The link between mental health illness and substance use disorder : Opinion

May 10, 2024

 A recent article published by Psychiatry Today and authored by Dr. Mark S. Gold examined the link between substance abuse and psychiatric issues. Specifically, Dr. Gold highlights the prevalence of simultaneous substance use disorder and mental health illness in some individuals, referring to them as “co-occurring disorders (CODS),” as well as “concurrent disorders” and “dual diagnosis.”

“Individuals diagnosed with co-occurring disorders often need more intense treatment than others due to the complexity of their cases. They also may face greater consequences from their substance abuse compared to patients diagnosed with a mental illness only,” said Dr. Gold in the text of his article.

One of the current theories to explain this co-occurrence is the self-medication theory developed by Dr. Ed Khantzian, a psychiatrist at Harvard, highlighting the inability to experience pleasure or suffering as the driving force behind addiction. According to this theory, existing psychological disorders may drive individuals to self-medicate their symptoms with alcohol and drugs.

Another theory proposed by the neuroscientist Dr. Kenneth Blum referred to as reward-deficiency syndrome (RDS) suggests that some individuals are unable to gain satisfaction from life due to dopamine deficiency, which can be hereditary. This theory suggests that RSD can lead individuals to take drugs or consume alcohol to alleviate their symptoms, resulting in co-occurring substance use disorder and mental illness.

Moreover, Dr. Gold highlighted the importance of early and simultaneous intervention of CODs. “The key point is to not delay treatment of one disorder in favour of the other. Instead, as much of a simultaneous approach as possible is best. This often means a team of experts is needed, including a psychiatrist, psychologist, therapists, and others to assess the problem, determine whether inpatient, residential, or outpatient treatment is best, and develop a cohesive treatment plan for the patient,” he said.

Likewise, he noted that as part of treatment of CODs, individuals should be evaluated for past or recent trauma and co-occurring psychiatric and medical illnesses and treated accordingly, with psychotherapy approaches as needed.  

“Future breakthroughs in genetic and other scientific research should make clearer why some individuals are more prone to such disorders, as well as lead experts toward the best medications, therapies, and other treatments to alleviate much more of this terrible suffering,” he concluded.