Substance Abuse and Mental Health Connections

1. Substance Abuse and Mental Health Connections Carlo C. DiClemente Lippitz Professor of Arts, Humanities, and Social Sciences Psychology Department

2. Overview • Interactions between • alcohol and/or substance use and • emotional and psychological problems • are many and varied. • Epidemiology • Types of interactions • College connections

3. Any Anxiety Disorder Any Mood Disorder Any Impulse Control Disorder Any Substance Disorder Any Disorder Males – 25.4% Females – 36.4% Males – 17.5% Females 24.9% Males – 28.6% Females 21.6% Males – 41.8% Females – 29.6% Males – 58.4% Females 56.5% Lifetime Prevalence - Psychiatric & Substance Abuse Disorders-2007 National Household Survey on Drug Use

4. Any Disorder Any Substance Disorder (SUD) Males - 29.9% Females - 34.7% 18-29 - 43.8% Males - 15.4% Females – 11.6% 18-29 – 22% 12 Month Prevalence - 2007 National Household Survey on Drug Use

5. Models for Interactions • A mental health problem increases the risk for substance use and dependence (secondary substance abuse model) • A substance abuse problem increases the risk for mental health problems (secondary psychopathology model) • Both are caused by a common underlying factor (common factor model) • Whichever one comes first there is an interaction between them so that one influences the other which in turn impacts the first in a negative feedback loop (bi-directional model) • Two independent events (independence model)

6. Mental Health & Substance Abuse • 29% of mentally ill abuse either alcohol or drugs • 47% of individuals with schizophrenia also have a substance abuse disorder (four times the general population) • 61% of individuals with bipolar disorder also have a substance abuse disorder (five times the general population)

7. Substance Abuse and Mental Illness • 37% of alcohol abusers & 53% of drug abusers have at least one serious mental illness • Lifetime Substance Use Disorder doubles the odds for depression • There are significant positive relationships between SUD and both mood and anxiety disorders

8. Secondary Psychopathology:Substance Abuse Causing Psychiatric Disorders • Some substances have reactions that mimic or trigger serious psychiatric symptoms (paranoia, hallucinations) • Some drugs can cause temporary organic brain syndromes (intoxication, blackouts, delirium) • Some drugs can cause or trigger anxiety or depression episodes that last well beyond the drug use.

9. Secondary Substance Abuse Model:Managing Life Stress and Problems • Many individuals try to self medicate psychological and emotional distress with prescription and illegal drug use • Some use drugs to escape from reality • Drugs and alcohol are used to cope with impulse and anger management and contribute to risky behaviors and violence • Some use drugs to enhance performance to meet some difficult goal or to reach some (unattainable?) expectation

10. Common Factors Model: Preexisting Vulnerability or Problems • At times addictive behaviors and mental illness emerge from some common source • Emotional, physical or sexual abuse • Traumatic events • Genetic vulnerability/family heritage • Two elements of a more chaotic lifestyle related to a developing personality disorder

11. Bi-Directional Models • Psychiatric symptoms can more easily be explained when using drugs • Stigma of psychiatric problem is relieved by hanging out with substance abusers which increases substance use which exacerbates psychiatric problem….. • Usually negative spiral of events ensues

12. College Connections: How is This Relevant to College Students • College students come to college with personal experiences with mental illness and substance abuse (direct or indirect) • College is a transformational experience that produces growth and includes stressful experiences that challenge mental and physical health • Family, friends, peers, & mentors offer messages and models about psychological health and substance use that we struggle with

13. How is This Relevant for College Mental Health • Experimenting and exploring our thoughts and behaviors is normative • Learning about strengths and weaknesses, how to cope successfully with failure and success, and what we can and cannot accomplish or tolerate is a critical part of this experience

14. College, Substances, and Stress • Late adolescence (18 – 26) is often a confusing time with unique stressors, significant challenges to our sense of identity & belonging, and experimentation • Substance use can complicate and distort these experiences • Individuals experiencing psychological and emotional problems are at higher risk for abuse and dependence on alcohol and drugs and vice versa • Alcohol and drugs become problems when they are used to cope with stress and manage college tasks

15. Take Away Messages • Be aware of the connections between substance abuse and psychiatric symptoms and syndromes • Individuals who may be abusing substances (including alcohol) may also be experiencing serious emotional or psychological problems • Seek help for yourself or others when the first signs of either or both types of problems emerge • Early intervention is the best way to short circuit the negative interactions no matter which causative model is operative.