In this segment, Dr. Sims discusses the difficulty in treating mental illness when drugs and alcohol complicate the clinical picture.
She will also discuss the increase in heroin use and the ongoing problem with methamphetamine and other illicit substances.
Selected Podcast
Co-occurrence of Mental Illness and Substance Abuse
Featured Speaker:
R. Nicole Sims, MD
Dr. Sims received her medical degree and completed her psychiatry residency at Indiana University School of Medicine in Indianapolis. Dr. Sims previously worked at St. Vincent Hospital, St. Elizabeth Hospital, Options Behavioral health , Catharsis Counseling and at Bloomington Meadows Hospital. Her awards include the Roger K. Jackson, MD Award for outstanding contribution to residency development and the Patricia Sharpley Senior Psychiatry Medical Student Award. Dr. Sims’ areas of interest include CBT, personality disorders and addiction/dual diagnosis. Transcription:
Co-occurrence of Mental Illness and Substance Abuse
Melanie Cole (Host): This is Melanie Cole sitting in for Bill today. Mental illness is a very complicated and challenging illness. When complicated with substance abuse, it can be even more difficult to manage. My guest today is Dr. Nicole Sims. She’s a psychiatrist at Centra Health. Welcome to the show, Dr. Sims. Tell us a little bit about the connection between mental illness and substance abuse.
Dr. Nicole Sims (Guest): Those who have mental illness do have a higher risk of engaging in illicit substance use. The difficulty that we have at times is that when people do come to us and they are acutely intoxicated or have a long history of substance use, it’s difficult for us to discern what is their primary mental illness. Is that of substance use or something else going on? People who have depression increase risk for alcohol use. Same with bipolar disorders, same with schizophrenia.
Melanie: Are there certain drugs that trigger mental health symptoms? And it’s kind of a vicious circle, so how do you know?
Dr. Sims: That’s a very good question. It’s very difficult to know. My personal opinion is that you really can’t tell what’s wrong with somebody unless they are sober for a great length of time. Usually, cannabis or marijuana use tends to trigger a lot of paranoia, even hallucinations. Some people who have early onset schizophrenia or the schizophrenic symptoms that start in their youth tend to turn to illicit substances like marijuana to help, for lack of a better terminology, control their hallucinations or their paranoia, albeit it makes it worse. Those who have bipolar disorder are also well known to abuse alcohol and other substances while they’re in their depressed phase or in their manic phase.
Melanie: Are you seeing an increase in some of the more harder drugs? You mentioned marijuana and alcohol. What about heroin and methamphetamines?
Dr. Sims: Heroin is on the rise now that there’s been legislation placed where physicians are able to prescribe larger amounts of narcotics. Unfortunately, heroin is far less expensive and much easier to come by these days because of that legislation. Methamphetamine is on the rise, and it has created numerous patients who have ongoing paranoia and hallucinations, even as they stop using those types of drugs. But yes, those harder drugs are definitely on the rise.
Melanie: What are some red flags that maybe parents of teens or young adults with mental illness should look for to know that these children who are maybe on some psychoactive medications are using other illicit substances? Is there something they can look for?
Dr. Sims: Definitely a change in behavior. Alcohol is a depressant, so if your child was once an outgoing child who had a lot of activities in school and now they’re trying to withdraw and isolate and tend to be out with their friends more on the weekends. Again, getting themselves into trouble, but they’re definitely a red flag. Any change in your child’s behavior needs to be taken into account. It’s not just growing issues or coming to their own person but distinct changes of behavior, especially agitation, paranoia, and the like.
Melanie: What treatments are available for these individuals with this kind of dual diagnosis of substance abuse and mental illness?
Dr. Sims: There are programs that can address those. Like I said earlier, it’s difficult to really say which came first. Is it the substance or the primary mental illness? And we’re not going to understand that until someone is sober for a good length of time. There are inpatient programs that can address both. Even here at Centra Health, our inpatient unit does address both of those issues, primarily the mental illness, but we also address the substance use as well, mainly detoxification syndrome and the like.
Melanie: What are some of the other complications, Dr. Sims, that can go with this dual diagnosis if somebody is?
