Mood disorders such as depression, bipolar disorder, anxiety disorders, are so tightly connected to addictive behaviors that it’s difficult to treat one alone and have success with the other. When the mood improves, the addiction can be managed more effectively and vice versa. This is one of the core challenge of the addictionologist.
To be a “Good” addictionologist, one has be an “Expert” at treating a wide variety of psychiatric conditions that increase risk of drinking or drugging. Ashley Halker of INSynergy Rehab Center in St. Louis, Missouri, preaches the importance of this relationship. “Treating and diagnosing accurately depends on the skill and attitude of the treating professional”.
“We are not only expected to be experts at the new discoveries and advancements in the growing science of ad- diction, we are also expected to understand the conditions that independently contribute impulsive behaviors that lead to addiction, relapse, and self medication” adds Halker.
Halker explains that other psychiatric conditions such as ADHD and Bipolar Disorder have tight associations with addiction. Because ADHD and Bipolar Disorder is over-represented in the population of substance abusers, there has to be special attention to understanding of the risks of treatment vs non-treatment in this population.
Bipolar Disorder and Addiction
Bipolar disorder has been one of the most challenging and frustrating psychiatric illnesses to diagnose and treat. Because of its different forms it may ex- press itself, Bipolar can be misdiagnosed as “regular” depression, anxiety, insomnia, personality disorder, and may also be the main factor why many persons struggling with Bi-Polar has substance abuse issues.
According to research, up to 60% of people with Bipolar will have issues with Substance Use Disorders (SUD). Diagnosing bipolar is essential to having a successful rehab experience. This is paramount because some medications that treat “regular” or major depression can actually promote mood destabilization. The group of medications called “Anti-Depressants
” are not indicated to treat Bipolar Disorder alone and treatment guidelines remind us to use caution when using them along with “Mood Stabilizers”.
The concern is that if a Bi-Polar with substance abuse issues complain of depression (which a majority do), an anti-depressant may be prescribed alone. This may cause mania (increased energy with euphoria), depression, insomnia, more anxiety. This in re- turn may cause more self-medication and make rehab treatment difficult and unsuccessful. This cy- cling type of mood in itself is associated with poor outcome.
ADHD and Addiction
Studies have shown associations from 30 to 70% of people with ADHD having co-morbid addictions. There are of course risks that include mis use of stimulants themselves but if you reduce impulsive behaviors, the risk has been shown to decrease in this population.
Understanding the type of depression is also para- mount. The reason is that the treatments for Major Depression and treatments for Bipolar Disorders are very different. Although both may present as de-
pression, treatments are each condition are at “polar opposites”. Many people in substance abuse treatment complain of depression and may get treated with standard anti-depressants. However, if one has a different form of depression, called bi- polar disorder, anti-depressants can actually make things worse and cause more depression, causing more impulsive behaviors, causing a stronger de- sire to self medicate, which ultimately leads to a re- lapse. It is very important to take a thorough family history, screen for bipolar disorder before offering traditional antidepressants.
How Are These Comorbid Conditions Diagnosed and Treated?
The high rate of comorbidity between drug use dis- orders and other mental illnesses calls for a comprehensive approach that identifies and evaluates both. Anyone seeking help for either drug abuse/ addiction or another mental disorder should be checked for both and treated accordingly.
Treatment Should be Integrated!
Specialists including psychiatrists, psychologists, physical health and fitness professionals should work in tandem to make a specific treatment plan for each person.
Addressing mood disorders, the role of medications, and the biology of addictions should be supervised by a Addiction Professional preferably one Board Certified by the American Board of Addiction Medicine (ABAM). Addressing psychological patterns, defenses, personality styles, core recurrent relation- ship themes, and cognitive distortions can be ad- dressed by psychologists.
Sleep, exercise, diet, can all influence emotional tone. Sleep hygiene is an important, non chemical approach, to helping the brain respond in a predictable fashion. Exercise can lift and regulate mood by stimulating natural endorphin release. A good healthy diet also key to helping the body and the brain heal itself.
By Arturo C. Taca, Jr., MD
Diplomate-American Board of Addiction Medicine
Diplomate-American Board of Psychiatry and Neurology
Medical Director- INSynergy
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