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What Are The Most Common Co-Occurring Disorders?

Sadly, it is exceedingly common for those who suffer from mental health disorders to turn to substances as a coping mechanism—a way to feel better. All too often, this pattern of behavior will result in a substance use disorder to add to a person’s list of treatment needs.

We often see that the links between the specific substance use disorder and the co-occurring psychiatric disorder do not come about haphazardly, but rather develop logically on the basis of neuropharmacology and environmental influences. Below are some of the most common co-occurring disorders with substance abuse combinations.

Marijuana and Schizophrenia

Substance abuse, in general, is extremely prevalent amongst the schizophrenic population, with marijuana abuse being the most pervasive. The mental health community uses a number of different models to both characterize and attempt to explain the relationship between the two.

The first of these—which is applicable to most, if not all co-occurring disorders-- is known as the self-medication hypothesis, which is rather straightforward and simple to understand from a logical perspective. The self-medication hypothesis essentially proposes that those who suffer from schizophrenia (or other mental disorder) and abuse substances do so in an attempt to ameliorate the symptoms of their disorder. That is to say, the symptoms of their condition cause them great discomfort, so they turn to substances in an attempt to feel better.

While this behavior is understandable and elicits empathy, it also causes for great concern from a treatment standpoint.

Symptoms of Schizophrenia

Many schizophrenics abuse marijuana and other drugs in an attempt to dispel their symptoms. Now let’s review common symptoms of schizophrenia and see how people try to alleviate their symptoms.

Symptoms of schizophrenia are categorized into two separate classes. Positive symptomology indicates the presence of a behavior that is considered abnormal. Positive symptoms of schizophrenia include:

  • Delusion: sometimes referred to as "magical belief" or "magical thought," delusion is an idiosyncratic belief or impression that is firmly maintained by someone despite being contradicted by what is generally accepted as reality.
  • Hallucination: the experience or perception of something that is not present. Hallucinations can affect any of the five senses: visual (sight), auditory (hearing), olfactory (smell), tactile (touch), gustatory (taste); and can also come in a general somatic form in which a person feels decentralized pain due to mutilation or an attempt to invade the body by another living creature (e.g., "there are bugs under my skin").
  • Disorganized Thinking: This one may be the most familiar from day to day life. Disorganized thinking describes a lack of logical continuity of thought, which is in turn characterized by speech that is generally incoherent. Speech is fragmented, disorganized and generally lacks organization-- what the layman might refer to as "crazy talk.”
  • Agitation: within the context of psychiatry, agitation refers to an excess of motor or verbal activity. It may appear in the form of a person continually shifting, unable to sit still or remain in one area. It may also appear in the form of rapid or excessive speech and is particularly noticeable when speech is also disorganized.

Negative symptomology is representative of behaviors which are considered normal that are not displayed.

These include:

  • Affective Flattening: the person’s range of emotional expression is clearly diminished. They may also display poor eye contact and/or reduced body language.
  • Alogia: a dearth of speech. A person may speak very little, if at all, or respond to queries with brief, empty replies.
  • Avolition: a lack of motivation characterized by an inability to initiate and persist in goal-directed activities. This tends to cause schizophrenics to withdraw from obligations such as school or work.

Why do schizophrenics use marijuana

Subjective reports indicate that marijuana use is intended mostly to relieve the positive symptoms of the schizophrenic condition. People with this mental illness may use cannabis to relieve the psychological strain caused by delusion or hallucination; or "chill them out" and relieve the effects of physical or verbal agitation.

The Diathesis-Stress Model

There is an additional model that has been developed to explain the unique correlation between co-occurring schizophrenia and substance use disorder for marijuana. The diathesis-stress model suggests that, within a person, there exists an inherent predisposition toward a particular condition (in this case, schizophrenia) and when the appropriate stressor is applied (in this case, marijuana) the condition tends to manifest. In such cases, marijuana use is the impetus for the manifestation of schizophrenia.

There is empirical evidence in support of this model, which indicates that marijuana use by men, particularly young men, tends to correlate with the development of schizophrenia later in life. Furthermore, it is not much of a stretch to see how marijuana use could both bring about schizophrenia, via the diathesis-stress model, and in turn, exacerbate a person's overall level of dysfunction via the self-medication model. This holds true for other co-occurring disorder as well.

Cocaine and Anxiety Disorders

Another co-occurring pair that fits itself well to the diathesis-stress model is cocaine abuse and generalized anxiety disorder.

Cocaine is a very potent, and incredibly addictive stimulant which causes acute effects that range from the desirable—exhilaration and euphoria—to the undesirable—insomnia, paranoia, suspiciousness, and even hallucination.

You may notice that many of the symptoms caused by cocaine use closely resemble those which characterize anxiety; namely insomnia, paranoia, and suspiciousness. Furthermore, the undesirable effects of cocaine tend to be exacerbated by the quick and inevitable withdrawal, or "come-down," when all desirable effects are removed. Cocaine withdrawal is uncomfortable, to say the least, and given an understanding of the diathesis-stress model, it takes little explanation to see how prolonged cocaine use anxiety disorders have become so inextricably linked.

Heroin use and Depression

Heroin abuse and depressive disorders are another commonly co-occurring pair. These two, like their counterparts mentioned above, have a grip of empirical evidence along with an abundance of colloquial evidence to establish and support their correlation.

