Don't Forget About Addiction

Wanda Ramirez was diagnosed with schizophrenia at 26 after a series of psychotic episodes. She moved back in with her family and began smoking marijuana as a means of coping with her symptoms. Over the course of two years, she became relient on the drug to do everything from moving around to cooking and cleaning. She gained 100 pounds in the process.

Wanda’s story is not uncommon, but it does come with a happy ending — recovery. With the help of Brooklyn Community Services and her own self determination, she overcame her drug dependency, removed marijuana from her life and uncovered more productive ways of managing her condition. But for thousands of others around the world, things don’t go nearly as well.

In 2014, 20.2 million adults in the U.S. had a substance use problem, of which 7.9 million were also battling another mental disorder at the same time. These crises often go hand in hand. Those on the mental disorder spectrum frequently turn to alcohol and drugs, both prescription and recreational, to numb the symptoms of their condition. Someone with social anxiety might drink excessively to ease the stress of gatherings. Someone struggling with low energy because of depression might turn to cocaine or other stimulants in order to feel energized and productive. Someone with panic attacks might abuse Xanax or Klonopin to get through the day without an episode.

Studies suggest that people with mood or anxiety disorders are nearly twice as likely as the general population to face substance abuse issues. And the National Bureau of Economic Research reports that people diagnosed with a mental disorder at some point in their lives are responsible for 69% of alcohol consumption, 84% of cocaine consumption, and 68% of cigarette consumption.

It starts out small. A drink before work to lessen anxiety. Then, drinks during the day to fight off the side effects of a hangover. Pretty soon, you’re drinking steadily, day in and day out, in order to feel normal. But the relief is temporary. In the long term, self-medication tends to worsen conditions by exacerbating symptoms and complicating the efficacy of professional treatment.

Unfortunately, this feels like the only option for millions without access to proper care or the knowledge to identify the kind of care they need. Without the support of therapy or regulated prescription drugs, sufferers are left to either ignore symptoms or find affordable options (i.e. recreational substances).

Mental conditions doesn’t just trigger drug use. The inverse is true as well. Addiction can make people with pre-existing conditions experience new symptoms, or change the brain in ways that make it more susceptible to developing a mental disorder.

Further, in understanding the ways in which mental conditions and substance abuse exacerbate one another, it’s crucial to remember that addiction is a mental condition all on its own — a truth many still deny.

People with addictive disorders face tremendous stigma and are frequently blamed for their dependencies. When they do seek help, they often fall victim to “you did this to yourself,” “it’s a choice,” and “if you weren’t so selfish you’d be able to stop.” But addiction is nowhere near as black and white as the general population assumes.

Drug dependency changes the brain in fundamental ways. It rewires the human mind to have overwhelming cravings for a particular substance, altering a person’s priorities and negatively affecting their ability to make decisions, learn, retain memory and control behavior. Over time, a person’s tolerance builds up, forcing them to use more and more of the substance in order to reach baseline. Stopping leads to withdrawal, and comes with tremendous emotional and physical pain.

Science has also shown that individuals can be predisposed to addiction. What’s easy for one person to pass up, may be far harder for someone else. Genetics can and do contribute to the likelihood of developing a reliance, as do other social, psychological, physiological and environmental factors.

Addiction is a disease of the mind, just like schizophrenia, depression or bipolar disorder, and must be recognized and combated as such. Leaving it out of current conversations about mental health and preventative care not only silences the experiences of millions, but disregards components of our mental health crisis that are key to overcoming it.

The support systems that allow individuals to reach recovery for an addictive disorder, are the same ones that help people struggling with other mental conditions — employment, housing, a supportive family, community programs.

Additionally, current failings within mental health treatment will never be accurately addressed without understanding the role that addiction plays in treating comorbid disorders. For instance, helping a patient recover from a substance abuse issue in addition to another mental condition requires highly skilled clinicians who are capable of tailoring treatment to a person’s drug history. Often times, this means treating the addiction prior to starting other necessary therapy.

These needs are not currently being met, both within the U.S. and outside of it. Our healthcare system is not well equipped to handle our existing drug or mental health crises independently, let alone together. So, what do we do?

Early detection and treatment efforts are a big first step. Recognizing and addressing mental conditions in their beginning stages keeps symptoms from worsening, helps people establish a healthy baseline, restores functionality and minimizes long term disability. It also helps keep children and young adults in school, employed, active, and away from drugs and alcohol.

As always, increased access to care is a must. Addiction affects individuals from all socioeconomic groups. However, those in low income communities face far greater barriers to treatment, which can lead to homelessness, incarceration and unemployment.

Other next steps include implementing or strengthening community programs focused on harm reduction — a set of strategies and ideas aimed at reducing the consequences associated with drug use. Harm reduction providers believe that while the end goal is to erratic addiction entirely, there is little benefit in ignoring or condemning the reality of drug abuse in the immediate. To minimize pain, they offer services like naloxone distribution, peer support programs, supervised consumption facilities, and needle distribution/recovery. Housing-first models that provide permanent shelter to the chronically homeless have been shown to improve wellbeing as well.

Lastly, our healthcare system needs to better train practitioners to recognize and address comorbid conditions. Patients shouldn’t be shuffled between care providers that aren’t interested in advancing their overall wellbeing, or are unable to craft holistic treatment plans. They deserve doctors that understand the overlap between addiction and mental health, and can help them reach recovery in healthy, sustainable ways.