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Substance Abuse and Mood Disorders
There is a correlation between the abuse of substances and the diagnosis of mood disorders. However, it is not always clear whether the mood disorder triggered the substance abuse or the substance abuse triggered the mood disorder.
While exploring these concepts, share your answers to the following questions:
- There is a difference between a mood disorder that a person is self-treating by abusing substances versus mood disorder symptoms that are caused by the abuse of substances. How might you distinguish between the two?
- Some therapists will not treat a person who is abusing substances until he or she stops using the substance, while others believe you have to address the other issues to get the substance abuse to stop. If you are faced with a client who has a mood disorder and abuses alcohol, which issue do you think should be addressed first? Why?
The prevalence of comorbid alcohol, other drug, and mental disorders in the US total community and institutional population was determined from 20,291 persons interviewed in the National Institute of Mental Health Epidemiologic Catchment Area Program. Estimated US population lifetime prevalence rates were 22.5% for any non-substance abuse mental disorder, 13.5% for alcohol dependence-abuse, and 6.1% for other drug dependence-abuse. Among those with a mental disorder, the odds ratio of having some addictive disorder was 2.7, with a lifetime prevalence of about 29% (including an overlapping 22% with an alcohol and 15% with another drug disorder). For those with either an alcohol or other drug disorder, the odds of having the other addictive disorder were seven times greater than in the rest of the population. Among those with an alcohol disorder, 37% had a comorbid mental disorder. The highest mental-addictive disorder comorbidity rate was found for those with drug (other than alcohol) disorders, among whom more than half (53%) were found to have a mental disorder with an odds ratio of 4.5. Individuals treated in specialty mental health and addictive disorder clinical settings have significantly higher odds of having comorbid disorders. Among the institutional settings, comorbidity of addictive and severe mental disorders was highest in the prison population, most notably with antisocial personality, schizophrenia, and bipolar disorders. (Regier DA, 1990) When patients are heavy users of psychoactive substances, it is challenging to assess their psychiatric symptoms, which may be independent of their substance use, caused by intoxication or withdrawal, or an expected effect of the substance used. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) of the American Psychiatric Association distinguishes "Substance use disorders" (SUDs), i.e., dependence on or abuse of a psychoactive substance, and "Substance-induced disorders" (SIDs), which are mental disorders caused by substance use, i.e., occurring during a period of heavy use or during the first four weeks of withdrawal. (Anne-Marit Langås, 2011)
Anne-Marit Langås, U. F. (2011). Comorbid mental disorders in substance users from a single catchment area - a clinical study. BMC Psychiatry, 1-25.
Regier DA, F. M. (1990). Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA, 264-283.