A "Chicken and the Egg" Dilemma: Mental Illness and Substance Abuse

By Angie McAlister, Office Manager

I have been working and volunteering in the field of substance use disorders and mental health for over 20 years. Recently, I took some refresher classes on substance use disorders to update me on new things going on in the field and to look at the connection between substance use and mental illness.

Listening to the instructor, I couldn’t help but think of the chicken and the egg problem. Did the chicken exist first, or did the egg? In comorbidity - when two disorders or illnesses occur in the same person, simultaneously or sequentially - it’s the same question. Did the substance use lead to the mental illness or did the mental illness cause the substance use? It’s a topic of which there is insufficient information and remains a priority for research at NIDA (National Institute on Drug Abuse) but regardless, correct diagnosis is critical to ensure appropriate and effective treatment. Not knowing or failure to treat a comorbid disorder can jeopardize a patient’s chance of recovery.

I’ve learned in class, though, that there are overlapping symptoms of drug addiction and mental illnesses, making diagnosis and treatment complex. Consumers who have both a substance use disorder and mental illness often have symptoms that are more persistent, severe, and resistant to treatment compared with those who have either disorder alone. Thus,  a fundamental principle of treating comorbidity is to treat both conditions concurrently. However, this can be difficult as a broad array of physicians and healthcare professionals do not have the expertise to address the full range of problems presented. I have observed these difficulties many times in my experiences of working with people who have a co-occurring mental illness and substance use disorder.

I’ve also learned that the greatest number of those needing treatment for comorbidity are in the criminal justice system. It’s estimated that roughly 45 percent of justice-involved individuals in both state and local prisons and jails have a mental health problem along with substance abuse and addiction. Treatment in these settings are greatly lacking even though providing treatment can mitigate the likelihood of an individual with mental illness and substance abuse returning to criminal behavior and/or being re-incarcerated. As an organization, we must continue to advocate for diversion of these individuals from prison or jail into community-based treatment.

I have hope that with better understanding of comorbidity and more training for physicians and mental health professionals to identify and treat these issues, that more people will get the help they need.

To learn more about comorbidity, symptoms, and treatment options, go here.