Transcription:
Substance Abuse and Mental Illness

Melanie Cole (Host): Often those dealing with a substance abuse issue can also have mental health conditions. My guest today is Melissa Salazar. She’s the Program Director of Psychiatric Care at Henry May Newhall Hospital. Welcome Melissa. I would like to start between the link of substance abuse and mental health, have you seen that link a lot in your practice?

Melissa Salazar (Guest): I definitely have unfortunately. Many individuals who develop substance use disorders are diagnosed with a mental disorder and vice versa. There are multiple national surveys that have found about half of those who experience a mental illness during their lives will also experience a substance use disorder. So, yes, I indeed have.

Host: Wow. Is drug addiction in and of itself, considered a mental illness or no?

Melissa: Disturbing a person’s normal hierarchy of needs and desires and substituting new priorities connected with procuring and using drugs. The resulting compulsive behaviors that override the ability to control impulses, despite the consequences are similar to hallmarks of other mental illnesses. And in fact, the DSM which is the definitive resource of diagnostic criteria for all mental disorders includes criteria for drug use disorders. And that distinguishes between two types the drug abuse and drug dependence.

The drug dependence is synonymous with addiction and so, by comparison, the criteria for drug abuse hinges on the harmful consequences of repeated use, but it doesn’t include the compulsive use, the tolerance. For example the needing higher doses to achieve the same effect or withdrawal symptoms that occur when the use is stopped. That can be signs of addiction.

Host: Well we’re talking with you today, so your opinion is what we are going with so, thank you for that answer. Now the big million dollar question. What comes first? Like chicken or the egg. Substance abuse or the mental health problem. If someone has an existing mental health issue; then they are more at risk for substance abuse or not necessarily?

Melissa: Well, the what comes first is a really good question. Substance abuse and mental health disorders such as depression and anxiety are very closely linked and while substance abuse can cause prolonged psychotic reactions; one does not directly cause the other. However, I feel that alcohol and drug abuse can make symptoms of a mental health problem worse. Substance abuse can sharply increase symptoms of mental illness or even trigger new symptoms. Abuse of alcohol or drugs can also interact with medications such as antidepressants, antianxiety pills, mood stabilizers and in turn, it can make them less effective. I’m not sure if I answered your question completely. I apologize.

Host: No, you did. You really did. Because I mean that certainly is the big question if they are more at risk and people turn to alcohol and drugs to self-medicate sometimes, don’t they? If they have depression or anxiety disorders or other mental health issues that could lead them to say well this made me feel better and then addiction could follow.

Melissa: Correct, correct. It’s called cooccurring disorders or even comorbidity disorders. Comorbidity meaning you have two disorders or illnesses that occur within the same person simultaneously or sequentially. And so, that’s important to understand that any one person can have multiple things going on and cooccurring disorders both mental health issues and drug or alcohol addiction have their own unique symptoms that can get in the way of your ability to function at work or school, home life and anything else going on in one’s life.

And to make the situation more complicated; the cooccurring disorders also affect each other. So, when a mental health problem goes untreated, the substance abuse problems usually gets worse. And when alcohol or drug abuse increases; mental health problems usually increase too.

Melanie: What an interesting topic Melissa. So, when someone has an alcohol or drug problem, we look for some red flags and some symptoms of that. Or if they have mental illness, maybe they’ve know about their depression for a few years or anxiety or other issues even schizophrenia anything on the spectrum, there are so many, of those kinds of issues; so how would you know which one is causing those issues that might send up red flags to family, work, loved ones? How do you discern which one is causing the issue?

Melissa: Well, the signs and symptoms of common cooccurring disorders and understanding which is which, for example, common signs of symptoms of depression are feelings of helplessness, and hopelessness, loss of interest in daily activities, loss of energy, your sleep patterns can changes, appetite changes, maybe some concentration problems, anger, some physical pain, reckless behavior and the reckless behavior is typically in more in one sex than the other.

Or common signs of anxiety which is excessive tension and worry, nausea, trembling. It can make us irritable, feeling restless, insomnia and then there’s some signs of mania in bipolar disorder which can be increased energy, decreased need for sleep, some grandiose beliefs, feelings of euphoria or extreme irritation, impaired judgement, hyperactivity, anger or rage. And so, because we don’t understand when a loved one or someone that we care about has a mental illness or substance abuse problem or both or – what we should do is maybe find some treatment for them in how to go about supporting them.

