COMORBIDITY IN ADDICTION AND OTHER MENTAL ILLNESSES The Chiromo Lane Medical Centre (CLMC) Approach

Definitions Mental illness - A wide range of mental health conditions – disorders- that affect the mood, thinking and behavior (Mayo clinic). Co-morbidity - Two or more disorders occurring in the same person (NIDA). Addiction - A primary chronic disease of brain-reward, motivation, memory and related circuitry ( ASAM).

Drug Abuse and Mental Illness: “Complex Dance” A “Complex Dance”

Complexities  Mental illnesses are often compounded by drug and alcohol abuse, making it a challenge to get the right diagnosis, treatment and management for both.  Mental illnesses can increase the risk for alcoholism or drug abuse  Alcohol and drug abuse can exacerbate underlying mental illnesses.

Drug Abuse and Mental Illness: Underlying Causes There are also other factors that could explain the frequent simultaneous occurrence of addiction and mental illness, including:

Underlying Causes cont…  Genetics Certain studies have found genetic variations that are associated with mental illness.  Chemical deficiency. Neuro-chemical deficiencies have been linked to mental illnesses Some of these deficiencies are found in dopamine, serotonin, norepinephrine

Underlying Causes cont….  Environment Some environments were found to be more stressful leading to mental breakdowns. These increase risk of alcohol and drug abuse

Drug Abuse and Mental Illness: Co-morbidities

 Depression In some cases, individuals may start to abuse a substance to handle the symptoms of depression. Bipolar Disorder Those with bipolar disorder may attempt to smooth out mood swings with alcohol.

Co-morbidities cont’d  Anxiety Disorders e.g. social anxiety persons may use alcohol and other drugs to get the courage to socialize. Generalized Anxiety Disorder people use substances to alleviate the worrying.  Trauma and Stressor – related Disorders e.g. People with Adjustment Disorder, Acute Stress Disorder and Post-Traumatic Stress Disorder may use substances to cope with the flashbacks of the trauma event..

Comorbidities cont’d  Schizophrenia Marijuana is commonly used by people with schizophrenia disorders to cope with the symptoms. Cigarette smoking is prevalent among people with schizophrenia.  Attention Deficit Hyperactive Disorder (ADHD) Persons with ADHD are likely to use substances impulsively and use cannabis to manage concentration.

Drug Abuse and Mental Illness: Treating Two Sets of Symptoms

It is very important, but often difficult, to distinguish primary mental disorders from drug induced symptoms. It is recommended that one is substance-free for a short period in order to tease apart the various symptoms.

Dual Management Treatment needs to focus on both conditions at the same time, once the right diagnosis has been made. CLMC – Retreat Relationship  Multidisciplinary approach – Psychiatrists, psychologists, psychiatric nurses, counselors, social workers, pharmacists..

Recommendations Research on local Kenyan co-morbidity rates informed by a specialized treatment facility Increase appreciation for dual treatment Enable formulation of effective policies that ensure best clinical practice Spearheading incorporation of context-based interventions to improve mental health in private and public institutions

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