Exploring the relationship between mental health and co-morbid substance misuse

In the build up to Christmas, we explored the relationship between mental health, and co-morbid conditions such as substance misuse, with Nicole Miller, Addictions Therapist at Priory Hospital Hayes Grove.

It is reported that 70% of individuals with mental health disorders who engage in community resources in the UK, also have substance abuse issues.  

Furthermore, a recent survey in the UK identified that a third of individuals who are at risk of alcohol and drug use disorders, also use mental health services, and those with more severe mental health disorders have been found to be more likely to smoke, and misuse alcohol and other recreational drugs.

Risk factors, signs and treatment

Due to the degree of prevalence of both mental health and substance abuse disorders combined, it is important for GPs to remain aware of the risk factors, signs, symptoms and treatments available for these disorders.

Co-morbid substance use and mental health both have shared risk factors. For example, individuals can have a genetic pre-disposition towards the development of substance use and mental health disorders, which in turn can increase the chances of them co-occurring. Additionally, using substances can exacerbate pre-existing mental health disorders and individuals might use substances to cope with their mental health challenges.

Identifying co-morbid mental health and substance misuse is often akin to the philosophical conundrum of “what came first, the chicken or the egg?” as both disorders can often mimic or cause the onset of the other, and it can often go unnoticed or misdiagnosed.

A patient may then present with a mental health disorder and the substance use can go unnoticed, unresolved, and increase the risk of further disturbing mental health symptoms.  

Mental health disorders can also occur as a result of going through withdrawal from substance use. For example, using substances or ingesting more than the normal units of alcohol per day may induce anxiety and depression, thereby creating confusion between mental health symptoms and substance use problems.

What can GPs do?

Screening and brief assessments for such occurrences is a beneficial part of routine care for GPs. A GP can enquire about a patient’s substance use history or behaviours, if they are concerned. If a person reports that they drink, a GP can ask how many units per day they drink and compare it to the recommended usage. If a patient reports drinking more than what is recommended, a GP may want to enquire further.

An answer of ‘yes’ to two or more of these questions may indicate that a patient has a substance use problem:

• Have you put yourself or others at risk as a result of your drinking/substance use behaviour?
• Have these activities caused problems relating to family, friends, work, school, or health?
• Have you noticed a need to use more/more often, to achieve the desired effect?
• Do you find yourself pre-occupied with thoughts of your substance use behaviour (planning, fantasising, rationalising)?

Additionally, a GP can use specialist screening instruments for co-morbidity, such as the Diagnostic Interview Schedule. If a patient presents with a problem after such an assessment, a GP can suggest a period of abstinence to help clarify the problem. If the patient is unable to maintain abstinence, or is pre-occupied with substances after abstinence (as indicated above), then a referral to a substance misuse service, for an in-depth assessment, will be imperative. Ideally, this should be a substance misuse rehabilitation centre that specialises in both mental health and substance abuse.

How can Priory help?

Priory offers treatment for co-morbid disorders, with mental health conditions such as depression, along with alcohol misuse, being the most prevalent. Our programmes offer evidence-based therapy to treat co-morbidities, such as cognitive behavioural therapy (CBT).

Priory services strive to provide patients with the sensitivity and utmost care needed to learn the tools that are necessary to maintain abstinence from substance abuse, and learn coping skills for living with other mental health disorders.

For details of how Priory can provide you with assistance regarding mental health and substance use, please call 0330 056 6020  or please click here to submit an enquiry form. For professionals looking to make a referral, please click here.