In the past, substance use disorders have been considered a reflection of the sufferers’ lack of willpower (Vaughn & Perron, 2012). This assessment does not represent the complete picture however. Approximately 50% of sufferers of severe mental disorders experience problems with substance use (Rosenthal, 2015). We also know from research (Rosenthal, 2015) that the development of mental disorder often precedes the development of a substance use disorder, and that sufferers of different types of mental disorders often use different types of substances. It is widely known that stress can precipitate mental disorder, but research has also demonstrated that stress is a predictor of substance use in young people (Cornelius, Kirisci, Reynolds, & Tarter, 2014). In its Diagnostic and Statistical Manual of Mental Disorders - widely employed throughout the world to establish criteria for mental disorders - the American Psychiatric Association (2013) goes as far as to define substance use as a mental disorder if it meets certain criteria. Genetics is another factor associated with both mental disorder and substance use. Anyone who has had a psychiatric evaluation will likely recall having been asked if there is a family history of mental disorder. Studies have also identified genes that indicate a susceptibility to certain addictions (Vaughn & Perron, 2012).
It should now be apparent that the association between mental disorder and substance use is not as clear cut as it may have been presented in the past. You cannot point the finger at the sufferer and claim it is a lack of willpower that causes their substance use disorder when they are dealing with stressors that other people may not be, as a result of their mental disorder. It simply is not a direct comparison with someone who does not have to manage a mental disorder. As far as the chicken and the egg type argument that exists over which came first, the mental disorder or the substance use disorder goes, it has lost its relevance. They may share common root causes which must be addressed in either case, and expert social workers practicing in the field of addictions argue that both conditions should be treated as a primary condition (Vaughn & Perron, 2012).
One of the models of substance use disorders is known as the self-medication model. In this theory, individuals consciously or unconsciously resort to substance use for relief from the symptoms of their mental disorders (Vaughn & Perron, 2012). That sufferers of different mental disorders tend to use different substances (Rosenthal, 2015) seems to support this model. When considering the implications of this model, it may be useful to reflect on the fact that the main thing that differentiates a medicine and an illegal drug is a relatively arbitrary declaration. Many of the substances used may in fact be substances that are, or have in the past been, used to treat the conditions they are seeking to self-medicate. Chemically what a substance user buys on the street probably is not very different to what is dispensed from a pharmacy. In this model, the assumption is that if the underlying mental disorder is addressed the substance use disorder will also cease to be a problem (Vaughn & Perron, 2012). Simply put, the problem is not that the person is using substances, it is that they are not receiving adequate treatment for their mental disorder.
Perhaps as a consequence of the prohibitionist moral model of tackling the problem of substance use, like the lack of will argument, there has arisen a belief in some people that the correct way to tackle the problem for families is to cut off support for the family member concerned. This may work in a circumstance where it is a simple risk versus reward transaction, but in the more complex circumstances such as in the case of a comorbid mental disorder, this approach may create more barriers to recovery than it removes. Experts who have observed familial interactions with dual diagnosis patients recommend a collaborative approach between families, professionals and patients (Rosenthal, 2015).
In conclusion, mental disorders or substance use disorders may occur as a consequence of, response to, or independently of the other. Irrespective of how they are precipitated, they occur with great frequency together, and the recommended treatment approach is to address both together in an integrated treatment plan. Treatments for both mental disorder and substance use disorders may benefit from familial support, but importantly if withdrawing familial support as a response to substance use harms the patients mental disorder treatment, that may also harm the substance use disorder treatment because both need to be addressed together.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Cornelius, J., Kirisci, L., Reynolds, M., & Tarter, R. (2014). Does stress mediate the development of substance use disorders among youth transitioning to young adulthood? American Journal of Drug & Alcohol Abuse, 40(3), 225-229. doi:10.3109/00952990.2014.895833
Rosenthal, R. N. (2015). Dual Diagnosis. New York, NY: Routledge.
Vaughn, M. G., & Perron, B. E. (2012). Social Work Practice in the Addictions. New York, NY: Springer.
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