How heroin works in the brain

Heroin is a potent opioid narcotic that causes drastic changes in human brain chemistry upon application. That is to say, the acute effects of heroin on the brain are powerful and impossible to ignore.

Dopamine is the neurotransmitter most heavily manipulated by heroin and other opioids. Among other things, dopamine is strongly associated with feelings of happiness, excitement, and well-being, while also acting as the catalyst in the chain reaction in the human brain that creates the sensation of reward. This is, in large part, what makes it so addictive, even in comparison to other addictive substances.

With substantial changes in brain chemistry come noticeable changes in mood, mind-state, and behavior. Some of the most noteworthy effects of heroin use include:

  • Euphoria: perhaps more so than any other class of drug, heroin sets off a cascade of dopamine that is released in the brain, which results in a massive "rush" or "high." This is one of the two quintessential effects of heroin that give it such a strong draw to those who abuse it.
  • Extreme Relaxation: closely related to the experience of euphoria is the feeling of relaxation and well-being that results from the manifestation of physical changes in the body. Heroin causes the heart rate to slow while also working as an analgesic or pain-reliever. When combined with euphoria, these functions produce a sensation that erases any and all anxiety and leaves the user in a relaxed, trance-like state. This is commonly referred to as "nodding out." The muscles of the body relax, leaving extremities feeling heavy, and users will often assume a position of comfort and close their eyes; somewhat lucid, yet appearing to be asleep.

How heroin abuse and depression are related

As a general rule in psychopharmacology, the withdrawal effects of a given substance are equal and opposite to the effects produced during intoxication. In regard to heroin, this would indicate that all of those intense feelings of euphoria, well-being, tranquility, and general happiness would turn to feelings of despondency, ill-being, angst, and depression. The degree of discomfort created by these withdrawal symptoms produces one of the strongest cravings and, by extension, rates of dependency of any drug of abuse.

How heroin dependency leads to depression

Studies have shown in spades that prolonged heroin abuse can drastically and permanently reduce the brain's ability to produce and respond to the positive effects of dopamine; namely happiness. By definition, this resulting inability to chemically create a condition of happiness can be referred to as depression.

This is not to say that those who abuse heroin will remain depressed for the rest of their days, although sadly that is the plight of some. Heroin-induced depression can be ameliorated. Unfortunately, the easiest way to achieve this is simply by using heroin itself—hence the astronomic relapse rate.

However, with willful adherence to a well-formulated recovery plan, which will likely include a combination of pharmacotherapy and cognitive behavioral therapy, and most importantly abstinence, recovery from heroin-induced depression is a real possibility, and a worthy one to pursue.

Alcoholism and Anti-social Personality Disorder

Anti-social personality disorder is a condition characterized by a skewed way of thinking and a resultant inability to relate normally with others. People who suffer from this disorder often come across as callous or awkward due to an inability to summon empathy for those around them. This often results in a lifelong pattern of social miscues and missed opportunities to develop strong relationships, leaving these people disconnected and ostracized from their social environments.

How does anti-social disorder cause alcoholism?

According to one source of co-occurring disorders statistics, up to 90% of those who suffer from ant-isocial disorder also develop some form of substance use disorder in their lifetime, with alcoholism being the most common.

The self-medication model might seem to be the most appropriate in determining a causal relationship between the two disorders. Lack of opportunity and ability to socialize are some of the most classic reasons people turn to substance use.

Alcohol, in addition to igniting the neurons of the reward pathway in the brain, is widely considered to be a "social lubricant" for its tendency to reduce inhibition and fuel social interaction. In the case of those with an anti-social disorder, alcohol and the culture which surrounds it very well may form the only common ground on which they are able to relate to others.

Opioids and Post Traumatic Stress Disorder

Post-Traumatic Stress Disorder (PTSD) is a mental illness suffered by those who encounter traumatic events in their lives and develop stress reactions which linger on well after the precipitating event is over. Symptoms of post-traumatic stress disorder include:

  • Hyperarousal: a state of increased psychological and physiological tension marked by such effects as reduced pain tolerance, anxiety, exaggerated startle responses, insomnia, fatigue, and accentuation of personality traits
  • Avoidance: commonly as a response to hyperarousability, people will avoid social interaction to avoid the discomfort brought about during such interaction.
  • Flashback: a phenomenon during which a traumatic event is vividly hallucinated, as though being re-experienced in real-time.

How PTSD and Opioid Use Are Related

PTSD and opioid use can each serve as the impetus or the consequence of one another. That is to say, either can cause the other.

Self-medication is the most obvious manner in which we might expect such a relationship to unfold. The symptoms of PTSD are uncomfortable at best and traumatic at worst. The desire to self-medicate under such circumstances are as understandable as they are tragic.

However, there is empirical evidence which shows that opioid abuse may also provide the impetus for the development of PTSD. A study reported by the American Journal of Drug and Alcohol Abuse in 2014 suggests that individuals who were addicted to prescription opioids developed PTSD at a rate 42% higher than those who did not.

In such cases, it would seem, the experience of chronic addiction to opioids is sufficiently traumatic to induce dysfunction that is diagnosable under the standard of the DSM-V (the diagnostic manual developed by the American Psychiatric Association).

While treating co-occurring disorders with any of the paired illnesses mentioned above can be challenging, achieving sobriety and developing healthy coping mechanisms can be achieved with the help of an accredited dual-diagnosis treatment center. These centers are uniquely equipped to deal with the many challenges their patients may face, and their sole mission is to help these people live happier, more fulfilled lives.