Rep. Patrick Kennedy’s release from drug rehab puts a limelight on people suffering from a trying combination of health problems: the abuse of substances and a mental health disorder.
Kennedy - the son of Senator Edward Kennedy – appeared in a rehab clinic in May 2006 after a car accident near the American Capitol. According to the younger Kennedy, he did not remember the incident; he also admits he had taken medicines normally prescribed him for sleep problems and to control nausea.
After his release from rehab, Kennedy informed the reporters that he suffers from serious addiction and bipolar disorder.
Physicians admit that they more and more frequently see patients from all walks of life who suffer from a combination of substance abuse and mental health problems. According to experts’ estimates, at least 60 per cent of people battling one of these conditions are struggling with both of them.
"Mental health problems and the abuse of substances are frequently met together due to the fact that one makes you more susceptible to the other," explains Alan Manevitz, MD, a psychiatrist with New York-Presbyterian Hospital, Cornell University campus, in New York.
Mental health problems are very common in the United States. According to estimates, one in five adults in America suffers from a diagnosable mental disorder, according to the National Institute of Metal Health.
When there is a biological or genetic susceptibility to any type of mental health problem, no matter of how big or small, Manevitz claims, substance use frequently triggers the beginning of such a problem.
"The substance is not truly causing the mental health condition, however it can be a precipitating factor that leads to the condition to manifest," Manevitz explains to WebMD.
"In this respect, the mental health problem is already actively present when the substance abuse starts, however the patient is not aware of it - the problem is driving the addiction, it just has not yet been recognized or diagnosed," Manevitz tells WebMD.
It is, actually, the growing awareness of this dual diagnosis that has opened the door to a whole new line of thinking about substance abuse and mental health problems at the same time. Indeed, some specialists contend that particular forms of mental diseases and some addictions may, actually, be a single illness.
Among the areas where these studies are most prominent is a condition known as bipolar disorder - a disease characterized by cycles of tremendous mood swings: from deep depression to high elation, or even mania. In the course of mania periods, patients demonstrate extreme irritability, racing thoughts, very little need for sleep, poor judgment, distractibility, drug abuse, and denial that anything is wrong. Depressive periods are connected with feelings of hopelessness, guilt, too much sleep, and thoughts of death or even suicidal attempts.
"What we have already discovered is that patients with bipolar disorder, especially women, have an extremely high rate of alcoholism - up to seven times that of the general population," explains Mark Frye, MD, director of the UCLA Bipolar Disorder Research Program in Los Angeles.
That’s also true, claims Frye, when both male and female bipolar patients are compared to patients with other forms of mental diseases.
And whilst the reason is still not exactly clear, Frye explains to WebMD that there is at least some evidence that the two conditions share a lot of similarities.
And that’s true: while the age of "brain science" continues to mature, a number of scientists have started to observe some startling similarities within the brain chemistry patterns of different types of mental health problems and substance abuse. Some of the fascinating discoveries had to do with animal models of addiction.
"The studies conducted on rats revealed that there were certain pleasure centers of the brain that, when they were stimulated, drew out such a powerful response, the animal would opt for stimulation over food," claims Francis Hayden, MD, associate director of the division of Alcohol and Substance Abuse at Bellvue Hospital in New York.
This finding, he claims, made many scientists consider whether there was anything different about the brains of substance abusers that "causes them to kind of feel not quite right - so that when they happen upon a substance, it kind of normalizes them in a way," explains Hayden.
He claims that that feeling of "not quite right," may be the mental health problem at work.
Another suggestion that they may be one disease: research that proves that when one condition becomes worse, the other worsens as well shortly after.
"In someone who suffers from both a mental disease and a substance abuse problem, almost without any exception, an addiction relapse is going to worsen the mental health problem, and when the mental health problem goes untreated, or declines, it makes them more vulnerable to renewing addictive behaviors," claims Kenneth Skodnek, MD, chairman of the department of psychiatry and psychology and director of the addiction service at Nassau University Medical Center in East Meadow, N.Y.
Moreover, Skodnek claims that it is obvious that activation of one problem very often activates the other in those patients who are vulnerable.
Finding the Effective Treatment
Whether the mental health problem - or the drug use - came first, physicians claim that good mental health can’t triumph until both problems are fully treated. The best way to achieve this, though, is still a matter of some discussion.
"When the two disorders exist at the same time, you often need to address the substance abuse issue immediately due to the fact that if somebody is intoxicated, they have to be detoxed," Frye explains to WebMD. Without that component in place, he claims, beginning therapy may be very complicated.
According to Frye, although this approach looks good on paper, the reality is not always so easy to accomplish. Frye claims that the very process of detoxification, can frequently leave an addict feeling so raw and defenseless that their mental health situation worsens sharply – which, in turn, may easily cause the substance abuse problem to quickly return as well.
"There is a relatively small window of opportunity in which to get the mental health problem under control by the time the patient comes back into substance abuse," claims Frye.
Due to this, a lot of healthcare providers are now turning to a dual treatment approach - a program that puts together detoxification of addictive substances with simultaneous identification and treatment of any coexisting mental health problems.
"This approach can be especially effective due to the fact that even if you get a clear history of a patient, even if you are sure that the substance abuse resulted in the mental disease, or vice versa, treating the first problem does not automatically leads to the cessation of the second problem, " claims Hayden.
Unluckily, the dual approach is still regarded as specialized, and often only available in expensive private hospitals. According to specialists, another best thing, is to integrate patient care among the professionals dealing with each part of the disease.
"If one physician or clinic is treating the mental disease and another is dealing with the addiction, there has to be some kind of synchronized effort in order to get both problems under good control," explains Manevitz.
When the patient is unable to synchronize that care on their own, the specialists claim that family members ought to intervene to make sure that all the physicians involved work together.
However, what happens if there is a relapse - of either the addiction or the mental health problem?
Healthcare providers claim that a slip up in one area often results in a decrease in the other area as well – however, this doesn’t mean that the patient is doomed to repeat their destructive behaviors for an indefinite period. The answer, claims Hayden is the development of a physician-patient alliance that both can trust.
"The main objective is to involve in a true therapeutic alliance between healthcare provider and patient, in order to establish a rapport that is strong enough and honest enough so that the patient informs the doctor what they are really up to," claims Hayden.
If this is the case, the specialists claim that relapses of both the mental health problem and the substance abuse can frequently be circumvented in the earliest, most easily treated stages - or some cases, even prevented from arising at all.
