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Essay: The Prevalence of Drug Abuse in Mood Disorders

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Mood Disorders and the Prevalence of Drug Abuse

Adriane L. Walsh

Tarleton State University

Abstract

While drugs have the potential to make a positive impact, they pose a real danger when they fall into the wrong hands.  Today there are drugs to address a plethora of conditions, both physical and psychological.  Some of these drugs can be labeled as sedatives, stimulants, hallucinogens, and several others.  Many, if not most, of the drugs were initially created to treat illnesses but due to their addictive nature, created a much bigger epidemic: drug addiction.

The contents of this paper will address mental health, prescription and illicit drug abuse, and their effect on society.  Several peer-reviewed articles are cited to assist in determining parallels between drug use and psychological disorders.

A mood disorder is a psychological condition in which an individual has an abnormal fluctuation of mood which can be disruptive to the lives of those diagnosed with them. Symptoms can range from severe and chronic depression to an uncontainable excitement and delusions (Drew Ramsey, Elizabeth & Muskin, 2013).  There are several mood disorders so far that have been identified.  The term bipolar is commonly used as an adjective to describe a person who is in a bad mood but in reality, bipolar disorder is a life-altering disorder.  There are two subtypes of this disorder: bipolar I and bipolar II.  The onset of bipolar I is typically earlier and more severe than bipolar II.   In some cases, people may experience a more subtle form of mania called hypomania.  Mood changes are a normal part of human nature, but bipolar disorder causes such extreme changes in emotion that it alters what the sufferer considers reality.  

The brain chemicals serotonin, dopamine, and norepinephrine are involved with how people regulate their emotions.  When the brain cannot adequately control the distribution of these chemicals, the result is either an overabundance of the feel-good chemicals which results in elation and/or agitation or depression from the lack of said neurotransmitters (Hilty, Leamon, Lim, Kelly, Hales, 2006).  In the past, researchers estimated that approximately 1% of the United States population is afflicted with bipolar disorder but in recent years, there has been a push to include people who have sub-threshold mania, hypomania, and drug-induced mania in those calculations.  Including people who experience symptoms just short of mania would raise the estimation of the U.S. population with bipolar disorder to approximately 5% (Kessler, 2006).  This is a significant difference.  In regard to treatment, some people with bipolar disorder are aware of their condition, seek treatment, and lead normal lives.  Others are in denial that they have a mood disorder and refuse treatment, even when the disorder has negatively impacted their lives.  

Major depressive disorder (MDD) is a mood disorder in which a person experiences an episode of chronic depression that lasts at least two weeks.  Some people experience an MDD episode once in their lifetime but studies have shown that it is episodic in nature (Verduijn et al., 2017).  Similar to MDD is dysthymia, a condition in which a person experiences a chronically irritable or depressed mood for at least two years.  This mood disorder is common, affecting approximately 3-7% of the United States population (Sansone & Sansone, 1996).   Despite the tendency of society to keep quiet on mental health issues, mood disorders are prevalent and do not discriminate.  They transcend race, gender, and geographical location. Studies show that nearly 30% of all adults will experience a mental disorder in their lifetime (Steel et al., 2014).

Mood disorders put a financial burden on society considering some people diagnosed with them find it difficult to retain employment. Studies show that people who experience psychological issues are much more likely to face job loss than people who do not (Bartley, 2018).  As a result, they depend on the government to provide them with money for food, medical, and housing assistance.  On average, mental health problems cost the United States approximately $193.2 billion per year in lost income (Insel, 2008).  There are resources available for people struggling mentally but for the severely mentally impaired, it may not be as easy to get help.  Often people experiencing a psychiatric emergency do not have the wherewithal to seek treatment on their own; the responsibility falls on the family or friends to help their loved one (Tang, n.d.).  However, mood disorders have a reputation for isolating an individual which not only prolongs their suffering for lack of treatment, it worsens the condition due to the isolation itself.

Social isolation is characteristic of mood disorders and is often due to the sufferer’s shame and embarrassment of their condition (Wang et al., 2017).   Isolation can also be a byproduct of one’s paranoia, hallucinations, grandiosities, lack of energy, depression, and poor self-esteem.  Despite these challenges, a survey has shown that 45% of the participants who struggle with mental issues still desire to have a close friend (Harvey & Brophy, 2011).  The desire to have a close friend indicates that even when a sufferer is isolating themselves due to their condition, they really feel they would benefit from close social interaction.  Despite desiring normal relationships, some with untreated mood disorders find themselves struggling to hold their work and personal lives together. This is evidenced by the struggles the mentally ill face in interpersonal relationships as well as financially (Meltzer, Bebbington, Brugha, Farrell, & Jenkins 2012).

