The Chicken or the Egg?: Psychiatric Disorders and Substance Abuse

Ben is now 25 years old and began smoking marijuana occasionally when he was 21 years old. Ben increased his marijuana usage when he was approximately 22 years old and graduated college. It was also around this time that he began to experience some depression and occasionally use cocaine. His depression has gradually worsened since then. Ben’s story begs the question—did drug use cause his depression or vice versa? To use a cliché, which came first, the chicken or the egg?

With many drugs, such as marijuana and cocaine, it can be difficult to determine if drug usage has caused a certain psychiatric disorder. (Although we do know that MDMA, commonly known as Ecstasy, can cause long-term problems with serotonin in the brain, which may lead to psychiatric disorders.) Many people begin to have psychiatric symptoms such as depressed mood or anxiety and “self-medicate” with alcohol or drugs. It often remains a mystery, even to professionals, as to whether drug use causes psychiatric problems or the individual is “self-medicating” the symptoms of his depression, bipolar disorder, etc. by using drugs. What is known is that those with a dual diagnosis have a higher success rate if they are treated for their psychiatric disorder and their substance abuse concurrently instead of separately. (Dual diagnosis refers to those who have a substance abuse problem as well as a psychiatric disorder such as depression, bipolar disorder, anxiety, etc.)

For years, those with a dual diagnosis have been shuffled back and forth between substance abuse treatment and mental health providers such as psychiatrists and psychotherapists. (It has been only recently that mental health professionals have created treatment strategies that address substance abuse and psychiatric problems at the same time.)

Some quick facts from a 2002 National Survey performed by the Substance Abuse and Mental Health Services Administration (SAMHSA):

* 17.5 million adults aged 18 or older (8%) were estimated to have a serious mental illness in the past year. About 4 million of the adults with a serious mental illness in 2002 also were dependent on or abused alcohol or an illicit drug; that is, they had a co-occurring substance abuse and mental disorder.

* More than half of the adults with co-occurring serious mental illness and a substance use disorder received neither specialty substance use treatment nor mental health treatment during the past year.

* Among adults with co-occurring disorders, 34% received mental health treatment only, 2% received specialty substance use treatment only, and 12% received both mental health and specialty substance use treatment during the past year.

One possible reason dual diagnosis treatment strategies have been so long overdue could be that some individuals are embarrassed or ashamed of their substance abuse and are unwilling to discuss these issues with their therapist. Another reason could be that individuals are in denial and minimize their alcohol and drug use. Your therapist may not be able to determine whether the chicken or the egg came first, but can provide better services based on more complete information. Substance abuse and psychiatric disorders occur together frequently. Some studies estimate that about 50% of people affected by mental health issues also have substance abuse issues. So remember that you are not alone.