Now finding treatment for them can be contacting a resource of sort. There are plenty of resources out there for substance abuse and mental health issues such as the Substance Abuse and Mental Health Services Administration or SAMSA as some might call it. That’s a good resource and can actually provide you with a facility locator where they can then screen for mental health issue or substance abuse issue.

Here at Henry Mayo Newhall Hospital, we currently have – we currently provide adult inpatient behavioral health care, psychiatric care and hoping to in the future, support the geriatric and maybe some outpatient. But we do have quite a bit of patients that come through with substance abuse issues as well that we refer out. We have plenty of resources and our social workers or care coordinators work diligently in supporting that effort and ensuring that they are discharged to a safe place and a place that’s going really care for their needs.

Host: You make a good point when you say discharge to a safe place. Do you see that mental health patients have more trouble in treatment? Is it harder to keep them in treatment if they’ve got addiction issues and how do you treat both together as you were talking about comorbidities and these things run along side each other, bipolar or mania, whatever it is? And maybe they are also addicted to alcohol or drugs. How do you treat them together? This must be very difficult form or treatment for you clinicians.

Melissa: Yes, I mean it takes time. It takes time and a behavioral health care unit or psychiatric unit like the one here at Henry Mayo we have a significant number of voluntary people and a significant number of involuntary folks that come through. So, we have most times we have a limited amount of time to be able to support them with medication management or with their diagnoses. So, it’s a little challenging, but we do the best that we can in treating both simultaneously, the mental illness and most places – mental illness and the drug addiction.

Here, our primary is the mental illness support. And so when we refer out, we are referring them out to an organization, a facility that can help them with if it’s drug addiction with that, whether it’s residential facility or an outpatient or intensive outpatient or transitional living. And we also care for a lot of our homeless which we discharge to – we try our best to discharge to a safe place as well. And we track that.

Host: What an interesting topic. Really, there is so much to discuss on this. We don’t have a lot of time in these episodes. When you’re treating somebody with substance abuse and a mental illness; if you get a handle on that substance abuse, but the mental illness might be something that they have for their whole life, you know bipolar something that they might have going on and off through their life, but you get a handle on that substance abuse. How does that fit into the picture of treatment?

What do you tell them about maintaining their sobriety while also treating their mental health issues and when you tell us about that, please also speak about how the families can get involved? What you would like families to know about when someone has both of these things which are each and in and of themselves difficult to deal with when you are watching somebody you love, go through that? How can you help the families?

Melissa: Well in helping the families, the most important thing to understand is that it’s not their fault. They didn’t do anything wrong. And that they educate themselves that they learn about their loved one’s mental health problems or substance abuse addiction. And most importantly, to be patient. Recovering from something like this is – doesn’t happen overnight and recovery is an ongoing process and it’s ongoing support for both the family member or loved one and those that they are trying to seek help for.

So, the best way to help someone is to accept what you can and cannot do. You can’t force someone to remain sober. You can’t make someone take their medications or keep their appointments. But what you can do is make positive choices for yourself and encourage your loved one to get help, offer support while making sure that you don’t lose yourself in the process.

And that you are accepting well understanding rather that you did nothing wrong and it is not your fault. Because we tend to think – we tend to look at ourselves first like what did I do wrong, where did I go wrong with my son, my daughter, my sister, my brother, my friend, you know what have you. So, it’s very important to understand that it’s not their fault. We didn’t do anything wrong.

Host: That’s great information and if you were to give us one piece of advice or information for people out there that want to look to a program like you have at Henry Mayo Newhall Hospital or are looking for advice and support; Melissa what would you tell them?

Melissa: I would tell them to be patient and seek guidance. Definitely there are facilities like Henry Mayo where we can give onsite evaluations. We have LPS evaluators that, they are certified in evaluating these kinds of things. And we – everyone gets evaluated that comes through our doors. So, definitely just being patient and assist your loved one in trying to get that support.

Host: It’s great information and again, I say what a fascinating topic and it’s something that we’re dealing with so much in the country today and it really is sad to see, but there is hope out there and you’ve given us that Melissa. Thank you so much for joining us today. You’re listening to It’s Your Health Radio with Henry Mayo Newhall Hospital. For more information, please visit www.henrymayo.com, that’s www.henrymayo.com. This is Melanie Cole. Thanks for tuning in.