A recently published paper, Understanding comorbidity between substance use, anxiety and affective disorders (Hall, Degenhardt & Teeson, 2009) gives a good overview of the current research on co-morbidity (though the focus of the article is arguing for the need for further research). They define co-morbidity as being when mental health problems and substance use problems occur either at the same time or one after another.
Something that stood out for me (apart from the fact problems don't have to happen at the same time) is that co-morbidity is not just limited to the link between cannabis and psychosis. In fact, the highest rates of co-morbidity are between anxiety/depression and substance use problems. Also, all of these problems have an onset of late adolescence/early adulthood, making it hard to work out cause and effect.
Why is it important? Because it's so widespread (e.g. a third of people with mental health problems also have a substance use problem) and because these people have poorer treatment and suffer more impairment, social disability etc.
They have three hypotheses for co-morbiditiy between substance use and anxiety/depression:
- One problem directly causes the other - e.g. sustained heavy alcohol use produces depression
- Some mental health problems indirectly increase the risk of substance use problems - e.g. people with anxiety/depression drink alcohol/take drugs to reduce symptoms, which leads to a substance problem
- Other common causes such as genetic predisposition, poverty, family circumstances, abusive relationships etc.
What's been your experience of co-morbidity?
Do you favour one of the suggested hypotheses of co-morbidity?
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NaNdeR
over 2 years ago
I feel that the anxiety/depression and substance use particularly for adolescents and young adults is a big mental health concern. As you said anxiety/depression is a big issue for adolescents and young adults but substance issues are often overlooked.
I think it's also quite a difficult topic because discussing drug use is still taboo. This becomes important when dealing with GP's, psychologists or whatever. I can imagine people lying or downplaying their substance use if asked by a clinician (that is even if the clinician asks).
Interestingly as terrible as it is to experience a mental health problem. I know a few people that have stopped using drugs after experiencing such difficulties. Which is good, but I do wonder what the chances of relapse is there ...
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