The mental health problems that most commonly co-occur with substance abuse are depression, anxiety disorders, and bipolar disorder.

Common signs and symptoms of depression

• Feelings of helplessness and hopelessness
• Loss of interest in daily activities
• Inability to experience pleasure
• Appetite or weight changes
• Sleep changes
• Loss of energy
• Strong feelings of worthlessness or guilt
• Concentration problems

Common signs and symptoms of mania

• Feelings of euphoria or extreme irritability
• Unrealistic, grandiose beliefs
• Decreased need for sleep
• Increased energy
• Rapid speech and racing thoughts
• Impaired judgment and impulsivity
• Hyperactivity
• Anger or rage

Common signs and symptoms of anxiety

• Excessive tension and worry
• Feeling restless or jumpy
• Irritability or feeling “on edge”
• Racing heart or shortness of breath
• Nausea, trembling, or dizziness
• Muscle tension, headaches
• Trouble concentrating
• Insomnia

Treatment for co-occurring substance abuse and mental health problems

The best treatment for co-occurring disorders is an integrated approach, where both the substance abuse problem and the mental disorder are treated simultaneously.

How do I find the right program for co-occurring disorders?

As with a substance abuse program, you want to make sure that the program is appropriately licensed and accredited, that the treatment methods are backed by research, and that there is an aftercare program to prevent relapse. Additionally, you should make sure that the program has experience with your particular mental health issue. Some programs, for example, may have experience treating depression or anxiety, but not schizophrenia or bipolar disorder.

There are a variety of approaches that treatment programs may take, but there are some basics of effective treatment that you should look for:

• Treatment addresses both the substance abuse problem and your mental health problem.
• You share in the decision-making process and are actively involved in setting goals and developing strategies for change.
• Treatment includes basic education about your disorder and related problems.
• You are taught healthy coping skills and strategies to minimize substance abuse, cope with upset, and strengthen your relationships.

Benzodiazepines are the most common class of anti-anxiety drugs. They include:

Benzodiazepines are fast acting—typically bringing relief within thirty minutes to an hour. Because they work quickly, benzodiazepines are very effective when taken during a panic attack or another overwhelming anxiety episode. But despite their potent anti-anxiety effects, they have their drawbacks.

Side effects of anti-anxiety drugs

Anti-anxiety drugs like benzodiazepines work by reducing brain activity. Understandably, this leads to side effects beyond anxiety relief.

The higher the dose, the more pronounced these side effects typically are. But some people feel sleepy, foggy, and uncoordinated even on low doses of benzodiazepines, which can cause problems with work, school, or everyday activities such as driving. Some even feel a medication hangover the next day.

Because benzodiazepines are metabolized slowly, the medication can build up in the body when used over longer periods of time. The result is oversedation. People who are oversedated may look like they’re drunk.

Benzodiazepines are also associated with depression. Long-term benzodiazepine users are often depressed, and higher doses are believed to increase the risk of both depressive symptoms and suicidal thoughts and feelings. Furthermore, benzodiazepines can cause emotional blunting or numbness. The medication relieves the anxiety, but it also blocks feelings of pleasure or pain.

Paradoxical effects of anti-anxiety drugs

Despite their sedating properties, some people who take anti-anxiety medication experience paradoxical excitement. The most common paradoxical reactions are increased anxiety, irritability, and agitation. However, more severe effects can also occur, including:

• Mania
• Hostility and rage
• Aggressive or impulsive behavior
• Hallucinations

While rare, these adverse effects are dangerous. Paradoxical reactions to these anxiety medications are most common in children, the elderly, and people with developmental disabilities.  Many times users of benzodiazepines find that they need to enter an inpatient detox center in order to come off of them.

“When people hear the word ‘cancer,’ there’s kind of an assumption that it’s a death sentence,” says Dr. Marvin Seppala, chief medical officer for the Hazelden Foundation. “That’s not the case, since so many cancers are treatable nowadays. Yet there’s still a chance that people in the midst of addiction treatment might say to themselves: ‘Why bother to get clean and sober? I’m not going to go through with it because I’ve got cancer.’ ”

Studies suggest that rates of substance abuse in people with cancer are lower than in the general population. However, these figures are difficult to interpret. They could simply mean that people in cancer treatment routinely hide their problems with alcohol and other drugs.

Secrecy is just one problem. “If you’re in the midst of an active addiction, you’ll also be undermining any kind of healing process related to cancer,” Seppala says. “And there’s always the question of whether some of the addictive drugs will interfere with medications used to treat cancer.”

In addition, a record of substance abuse can strain the human relationships that underlie cancer treatment. If doctors and nurses suspect that their cancer patients are lying about drug use, they may doubt anything that these patients say about their health.

People with cancer might sense this mistrust, doubt the goodwill of their health care team, and decide not to follow through with their cancer treatments. When this happens, prescriptions go unfilled, medical appointments are missed, and people with cancer can get sicker or die earlier.

A report on substance abuse issues from the National Cancer Institute underscores these problems. It also suggests ways to help people face cancer and abstain from alcohol and illicit drugs at the same time:

Gather facts without judgment. When taking a health history, doctors and nurses sometimes avoid questions about alcohol and other drug use. They may feel awkward about raising the issue, or simply assume that they’ll never get honest answers. This assumption undermines cancer treatment. When health professionals ask about drug use with a non-judgmental attitude, people with cancer are more likely to speak candidly.

Involve a multidisciplinary health care team. Treatment for people with cancer and addiction should involve specialists in mental health and addiction medicine. Many people with a history of substance abuse–including those with cancer–also struggle with anxiety, depression, or personality disorders.

Treat pain with an accurate understanding of addiction. People can become physically dependent on opioid drugs such as codeine and oxycodone (OxyContin) that are used to treat cancer pain. This means that withdrawal symptoms will occur if the drugs are suddenly stopped. In this context, however, physical dependence and addiction are not the same. Addiction refers to the compulsive use of drugs for reasons other than pain control. Careful treatment planning can relieve withdrawal without triggering such use.

Current treatments also offer many options for treating cancer pain without drugs. Examples are acupuncture, acupressure, biofeedback, chiropractic treatment, osteopathic medicine, massage therapy, and meditation.

Set realistic treatment goals. There’s a saying among members of Alcoholics Anonymous: “Getting clean and sober is simple–just change everything about your life and do it now.” This slogan reminds us that recovery from addiction requires a transformation in thinking and behavior, which calls for decades of sustained effort. The risk of relapse is high, especially with the added stress of a cancer diagnosis.

Cancer specialists need to be realistic about this fact. Treatment planning for people in recovery should set up a structure for preventing relapse–and dealing with it openly if it does occur.

For more on this topic, visit the National Cancer Institute Web site at http://www.cancer.gov/ and click on “Cancer Topics” and “Coping with Cancer.”

Source: Hazelden