Mood disorders such as depression, bipolar disorder, anxiety disorders, are so tightly connected to addictive behaviors that it’s difficult to treat one alone and have success with the other. When the mood improves, the addiction can be managed more effectively and vice versa. This is the challenge of the addictionologist.
To be a “Good” addictionologist, one has be an “Expert” at treating a wide variety of psychiatric conditions that increase risk of drinking or drugging. Dr. Arturo Taca of INSynergy Rehab Center in St. Louis, Missouri, preaches the importance of this relationship. “Treating and diagnosing accurately depends on the skill and attitude of the treating professional”.
“We are not only expected to be experts at the new discoveries and advancements in the growing science of addiction, we are also expected to understand the conditions that independently contribute impulsive behaviors that lead to addiction, relapse, and self medication”.
Dr. Taca explains that other psychiatric conditions such as ADHD have high risk of substance use behaviors and treating ADHD can actually lower the risk even if that means careful treatment with stimulants, which are very effective in treating this condition. Because ADHD is over-represented in the population of substance abusers, there has to be special attention to understanding of the risks of treatment vs non-treatment in this population. Studies have shown associations from 30 to 70% of people with ADHD having co-morbid addictions. There are of course risks that include mis use of stimulants themselves but if you reduce impulsive behaviors, the risk has been shown to decrease in this population. Dr. Taca adds, “To be an effective additionologist, one must also be very comfortable and have good experience with treatments designed for ADHD.”
Understanding the type of depression is also paramount. The reason is that the treatments for Major Depression and treatments for Bipolar Disorders are very different. Although both may present as depression, treatments are each condition are at “polar opposites”. Many people in substance abuse treatment complain of depression and may get treated with standard anti-depressants. However, if one has a different form of depression, called bipolar disorder, anti-depressants can actually make things worse and cause more depression, causing more impulsive behaviors, causing a stronger desire to self medicate, which ultimately leads to a relapse. “It is very important to take a thorough family history, screen for bipolar disorder before offering traditional antidepressants,” says Dr. Taca.
How Are These Comorbid Conditions Diagnosed and Treated?
The high rate of comorbidity between drug use disorders and other mental illnesses calls for a comprehensive approach that identifies and evaluates both. Accordingly, anyone seeking help for either drug abuse/addiction or another mental disorder should be checked for both and treated accordingly.
Treatment Should be Integrated!
Specialists including psychiatrists, psychologists, physical health and fitness professionals should work in tandem to make a specific treatment plan for each person.
Addressing mood disorders, the role of medications, and the biology of addictions should be supervised by a psychiatrist. Addressing psychological patterns, defenses, personality styles, core recurrent relationship themes, and cognitive distortions can be addressed by psychologists.
Sleep, exercise, diet, can all influence emotional tone. Sleep hygiene is an important, non chemical approach, to helping the brain respond in a predictable fashion. Exercise can lift and regulate mood by stimulating natural endorphin release. A good healthy diet also key to helping the body and the brain heal itself.