Substance-Related and Addictive Disorders: A Special Case
Substance-Related and Addictive Disorders: A Special Case
Substance-Related and Addictive Disorders: A Special Case
COMORBID DISORDERS
Frequently, a person who is addicted to drugs and/or alcohol has an additional psychological disorder. Saying a person has comorbid disorders means the individual has two or more diagnoses. This can often be a substance-related diagnosis and another psychiatric diagnosis, such as depression, bipolar disorder, or schizophrenia. These individuals fall into the category of mentally ill and chemically addicted (MICA)—their problems are often chronic and expensive to treat, with limited success. Compared with the overall population, substance abusers are twice as likely to have a mood or anxiety disorder. Drug abuse can cause symptoms of mood and anxiety disorders and the reverse is also true—people with debilitating symptoms of a psychiatric disorder may self-medicate and abuse substances.
In cases of comorbidity, the best treatment is thought to address both (or multiple) disorders simultaneously (NIDA, 2012). Behavior therapies are used to treat comorbid conditions, and in many cases, psychotropic medications are used along with psychotherapy. For example, evidence suggests that bupropion (trade names: Wellbutrin and Zyban), approved for treating depression and nicotine dependence, might also help reduce craving and use of the drug methamphetamine (NIDA, 2011). However, more research is needed to better understand how these medications work—particularly when combined in patients with comorbidities.
Summary
Addiction is often viewed as a chronic disease that rewires the brain. This helps explain why relapse rates tend to be high, around 40%–60% (McLellan, Lewis, & O’Brien, & Kleber, 2000). The goal of treatment is to help an addict stop compulsive drug-seeking behaviors. Treatment usually includes behavioral therapy, which can take place individually or in a group setting. Treatment may also include medication. Sometimes a person has comorbid disorders, which usually means that they have a substance-related disorder diagnosis and another psychiatric diagnosis, such as depression, bipolar disorder, or schizophrenia. The best treatment would address both problems simultaneously.
QUESTIONS DESCRIPTION
Recognize the goal of substance-related and addictive disorders treatment
Discuss what makes for effective treatment
Describe how comorbid disorders are treated
1. You are conducting an intake assessment. Your client is a 45-year-old single, employed male with cocaine dependence. He failed a drug screen at work and is mandated to treatment by his employer if he wants to keep his job. Your client admits that he needs help. Why would you recommend group therapy for him?
2. What are some substance-related and addictive disorder treatment facilities in your community, and what types of services do they provide? Would you recommend any of them to a friend or family member with a substance abuse problem? Why or why not?
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