Given that mood disorders can lead to isolation, it is not surprising that divorce is a reality to some sufferers.  A study that reviewed the 2004 National Nursing Home Survey determined that the divorce rates were higher among residents diagnosed with bipolar disorder and schizophrenia.  In addition, 79% of the participants with a mental illness answered that they have never married at all (Walid & Zaytseva., 2011).  For people with mood disorders, losing a marriage can exacerbate existing mental issues.  In severe cases, mental illness has disrupted a person’s life so much that a sufferer loses their job, family, and home.

Not surprisingly, there is a strong connection between those with a mental disorder and drug abuse as the individual attempts to self-medicate and escape the distressing symptoms being encountered.   Developing an understanding of the underlying cause of this comorbidity is essential to improve mental health treatment and prevent substance abuse problems.  If timely screening and early treatment can prevent substance abuse among those with mood disorders, it may be possible to prevent the onset of substance use disorders among this vulnerable population.  

The purpose of this paper is to examine the correlation between mood disorders and substance abuse.  If the source of the problem can be isolated, it inches society one step closer to finding a solution and removing the stigma associated with mental health issues.

Addiction can be defined as a chronic condition in which a person becomes physically and/or psychologically dependent on a substance or behavior that is harmful and disruptive within their lives.  The desire of an individual to self-regulate emotions in response to stressors in life is often driven by pre-programmed biological factors.  When mood-altering drugs are utilized to cope with stressors, it creates the potential for misuse and dependency.   Drug addiction is the impulsive desire to abuse a substance despite its detrimental effects.  Evidence of these destructive effects can be seen in any large city plagued by drugs; homelessness, unemployment, domestic violence, and gang violence is a reality that many faces.  Drug addiction is prevalent in the United States and internationally.  Addiction afflicts 6.9% of the U.S. population and has been a crisis for so long that presidents have called for a war on drugs (Scott, Dennis, Laudet, Funk, & Simeone, 2011).  Every day, nearly 115 people die of opioid overdose alone (NIDA, 2018).  

Studies show that adolescents who used cannabis on a regular basis prior to turning 17 experience notable executive functioning impairment (Substance Abuse and Mental Health Services Administration, 2016).  Knowing the impact drugs have on the brain opens up the possibility that not only are people with existing mood disorders more likely to abuse drugs but that drug abuse can cause the development of mental illness (Aldandashi & Blackman, 2009).

As mentioned earlier in this report, people who struggle with mood disorders often face problems such as isolation, marital woes, unemployment and lack of medical care.  As a result, individuals struggling mentally seek refuge from the pain that their illness causes.  Mood disorders have a reputation for driving family and friends away, therefore, people with mood disorders do not always have someone to ensure they get the psychological help they need. Out of desperation and inadequate coping mechanisms, drug addicts attempt to numb their out-of-control emotions (Enevoldson, 2004).  Also mentioned in previous paragraphs was the prevalence of homelessness people struggling with mental illness. Research shows that half of the homeless people in shelters today have serious drug and/or alcohol problems as well (Meynen, 2010).

It is common knowledge that drug addicts struggle with self-control when it comes to substances. Free will and responsibility are actually compromised in individuals who have a mental disorder. For example, one study examined how people with mental disorders characterize themselves as having no free will (Meynen, 2010). The lack of free will indicates that mental disorders are associated with compulsivity which is linked to drug abuse.

Illegal drugs can easily be accessed on the streets but the battle of addiction does not always begin there.  There are individuals who have never struggled with addiction in the past but become addicted to pain-killers they are prescribed by their doctors after a surgery or car accident. Similar to the spike in mental illness over the last few decades, prescription abuse has increased as well. In 2012, the National Survey on Drug Use and Health (NSDUH) estimated 16.7 million people 12 years-old and over abused prescription medication.   This is up 250% from 20 years ago (McHugh, Nielsen & Weiss, 2015).

Benzodiazepines, a class of drug commonly used to treat anxiety conditions and epilepsy, has rapidly become one of the most prescribed medications in America despite its addictive nature (Olfson, King & Schoenbaum, 2015).  In fact, on a global scale, substance abuse is at an all-time high.  Some research suggests the surge of drug use can be blamed on the overproduction of poppy fields in Asia (Saah, 2005).  Blaming drug abuse on the production of drugs is not a valid explanation for the surge of drug use.

