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:

A “Complex “Complex Dance”Dance”

ComplexitiesMental 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

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

Thank You