A Beginner’s Guide to the Rx Drug Abuse Epidemic in America
Part 4: The Mental Health Factor
The same stereotypes that keep us from viewing substance addiction as an illness instead of a character flaw also keep us from seeing the root cause of these addictions. For many, addiction is paired with mental illness.
A 2011 Huffington Post article1 states that, according to Dr. Harold Koplewicz, child and adolescent psychiatrist and president of the Child Mind Institute, untreated mental illness can lead to drug abuse. When someone is diagnosed with both a mental illness and substance abuse, it’s called having co-occurring disorders, or a Dual Diagnosis.
In the article,1 Dr. Koplewicz says, “I think we are making great progress in the fight against the stigma of mental illness—a fight that is necessary to ensure that people of any age with psychiatric or learning disorders feel comfortable getting the care they need.”
Becoming more familiar with these mental illnesses and how they can contribute to substance abuse is paramount to providing treatment that can heal the whole person. Any stigma still connected with mental illnesses or substance addiction continues to prevent people from choosing life-saving treatment options.
Self-Medicating with Prescription Drugs
For fear of recognizing and admitting these illnesses, some people will try to “fix” themselves by self-medicating. Our fast-paced and stressed world is always looking for a quick fix. Choosing to take the long way to healing, even if it would be better in the end, is not the preferred option. When it comes to mental health, it’s the same. Instead of seeking medical or psychological attention, many are turning to prescription drugs to treat diagnosed and undiagnosed issues for everything from anxiety to bipolar disorder.
It’s become an impulse reaction for many to reach for a pill bottle to quickly soothe an illness when it appears. After marijuana, abuse of pain relievers is now the second most common2 type of illicit drug use.
Self-medicating with these drugs can be a very dangerous situation. What Dr. Koplewicz terms a maladaptive coping mechanism,1 this type of self-medicating is often the first step to serious drug abuse.
Proposed by E J. Khantzain in the ’80s, the self-medication model states that “pre-existing mental disorders3 are a significant cause of substance use.” It goes on to explain that people chose these drugs because they lessen the painful feelings associated with their mental illnesses.
So with a trip to the doctor for a prescription to deal with depression or anxiety, many believe that they’re taking a healthy approach to their problem. If a doctor prescribes it, it should be safe. Right?
A 2010 Forbes article2 quotes Paul Doering, professor in the Department of Pharmacotherapy and Transitional Research at the University of Florida College of Pharmacy: “Many people equate taking medication with getting better. My mantra when it comes to prescription is ‘less is more’ for a lot of reasons—not only financial, but also because those drugs can hurt you sometimes.”
The Nature of a Dual Diagnosis
But even though we’re becoming more open about mental illness, pairing it with addiction resurrects all our old thoughts about shame and stigma. We forget that addiction is also in fact an illness.
To fully treat this sometimes volatile pairing, we have to understand the dangers that accompany people with these issues.
According to the National Alliance on Mental Illness,4 people diagnosed with co-occurring disorders have a statistically greater propensity for violence, medication noncompliance and failure to respond to treatment than those with just substance abuse or a mental illness. When left untreated, there is also a greater chance of relapse, homelessness and incarceration. An estimated 50 percent of homeless adults4 with a serious mental illness have a co-occurring substance abuse disorder, and an estimated 16 percent of inmates have severe co-occurring disorders.
To combat these serious issues, many treatment facilities are changing to include Dual Diagnosis treatment programs. When addressing only the mental illness or the substance abuse, the patient will be bounced back and forth between facilities or may even be refused on each side because of the other issue. Research has shown that for someone with co-occurring disorders, Dual Diagnosis treatment4—also known as integrated treatment—offers a better chance of finding lasting recovery.
According to posts by the Journal of the American Medical Association,4 roughly 50 percent of individuals with severe mental health disorders are affected by substance abuse, and of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs. With these kinds of percentages, it’s easy to see why integrated treatment facilities are becoming more popular in the treatment field.
“The bottom line is that addiction is an illness that we are able to treat and manage, if not cure, provided that we focus on the person with the addiction, the family and the community—a holistic approach to a sprawling problem,” says Dr. Koplewicz in the 2011 Huffington Post article.1 That holistic approach is exactly how these Dual Diagnosis facilities are taking action.
When done correctly, an integrated treatment program will not only help bring healing to the addicted person, but also to that individual’s family and friends. With an approach that treats the whole person, these programs not only include the psychological side of recovery, but also the physical side with diet, exercise and social aspects.
Some key factors in an effective integrated treatment program can include education, case management, sessions on creating healthy relationships, Motivational Interviewing, counseling, long-term community building and life skills courses.
With all this experience, help and support, patients with co-occurring disorders are equipped with the perfect mix of tools to create and lead healthy, sober lives. So what can we do to help them—and ourselves as well? We’ll have to start spreading the word.
You May Want to Know:
 “Drug Addiction: Stigma Paints It as a Choice, Not a Mental Illness.” Dr. Harold Koplewicz. The Huffington Post. Posted May 11, 2011. HuffingtonPost.com. Accessed November/December 2013. http://www.huffingtonpost.com/dr-harold-koplewicz/is-drug-addiction-mental-illness_b_858815.html
 “The Most Medicated States.” Nathalie Tadena. Forbes Magazine. Posted August 16, 2010. Forbes.com. Accessed November/December 2013.
 “Medication Assisted Treatment for Opioid Addiction in Opioid Treatment Programs.” Chapter 12: Treatment of Co-occurring Disorders. Treatment Improvement Protocol (TIP) Series, No. 43. Center for Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. NCBI.NLM.NIH.gov.
 Dual Diagnosis and Integrated Treatment of Mental Illness and Substance Abuse Disorder. Reviewed by Robert Drake, MD, September 2003. National Alliance on Mental Illness. NAMI.org. Accessed November/December 2013.