While using drugs may be linked to mood disorders, it is not always the case. Some people manage to live with the symptoms of their mental disorder without ever enlisting the help of medications. Others take medication as prescribed and do not exhibit signs of addiction. However, the occurrence of the two together happens too frequently to ignore.

Taking the similarities between mood disorders and addiction into account, it is best to try to isolate which condition came first. In doing so, the individual can seek treatment for the problem that was the trigger.  Statistics show that 20% of people with a severe mental health issue will develop a substance use disorder, but only 7.4% receive treatment for both disorders.  Unfortunately, 55% of the individuals will receive no treatment at all (Priester et al., 2016).

Determining a connection between substance abuse and mental illness requires some research into drug addiction.  Addicts will describe a high that drugs provide.  The high acts as an escape for the user as it allows them to focus their thoughts outside of reality.  Opioids, which includes drugs such as Vicodin, oxycodone, and morphine, are medically beneficial when used properly.  When a person is in extreme pain, opioids act as a pain reliever.  Unfortunately, they also have a sedative effect in which people become addicted (Boys, 2012). Neurotransmitters are responsible for sending messages, both good and bad, in the brain.  Drugs interact with the neurotransmitters and alter the message being sent.  Opioids, for example, affect brain chemistry by posing as neurotransmitters.  By doing so, the drug is able to attach itself to neurons and this results in the neuron behaving differently (NIDA, 2018).   Initially, altering the brain chemistry feels good to the user.  Over time and with repeated use, however, the high fades and the user experiences withdrawal.  Faced with the discomfort of withdrawal proves too difficult for some people and they begin the cycle of abuse.  

In addition to altering neurotransmitter absorption, the frontal cortex, responsible for the higher functioning processes such as reasoning and emotional control, is affected.  Studies show that adolescents who used cannabis on a regular basis prior to turning 17 experience notable executive functioning impairment (Substance Abuse and Mental Health Services Administration., 2016).  Knowing the impact drugs have on the brain opens up the possibility that not only are people with existing mood disorders more likely to abuse drugs but that drug abuse can cause the development of mental illness.

It is now widely accepted that there is little debate over nature versus nurture in regards to mental illness.  Most scientists today would agree that the development of mental illness is a product of both genetic predisposition and environmental factors.  While the gene component is not completely understood, it undeniable plays a role in mental disorder development (Levitt, 2013).  Epigenetics is the study of inherited DNA changes that regulate gene expression from one generation to the next.  Epigenetic modifications which mediate the influence of environment on the genome are at the heart of the modifications.  Studies have shown a correlation of inherited traits across psychiatric disorders with windows of time during development that environmental factors may interact with environmental influences that cause risk.  The risk is greater during the gestational developmental periods of the early postnatal and periods of major hormonal arrangement (Guintivano & Kaminsky, 2016). Psychiatric genetics is undergoing a transformation that is expected to improve treatment for those with mood disorders.  Recent studies of schizophrenia, bipolar, and substance abuse have shown promise in unraveling the connection between pathophysiologic mechanisms and the contributions of genetics and environment to brain-based behavior. The importance of identifying biomarkers or genetic risk factors for mood disorders cannot be understated for discovering better treatments for mood disorders.  Even though symptoms may be severe, treatment can be successful if the correct diagnosis is made and treatment is initiated early (State & Geschwind, 2015).  

Some experts believe that common genetic risk factors are shared between anxiety disorders, illegal substance abuse, alcohol dependence, and attention-deficit/hyperactivity disorder, which often co-occur with bipolar disorder.  Bipolar disorder has been presented as a group of related mood disorders which is referred to as bipolar spectrum disorders.  When two disorders or illnesses occur simultaneously or sequentially, they are described as comorbid; there is an implication of interactions that have an effect on the course and prognosis of both.  

Understanding the comorbidity of mood disorders and substance abuse first requires that we recognize addiction is a mental illness; it is a complicated brain disorder characterized by drug seeking, craving, and irresistible drive to use drugs which occur from drug-induced changes in brain structure and function.  Some of these changes occur in the same brain areas that are affected in other mental disorders (such as schizophrenia, depression, or anxiety) so it not surprising that studies show a high rate of comorbidity between mental illness and drug addiction.  

