Mental health articles

Co-occurring Disorders and Medications
Alcohol and other drug problems have the uncanny ability to mimic psychiatric
disorders, coexist with them, and create them. On the one hand, substance abuse
can cause one’s life to become unglued, which naturally can lead to depression
or anxiety. And drugs may even induce hallucinations, paranoia, ideas of reference,
and delusions that appear very much like functional psychosis. On the
other hand, sometimes an underlying depression or anxiety disorder precedes
and precipitates alcohol, marijuana, or other drug use. Once substances are used
as self-prescribed medications, they can lead to substance abuse or dependence.
Minkoff (2005) argues that dual diagnoses occur so oft en that they should
be considered the norm rather than the exception, and when mental illness
and a substance abuse disorder coexist, both should be considered primary
and treated simultaneously. Psychotherapy with dual-diagnosis patients
should be started right away, ideally by a mental health clinician who fully
understands substance abuse issues.
Th ere are no clear, empirically based prescribing guidelines for treating
dually diagnosed patients (Denning, 2000), and so the decision to provide psychiatric
medications to a substance-using patient is somewhat controversial.
Denning (p. 157) suggests that a treatment team rule out three possibilities
when deciding whether to prescribe medication to an alcohol or other drug
user: Does the medication cause physiological dependence? Does the medication
have street value, so that the patient might be tempted to sell it? Does the
medication interact negatively with the person’s drug of choice? Th e second
question is particularly important when considering stimulant medications
for attention defi cit disorder, given that students may abuse such medicines.

Tags: disorders