2.4 Concurrent disorders

We all have mental health, like we all have physical health.  Our mental health is shaped by many factors, including “our social, economic, and physical environments”. ^[1] It can depend on what we are experiencing at any moment, our ability to cope and our ability to be resilient.  Reflect on the reasons why people use substances.  As we have explored, not all substance use will develop into a substance use disorder.  There are many reasons why people use substances, one reason you may not have explored is mental health.  Mental health is one of the social determinants of health, and good or poor mental health does play a role in a person’s substance use.

There are many individual factors that make people vulnerable or resilient to a substance use disorder.^[2] When we look at these characteristics, they may include positive self-image, self-control, or social competence as well as chronic illness, poverty, and homelessness.^[3] You may start to see a connection between mental health and substance use.  There is a direct relationship (sometimes called a correlation) between mental health disorders and substance use disorders.

This is different than someone using a substance because of how they are feeling.  Emotions like happiness and sadness may be a reason why someone uses a substance, for example having a drink at a social event.  The difference between mental health and a mental health disorder, for example, depression, is  that the mental health disorder is a diagnosable illness, like a substance use disorder.  Healthcare practitioners use the DSM-V to diagnose mental health disorders, like substance use disorders. Some of the people you will meet will be living with mental health disorders AND substance use disorders; this may be called a concurrent disorder, or a dual diagnosis.  People who have a concurrent disorder may experience a “combination of problems, such as: anxiety disorder and an alcohol problem, schizophrenia and cannabis dependence, borderline personality disorder and heroin dependence, and bipolar disorder and problem gambling”. ^[4]

Which comes first, mental health or substance use?  There are researchers on both sides of this argument.  According to the Canadian Mental Health Association, “people who experience problems with alcohol or drug use are more likely to be diagnosed with a mental illness and people who experience a mental illness are more likely than others to also experience a substance use problem”. ^[5] What we do know empirically, which means through research and observation, is mental health disorders and substance use disorders are related, regardless of which came first.

Please watch this video by Royal Talks, which helps explain the concurrent disorders and the importance of support for improved health outcomes.^[6]

The risks of developing a substance use disorder if you have been diagnosed with a mental health disorder are high.  According to the Mental Health Commission of Canada, “people living with mental illness are twice as likely as other Canadians to experience problematic substance use”. ^[7]  When we dig further into mental health disorders and look at specific disorders, Buckley et al.^[8] suggest at least 50% of people who have been diagnosed with schizophrenia have a co-occurring substance use disorder.

Mental illness can impact anyone at any time; however, “70% of mental health problems have their onset during childhood or adolescence”^[9] making substance use among youth especially problematic.  If a young person is using substances to reduce the impacts of a mental health disorder, it is critical the mental health disorder be diagnosed early, so the appropriate treatments can be implemented, and the outcomes can improve.  Early intervention programs that diagnose mental health disorders, along with programs to improve mental health, reduce risks for developing a substance abuse disorder.  Promoting mental health, preventing mental health disorders, and preventing substance use are part of Health Canada’s focus on helping to “prevent, treat or reduce the harms associated with opioids, stimulants, alcohol, prescription drugs, and other potentially harmful substances”.^[10]

One way we can support individuals with concurrent disorders is to ensure they have access to appropriate resources, and the resources are working in collaboration.

As Social Service workers it is important to be aware of any diagnosis your client may have.  This will help you direct clients to appropriate services for their health.

Try this quiz to check your learning on Chapter 2 thus far.

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