Certain mental disorders have an established risk factor for subsequent drug abuse— and vice versa.  Diagnosis and treatment are complicated by the overlapping symptoms of drug abuse and mental illness; understanding and correctly diagnosing and treating the correct disorder is essential to a successful treatment plan.  Failure to treat a comorbid disorder can jeopardize the client's recovery.  Increasing the understanding of genetic, environmental, and neural bases of these disorders leads to improved treatments for comorbidity and helps diminish the social stigma that makes patients reluctant to seek needed treatment.  Comorbidity of substance abuse and mental illness is evident in studies on soldiers with post-traumatic stress disorder (PTSD).  

PTSD is a condition in which a person suffers psychologically due to exposure to a traumatic event.  The symptoms can vary in type and severity and can include depression, anxiety, and flashback and can greatly impact the sufferer's quality of life.  Some soldiers who deploy without noticeable mental illness return with psychological issues they never experienced prior to combat.  The term PTSD was coined shortly after the Vietnam War but the effects of war on returning soldiers have been documented much longer than that. Da Costa’s Syndrome, also known as “soldier’s heart,” was named after Jacob Mendes Da Costa, an aspiring medical doctor who studied the effects combat had on soldiers during the Civil War.  He noted that soldiers experienced heightened anxiety, detachment, sensitivity to sounds, and an inability to cope with stress effectively.  Additionally, Da Costa found that soldiers exhibited physical symptoms that mimicked heart disease.  

Studies have shown that comorbidity of PTSD with other mental illnesses is common.  Over 90% of individuals with PTSD have an additional psychological disorder (Kessler et al., 1995).  Studies also show that drugs and alcohol are more likely to be abused as a form of self-medication in people diagnosed with PTSD (Chilcoat & Breslau, 1998).  While drugs may temporarily numb the pain, drug use can actually exacerbate PTSD symptoms, leading to trouble maintaining employment, relationships, and sobriety.  As a result, the country has acquired a growing concern regarding housing instability for war veterans as they constitute at least 12% of the homeless population (Tsai & Rosenheck, 2015).

As mentioned earlier, people who struggle with mood disorders often face problems such as isolation, marital woes, unemployment and lack of medical care.  As a result, individuals struggling mentally seek refuge from the pain that their illness causes.  Mood disorders have a reputation for driving family and friends away, therefore, people with mood disorders do not always have someone to ensure they get the psychological help they need. Out of desperation and inadequate coping mechanisms, drug addicts attempt to numb their out-of-control emotions. Also mentioned in previous paragraphs was the prevalence of homelessness people struggling with mental illness. Research shows that half of the homeless people in shelters today have serious drug and/or alcohol problems as well (Meynen, 2010).

It is common knowledge that drug addicts struggle with self-control with substances. Research has shown that free will and responsibility is actually compromised in individuals who have a mental disorder. One study examined how people with mental disorders characterize themselves as having no free will (Meynen, 2010). The lack of free will indicates that mental disorders are associated with compulsivity which is linked to drug abuse.

Conversely, drug use may trigger the onset of a psychiatric disorder. While using drugs may be linked to mood disorders, it is not always the case. Some people manage to live with the symptoms of their mental disorder without ever enlisting the help of medications. Others take medication as prescribed and do not exhibit signs of addiction. However, the occurrence of the two together happens too frequently to ignore.

Taking the similarities between mood disorders and addiction into account, it is best to try to isolate which condition came first. In doing so, the individual can seek treatment for the problem that was the trigger.  Statistics show that 20% of people with a severe mental health issue will develop a substance use disorder, but only 7.4% receive treatment for both disorders.  Unfortunately, 55% of the individuals will receive no treatment at all (Priester et al., 2016).

Homelessness in a first world country, such as the United States, is hard to fathom.  The rate of homelessness in developed countries has reached nearly .5%.  The percentage may not seem large but when the total U.S. population is considered, half a million is a significant amount of people (Turnbull, Muckle & Masters, 2007).  According to similar studies conducted in 1980, 1990, and 2000, both homelessness and mental illness are on the rise (North, Eyrich, Pollio & Spitznagel, 2004).   

