Comorbidity & Addiction

 

The topic of this week’s blog is comorbidity. Comorbidity is a term used to describe the occurrence of interacting conditions (National Institute on Drug Abuse, 2020). When discussing comorbidity and benzodiazepine usage it is common to see both mental illness and substance abuse issues occurring within one person but this is because benzodiazepine is a class of medications used to treat many mental disorders alone or with complimenting medications. Mental conditions such as anxiety, depression, sleep disturbances, and post-traumatic stress disorder may be treated using benzodiazepines such as Klonopin, Ativan, and Xanax. These drugs are often abused due to their euphoric, relaxing effects and those with prescriptions to these medications are especially at risk for abuse. Risk factors of both substance abuse and mental illnesses are often similar such as genetic factors, environmental factors such as trauma, or interfamilial influences such as being subject to abuse or neglect as well.

Exploring research regarding comorbidity can aid in understanding which treatment efforts may be better suited for those experiencing a dual diagnosis of a mental condition and substance abuse issues or addictive behaviors. Research can also help us to understand the contributing factors of these collective conditions.

Research article one: Treatment of benzo dependence in methadone maintenance treatment patients

Heroin addiction is a serious issue impacting many families in the US. Many of those struggling with heroin addiction have struggled with opioid addiction as well. What does this have to do with benzo usage? Well, a lot. Research indicated that benzo dependency occurs among heroin users at a rate of 10.5-70% of patients using benzos either along with heroin or during heroin detoxification (Weizman, Gelkopf, Melamed, Adelson, & Bleich, 2003). For three years, over 80 patients admitted to abusing benzos while being treated for heroin dependency. Tapering of benzo usage while participating in methadone treatment for heroin addiction is suggested for best results. Those with psychiatric disorders often find better success with adequate methadone dosing but many find themselves using substances such as alcohol, cocaine, cannabis, and benzos to help ease suffering (Weizman, et al., 2003). This research aids in the understanding of how one substance abuse issue can become another, or a dual addiction. During treatment for heroin addiction, which may have stemmed from opioid addiction, can lead to the abuse of mood-stabilizing medications such as benzos. For those facing mental health issues, this can be especially challenging.

Research article two: Psychopharmacological treatment of pediatric PTSD

PTSD or post-traumatic stress disorder is a psychological condition caused by being exposed to trauma. Childhood maltreatment, neglect, and abuse can lead to the development of PTSD in children and adolescents. This trauma exposure can impact development adversely by developing dissociation, cognition impairment, attachment issues, self-concept development, and more (Naveed, Shaik, Amber, Kumar, & Motiwala, 2020). Those who suffer from PTSD are often treated with antidepressants, mood stabilizers, and antipsychotic medications. While this article addresses the many medications used to help treat PTSD it must be noted that trauma also impacts many other mental conditions as well as substance use risks. Those being treated for PTSD will have early access and exposure to benzodiazepine medications, which could increase the chance for abuse of this drug, and others like it.

For people facing mental conditions as well as substance abuse issues treatments for one may have to come before the other. For example, treating mental disorders such as PTSD can help reduce possible future substance issues. Treating comorbid conditions requires an approach designed with age, drug misuse, mental conditions, and other factors in mind. The National Institute on Drug Abuse (2020) suggests a combination of medications as well as behavioral therapies such as assertive community treatment, dialectical behavior therapy, and cognitive behavioral therapy as an effective measure for comorbid conditions.

References:

National Institute on Drug Abuse. (2020). Comorbidity: Substance Use Disorders and Other Mental Illnesses DrugFacts. Retrieved from https://www.drugabuse.gov/publications/drugfacts/comorbidity-substance-use-disorders-other-mental-illnesses

Naveed, S., Shaik, S. N., Amber, E. F., Kumar, V., & Motiwala, F. (2020). Psychopharmacological treatment of pediatric PTSD. Psychiatric Annals, 50(5), 209-228. doi:http://dx.doi.org.bakerezproxy.palnet.info/10.3928/00485713-20200330-01

Rehab Center. (2020). Comorbidity [Image]. Retrieved from https://visual.ly/community/Infographics/health/substance-abuse-and-mental-illness-content-visual

Weizman, T., Gelkopf, M., Melamed, Y., Adelson, M., & Bleich, A. (2003). Treatment of benzodiazepine dependence in methadone maintenance treatment patients: a comparison of two therapeutic modalities and the role of psychiatric comorbidity. Australian & New Zealand Journal of Psychiatry, 37(4), 458–463. https://doi.org/10.1046/j.1440-1614.2003.01211.x

 

 


Comments

  1. AnonymousOctober 4, 2020 at 8:26 PM

    Karissa, you did a great job at explaining the facts! I never knew that those who suffered from heroin addiction were also so exposed to addiction to benzodiazepines at such a high rate. In the research you provided, it would seem that most heroin abusers also abuse benzos – solidifying the fact that addiction is so much deeper than what’s on the surface. In fact, a recent article explained that individuals with comorbid disorders “demonstrate poorer treatment adherence and higher rated of treatment dropout than those without” (NIH, 2020). However, for those who may suffer, treatment mainly includes behavioral therapies, which have proven the most effective (NIH, 2020). This includes Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Assertive Community Treatment (ACT), Therapeutic Communities (TCs), Contingency Management (CM) or Motivational Incentives (MI), Exposure Therapy, Integrated Group Therapy (IGT), Seeking Safety (SS) and Mobile Medical Application (NIH, 2020). Overall what a great blog entry, thanks for sharing!
    National Institutes of Health. (2020, April). What are the treatments for comorbid substance use disorder and mental health conditions? https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/what-are-treatments-comorbid-substance-use-disorder-mental-health-conditions

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