For many people, prescription and illicit drug abuse is inextricably tied to mental illness, forming a kind of feedback loop where one influences and worsens the other.
“A very large percentage of folks with a mental health issue have substance-abuse issues and vice versa,” said Matt Patten, chief clinical officer at Cascade Mental Health Care.“You think about drugs being mood altering substances and the treatment for a mental illness is a mood altering substance.”
In a common scenario, Patten said, a person starts with a perception that they’re different somehow from other people, but taking drugs makes them feel better, at least as long as the high lasts.
“You’re not dealing with the issue, where the problem developed in the first place. Now you’re adding a whole range of problems,” he said.
While drug users might have the right idea — using a mood-altering substance to treat mental illness — self-medication with drugs of any kind, including alcohol, caffeine, prescription pain pills and particularly illicit drugs such as methamphetamine and heroin, is an inexact science.
“Self-medication is a huge part of the problem,” Patten said. “You never know exactly what you’re getting, how much you’re getting, or keeping yourself on a dosing schedule.”
Dr. Patrick O’Neill, a retiring ER doctor at Providence Centralia and Lewis County medical program director for West Region Emergency Medical Services and Trauma Care Council, said he has seen people with psychotic disorders self-medicating with methamphetamine, which he said was counterintuitive since meth is a stimulant.
“Maybe we don’t understand schizophrenia as well as we think we do,” he said. “We’re seeing more of the people who have psychiatric illnesses … using meth.”
Patten said many other examples of self-medication actually work against the mental disorder, making it worse in the long or short term. It is common, he said, for depressed people to use alcohol in attempt to treat their depression. However, alcohol is a nervous-system depressant, and can negate traditional treatments.
“If I have a glass of wine, that has an effect on my central nervous system,” he said. “If I’m prone to depression, that could cause problems.”
Heroin and prescription opiate-based pain pills are also depressants, and become self-medication tools. Some users think pain pills are inherently safer than illicit drugs because they are regulated and come with prescriptions from doctors, Patten said.
“Frankly it’s a higher quality medication than they get on the streets. That ends up being a problem as well,” he said. “Our community, our state, has done a pretty good job on controlling who these medications are prescribed to.”
Steven Freng, prevention and treatment manager for the Northwest High Intensity Drug Trafficking Area and a doctor in psychology, said many people focus on the physically addictive nature of drugs, but said there’s another part to the story. Prescription opiates can give users an emotional state of well being, that is, until they wear off.
“People think it’s the emotional side of the drug that’s more addictive than the physical,” he said, at a meeting last month in Morton.
In some cases, drug use can worsen an undiagnosed mental disorder, or create one on it’s own. For example, Patten said, drug use could potentially bring on psychotic symptoms in someone prone to schizophrenia.
Long-term use of methamphetamine is associated with a number of medical conditions, O’Neill said, such as methamphetamine psychosis, which causes hallucinations and delusions.
“Usually meth will wear off in a matter of hours,” O’Neill said. ”Some of these people (who) do a lot of meth, you’re still dealing with the effects of this, their mental state, 24 hours later.”
Other, more innocuous drugs can still cause lasting psychiatric problems, Patten said. While some people use marijuana to deal with anxiety, prolonged, long-term use of the substance has been shown to induce anxiety in some patients, he said.
“We even have worries about legal substances having an impact on a person’s mental health,” he said.
Even common substances such as caffeine can lead to serious psychiatric conditions. High levels of caffeine in a person’s diet upset sleep patterns and can lead to depression. In people prone to psychotic disorders, high levels of caffeine could cause hallucinations, Patten said.
Given the complicated relationship of drugs, addiction and mental health, Patten said there isn’t a silver bullet to defeat a drug problem. As long as there are drugs, people will use them, he said.
Freng echoed that sentiment at his presentation in Morton, but said he’s “not hopeless.”
“The most cost-effective way to do it is prevention,” he said.