Not surprisingly, homelessness, substance abuse, and mental illness are inextricably linked together.  Research has shown that nearly half of the homeless adult population have been diagnosed with substance use disorders, with alcohol abuse occurring in nearly 50% of this population, and drug abuse in one-third.  Individuals with co-morbid disorders require more assistance and are more likely to remain homeless than other groups of people.  This can be associated with the fact that homeless people with substance use disorders are more likely to have an arrest record and felony drug convictions.  Homeless people with substance use disorders, especially those with co-occurring mental disorders, are at risk of losing their housing due to eviction, arrest, and incarceration.  Once homeless, success in substance abuse treatment is unlikely without access to safe, sober housing (Conrad, 2016).

Homelessness, substance use, and mental disorders have also been associated with high rates of emergency department (ED) use and hospitalization.  The de-institutionalism of psychiatric patients from mental institutions that began in the 1960s set the stage for the mental health crisis the United States faces today.   Those who are mentally ill that would have in the past been institutionalized are now left to fend for themselves to obtain housing, food, and medication; often the medication of choice is illegal drugs or alcohol.  Without treatment and proper medication, psychotic breaks, bizarre behavior, and suicidal ideation usually result in a trip to jail or a psychiatric hospital.  Once stabilized, the individual is discharged with a prescription, not medication, usually back to the street or a homeless shelter (Munetz & Geller, 1993).  Without access to transportation, or the money to refill their medications, the newly discharged patient frequently goes untreated.  This generally results in the patient relapsing into another psychotic break, thoughts of suicide, and a subsequent re-hospitalization.  Not only is this less than ideal for the patient, but the cost of the hospitalizations are also passed on to taxpayers.  But the risk of suicide is the greatest tragedy of all.  

Bipolar disorder, alcohol use disorder, and substance use disorders are serious and recurrent mental health conditions that have poor treatment outcomes; medication non-adherence is common in this population.  As a result, a significant burden is placed on public health and social security disorder.  When alcohol and substance abuse are combined with a mood disorder there is an increased risk of hospitalization, a longer period of time to symptom remission, and an increased risk of violence.

 More alarming is that comorbidity of bipolar disorder and substance/alcohol abuse disorder may also increase the likelihood of suicide attempts.  Suicide is a critical risk factor for those individuals diagnosed as bipolar; suicide attempt rates range fr4om 25% to 65%, and of that 10 % to 15% are completed suicides.  Bipolar individuals who were physically or sexually abused in childhood, have a family history of suicide, are single, and have alcohol or drug dependence have been clearly identified as being at high risk of a suicide attempt (Carrà, Bartoli, Crocamo, Brady, & Clerici, 2014).

  Because of the extremely high risk of suicide attempts in those with mood disorders and an alcohol/substance abuse disorders, an ongoing assessment of suicide risk is an essential part of management.  Early age onset, a history of depressive episodes, and a family history of suicidal behavior can help identify subgroups at risk.  Attention should be given to the individual’s social network, living conditions, and employment status as isolation, homelessness, and lower socioeconomic status increase risk.  Prevention, early detection, and aggressive treatment of alcohol/substance abuse disorders in individuals with bipolar are imperative to reduce suicidality.  

   Medication management with mood stabilizers should begin as soon as possible (Bellivier et al., 2011).  Lithium treatment can decrease impulsivity and reduce the risk of suicide.   Integrated Group Therapy has shown effectiveness in decreasing recovery and relapse

A mood disorder is a psychological condition in which an individual has an abnormal fluctuation of mood which can be disruptive to the lives of those diagnosed with them.  Not surprisingly, there is a strong connection between those with a mental disorder and drug abuse as the individual attempts to self-medicate and escape the distressing symptoms being encountered.   

Drug use and mental illness have several overlapping commonalities; there is a strong connection between those with a mental disorder and drug abuse as the individual attempts to self-medicate and escape the distressing symptoms being encountered.

  Isolation and broken homes are common amongst both those afflicted with drug addiction and mental illness as the family becomes exhausted emotionally and financially from dealing with their mentally ill loved one.  Homelessness, substance use, and mental disorders have also been associated with high rates of emergency department (ED) use and hospitalization.  Without employment or the emotional support of loved ones, the threat of homelessness is a reality for those who have alcohol and/or substance abuse disorder and the mentally ill alike.  Bipolar disorder, alcohol use disorder, and substance use disorders are serious and recurrent mental health conditions that have poor treatment outcomes; medication non-adherence is common in this population.  

The importance of identifying biomarkers or genetic risk factors for mood disorders cannot be understated for discovering better treatments for mood disorders.  Because of the extremely high risk of suicide attempts in those with mood disorders and an alcohol/substance abuse disorders, an ongoing assessment of suicide risk is an essential part of management.  

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