Dr. Sims: A lot of times, the primary mental illness is not treated because it can be written off as a side effect of ongoing substance use. People who do have genuine depression or bipolar disorder or schizophrenia may not have access to those treatments because they’re written off as someone who does have substance abuse problem. The other side of that is people who do have a substance use problem, unless they want to engage in sobriety, you can’t force somebody to do that. They can continue to use whatever substance, and their lives spiral out of control and we can’t really stop that, unfortunately.
Melanie: Are there things that they can do at home—diet and exercise—any of these kinds of things that can help with this treatment as an adjunct?
Dr. Sims: Absolutely. Anytime a person takes more care of themselves physically, it will improve their overall mental health as well. Unfortunately, a lot of our patients who do have chronic mental illness or even depression and whatnot, their self-care takes a back seat to -- and also to their substance use as well. Many times people come in here, and they will tell us that they can’t afford medications. However, they are perfectly capable of going out and drinking every evening, or they can obtain cocaine, marijuana, methamphetamines, but their medications and going to the doctor are far down on their list. If people do make their self-care a priority, then yes, they could improve dramatically.
Melanie: Dr. Sims, recap for us the difficulty in treating people with substance abuse that also have mental illness and why they should consider coming to Centra for their care.
Dr. Sims: Absolutely. The difficulty is it’s difficult for us to know what is the primary issue as long as somebody is actively using any kind of substance. We have a clear picture when somebody is able to maintain sobriety for at least six months to a year, allowing their bodies to heal from whatever substance they have been abusing. The difficulty is that we can’t force somebody into sobriety. We have a lot of people who come to us with intoxication issues or ongoing substance use issues who don’t want to quit. So we’re kind of chasing our tails, so to speak, to treat a depression when somebody is using a depressant every day or trying to treat psychosis when somebody is using drugs that can make them paranoid or hallucinate. My professional opinion, we do need to make the priority having these people have their sobriety come first. We can treat the mental illness along the way. But until that sobriety is in place, it would be very difficult for us to do so. We here at Centra, we do have our Pathways Rehabilitative Services, which is a 30-day rehab program to address the sobriety aspect. Then we have outpatient services as well as partial or day hospital programming. There’s also our acute services to address other mental health problems.
Melanie: Thank you so much. It’s really great information, very helpful. You’re listening to Central Healthy Radio. For more information, you can go to centrahealth.com. That’s centrahealth.com. This is Melanie Cole, sitting in for Bill Klaproth. Thanks for listening.
Co-occurrence of Mental Illness and Substance Abuse
Melanie Cole (Host): This is Melanie Cole sitting in for Bill today. Mental illness is a very complicated and challenging illness. When complicated with substance abuse, it can be even more difficult to manage. My guest today is Dr. Nicole Sims. She’s a psychiatrist at Centra Health. Welcome to the show, Dr. Sims. Tell us a little bit about the connection between mental illness and substance abuse.
Dr. Nicole Sims (Guest): Those who have mental illness do have a higher risk of engaging in illicit substance use. The difficulty that we have at times is that when people do come to us and they are acutely intoxicated or have a long history of substance use, it’s difficult for us to discern what is their primary mental illness. Is that of substance use or something else going on? People who have depression increase risk for alcohol use. Same with bipolar disorders, same with schizophrenia.
Melanie: Are there certain drugs that trigger mental health symptoms? And it’s kind of a vicious circle, so how do you know?
Dr. Sims: That’s a very good question. It’s very difficult to know. My personal opinion is that you really can’t tell what’s wrong with somebody unless they are sober for a great length of time. Usually, cannabis or marijuana use tends to trigger a lot of paranoia, even hallucinations. Some people who have early onset schizophrenia or the schizophrenic symptoms that start in their youth tend to turn to illicit substances like marijuana to help, for lack of a better terminology, control their hallucinations or their paranoia, albeit it makes it worse. Those who have bipolar disorder are also well known to abuse alcohol and other substances while they’re in their depressed phase or in their manic phase.
Melanie: Are you seeing an increase in some of the more harder drugs? You mentioned marijuana and alcohol. What about heroin and methamphetamines?
