Summary notes on lecture Alcohol, Drugs and Mental Health, module Understanding Mental Health, course Psychology. The summary was made in preparation for a MCQ test at the end of the semester. I passed the test with 1st (A+).
Dual Diagnosis
It is suggested that between 50-65% of people who come in contact with substance use
treatment services may also experience mental health difficulties although may never have
been in contact with mental health services (Rethink 2007). Approximately one third of the
drug treatment population and half of the alcohol treatment population also had multiple morbidity,
i.e. the co-occurrence of several psychiatric disorders or substance misuse disorders.
Past year drug use/harmful alcohol use among mental health patients was 44%
By the way, this study also found:
Both mental health and substance use services failed to identify significant
numbers of dual diagnosis patients
Most patients with substance use problems in mental health services received no
substance use interventions
A third of substance use misuse patients with mental health problems received no
mental health interventions
Etiological hypothesis
Mental illness is a result of substance misuse
(e.g. drug induced psychosis )
Substance misuse follows mental illness
(coping/self- medication hypothesis)
1. . Primary substance misuse with psychiatric consequences
2. Mental illness is primary and substance misuse is secondary (self-medication
hypothesis)
3. Common biopsychosocial factors
Does substance use/misuse cause mental health problems?
There are at least 3 situations in which psychoactive substances can cause psychiatric like
symptoms:
Acute intoxication
(while under the effects of the substance)
, Short-term effects (come-down)
Long-term effects
Withdrawals
Psychotic states beyond a duration of 3 weeks after cessation of drug intake should
not be considered to be only a drug-induced psychosis (Hambrecht and Hafner,
2003). Amphetamine induced psychosis
Cannabis psychosis
Cannabis is linked to long term mental health problems in people with a
predisposition.
SPICE (synthetic cannabinoid) can cause serious
acute psychiatric symptoms
Cognitive impairment as a consequence of alcohol misuse
Substance use may mask disorders that appear when use is ceased (e.g. Milani et al.
2004)
Substance can exacerbate precipitate symptoms
An extensive literature review by Curran et al. (2004) revealed that a single dose of
stimulants increase psychotic symptoms of 50-70%, regardless of adherence to
treatment.
On the other hand ketamine use was found to increase positive symptoms in people
with schizophrenia to the same extent as in healthy volunteers
2. Why people with mental health problems use or misuse substances: the
self-medication hypothesis
Social/environmental/cultural factors
To cope with social anxiety and tension (Noorsdy et al., 1991)
To cope with social exclusion, people may find a sense of belonging and community
with other drug users
To cope with boredom and the feeling of not having a purpose in life
To cope with difficult situations such as homelessness
To cope with domestic violence
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