of abuse and dependence and secondly substance induced disorders such as intoxicants, withdrawal, mood disorder, anxiety and depression (Videbeck, 2010).

Before this discussion is further preceded here is the definition, explanation and different other concepts related to substance abuse. Substance abuse is defined as inadequate pattern of use of a substance but it is not considered dependent and at the same time cannot be excluded from dependency. Thus substance abuse is use of substance in nonmedical contexts. This term is further explained with wide range of definitions such as it is related with the alcohol intake or drugs intakes. In particular to drugs intake it is associated with psychoactive drug or performance enhancing drug for a non-therapeutic or non-medical effect. On the other hand the term substance abuse refers to negative concept of drug use, for instance using drugs for non-medical purpose or with negative intention which results in social, physical and psychological harm. Using drugs with no medical prescription or for negative intention may lead to criminal penalty. Other concepts related to substance abuse are addiction and misuse of drug but on the basis of underlying meaning of these concepts they are different from substance abuse. Substance abuse cannot solely be defined as addiction: similarly misuse of drug is different from substance abuse with intensity level.

Considering the harmful effects of substance abuse as it causes illicit drugs and personal injury or substantially interferes with social or economic functioning, it is important to understand different factors that may lead to substance abuse in the individual with mental disorders. Different studies have shown that mental illness or mental disorder such as anxiety, depression and bipolar may lead to substance abuse (Ries, 1996). American Psychiatric Association (DSM-IV) reports that few individuals with these disorders and drug prescription are vulnerable to resist the chronic drug intake (Lowinson et al, 2005). Bipolar disorder, anxiety and depression are those disorders which carry increased risk of drug abuse. The question how these disorders lead to substance abuse can be described with the fact that people suffering from mentioned mental illness sometime undiagnosed take drugs to overcome the symptoms of disorders (self medication). These people take drugs to alleviate the negative symptoms. Studies have found that many individuals with mental disorders have been found to be use drugs illegally. It is defined in different ways like people with mental disorders can be substance abuser if there is overlapping genetic vulnerabilities. Sometime people have genetic tendency of substance abuse and when they have environment exposure like diagnosed with mental illness or drug prescription they respond to exposure. In some case individual are diagnosed with mental illness as a result of drug abuse and thus symptoms of a mental disorder increases the vulnerability to drug abuse. Research has shown that around 20% of people only with bipolar disorder are drugs abuser which is about 2% compared with the general population.

Conclusion

The finding of discussion can be summed up as mental disorder itself not a reason to lead the substance abuse but it is rather result of self medication. Self medication in individual with mental illness is very common and thus it leads to substance abuse. Besides, there is another fact that some people with mental illness are found to be vulnerable to drugs abuse and even after get healed they do not stop drugs intake. It is justified that it is not an addiction, but rather people sometimes with either genetic reason or environmental exposure get into abuse (Evans& Sullivan, 2001).  No matter what the other or secondary causes of substance abuse, mental illness directly or indirectly leads to substance abuse (Dziegielewski, 2005).   


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