Dr. Sims: Heroin is on the rise now that there’s been legislation placed where physicians are able to prescribe larger amounts of narcotics. Unfortunately, heroin is far less expensive and much easier to come by these days because of that legislation. Methamphetamine is on the rise, and it has created numerous patients who have ongoing paranoia and hallucinations, even as they stop using those types of drugs. But yes, those harder drugs are definitely on the rise.
Melanie: What are some red flags that maybe parents of teens or young adults with mental illness should look for to know that these children who are maybe on some psychoactive medications are using other illicit substances? Is there something they can look for?
Dr. Sims: Definitely a change in behavior. Alcohol is a depressant, so if your child was once an outgoing child who had a lot of activities in school and now they’re trying to withdraw and isolate and tend to be out with their friends more on the weekends. Again, getting themselves into trouble, but they’re definitely a red flag. Any change in your child’s behavior needs to be taken into account. It’s not just growing issues or coming to their own person but distinct changes of behavior, especially agitation, paranoia, and the like.
Melanie: What treatments are available for these individuals with this kind of dual diagnosis of substance abuse and mental illness?
Dr. Sims: There are programs that can address those. Like I said earlier, it’s difficult to really say which came first. Is it the substance or the primary mental illness? And we’re not going to understand that until someone is sober for a good length of time. There are inpatient programs that can address both. Even here at Centra Health, our inpatient unit does address both of those issues, primarily the mental illness, but we also address the substance use as well, mainly detoxification syndrome and the like.
Melanie: What are some of the other complications, Dr. Sims, that can go with this dual diagnosis if somebody is?
Dr. Sims: A lot of times, the primary mental illness is not treated because it can be written off as a side effect of ongoing substance use. People who do have genuine depression or bipolar disorder or schizophrenia may not have access to those treatments because they’re written off as someone who does have substance abuse problem. The other side of that is people who do have a substance use problem, unless they want to engage in sobriety, you can’t force somebody to do that. They can continue to use whatever substance, and their lives spiral out of control and we can’t really stop that, unfortunately.
Melanie: Are there things that they can do at home—diet and exercise—any of these kinds of things that can help with this treatment as an adjunct?
Dr. Sims: Absolutely. Anytime a person takes more care of themselves physically, it will improve their overall mental health as well. Unfortunately, a lot of our patients who do have chronic mental illness or even depression and whatnot, their self-care takes a back seat to -- and also to their substance use as well. Many times people come in here, and they will tell us that they can’t afford medications. However, they are perfectly capable of going out and drinking every evening, or they can obtain cocaine, marijuana, methamphetamines, but their medications and going to the doctor are far down on their list. If people do make their self-care a priority, then yes, they could improve dramatically.
Melanie: Dr. Sims, recap for us the difficulty in treating people with substance abuse that also have mental illness and why they should consider coming to Centra for their care.
Dr. Sims: Absolutely. The difficulty is it’s difficult for us to know what is the primary issue as long as somebody is actively using any kind of substance. We have a clear picture when somebody is able to maintain sobriety for at least six months to a year, allowing their bodies to heal from whatever substance they have been abusing. The difficulty is that we can’t force somebody into sobriety. We have a lot of people who come to us with intoxication issues or ongoing substance use issues who don’t want to quit. So we’re kind of chasing our tails, so to speak, to treat a depression when somebody is using a depressant every day or trying to treat psychosis when somebody is using drugs that can make them paranoid or hallucinate. My professional opinion, we do need to make the priority having these people have their sobriety come first. We can treat the mental illness along the way. But until that sobriety is in place, it would be very difficult for us to do so. We here at Centra, we do have our Pathways Rehabilitative Services, which is a 30-day rehab program to address the sobriety aspect. Then we have outpatient services as well as partial or day hospital programming. There’s also our acute services to address other mental health problems.
Melanie: Thank you so much. It’s really great information, very helpful. You’re listening to Central Healthy Radio. For more information, you can go to centrahealth.com. That’s centrahealth.com. This is Melanie Cole, sitting in for Bill Klaproth. Thanks for listening.