Britain’s Daily Mail recently ran an article from the mother of a 12-year-old who told how her daughter’s friends are experimenting with marijuana and being expelled from school.  Once confined to older teens and young adults, smoking marijuana is now more common among teens and pre-teens.

From states in the U.S. deciding to legalize marijuana to movie stars and rock stars being photographed using it, the message sounding loud and clear to youngsters is that smoking marijuana has no repercussions.  The Daily Mail article recounted the stories of several pre-teens who had been either expelled from their private schools or who were using the drug off-campus to avoid expulsion.  The obvious point was that young children were getting their hands on marijuana and seemed to have no worries about the consequences.

The British newspaper article did not hesitate to point fingers at singers like Lil Wayne and the late Amy Winehouse among others – stars who make no bones about using marijuana.  Public icons, especially music icons, are influential for young teens and pre-teens.  Their cavalier attitude and, in some cases, promotion of marijuana use, has more impact than many parents might like.

At Risk

The article also reported on studies in the Commonwealth that have found that when a teen uses marijuana s/he becomes more at risk than alcoholics for developing mental illness.  Teens who use pot also tend to have more problems with relationships and have a tougher time finding steady employment.  These facts are lost on the pre-teen and early teenager who only knows that they want to be like the superstars they see on TV and splashed across online tabloids.

In Great Britain, one out of every eight arrests for dealing marijuana involves a child.  Kids are smoking it.  Kids are selling it.  Kids don’t think marijuana is anything to stay away from.  The facts, of course, are far different but evidently we aren’t getting the message through.  There is too much confusion between what is being portrayed and what is being said.

The truth is that early marijuana use can increase the likelihood of later addictions.  Teens who use marijuana run a greater risk of depression.  One out of every 10 marijuana users will experience severe effects such as anxiety, paranoia and hallucinations.  No one can say who will be in the 10 percent.

One of the researchers in Australia who investigated the outcomes for teens who decide to smoke marijuana said use of cannabis can negatively affect teens for years.

You would be forgiven for thinking that the prescription drug epidemic affects only the users themselves. Abusing medicines such as Vicodin and OxyContin—opiate drugs with chemical similarities to heroin—puts the users at significant risk, killing more Americans than heroin and cocaine combined in 2008; but using when you’re pregnant presents a whole new class of risks. Babies of opiate-using mothers can be born in withdrawal, their systems shocked by the abrupt withdrawal of substances, and research has revealed that this is happening more and more frequently in the United States. In fact, three times as many babies were born with neonatal abstinence syndrome (NAS) in 2009 than in 2000, reflecting the rapid rise in the prescription drug problem.

The Study

Lead researcher Dr. Stephen Patrick had noticed an increase in the number of babies with NAS at CS Mott Children’s Hospital at the University of Michigan, and set out to determine whether the numbers were also increasing across the country. The researchers looked at discharge records from 2000, 2003, 2006 and 2009 from a database of patients that covers 44 states and over 4,100 hospitals. When the researchers determined which of the births were associated with opiate use, they revealed some shocking statistics about the extent of the problem.

They found that the number of pregnant women abusing opiate medicines when the baby was being delivered was five times higher in 2009 than in 2000. In addition, the researchers found that the rates of illicit drug use during pregnancy were 16.2 percent of teens and 7.4 percent of adults. Generally speaking—and somewhat obviously—any drug use during pregnancy poses some risk to the infant since they’re getting small doses of anything the mother takes.

As you might expect with the increase in numbers of opiate-using mothers, the number of babies born with NAS has also increased significantly. The rate almost tripled over the experimental period, from 1.20 per 1,000 births up to 3.39 in 2009. This has a disturbing parallel with the numbers of overdose deaths from prescription painkillers since the 1990s, which has also increased three-fold. The problem can’t exist in a vacuum—related issues, like babies born with NAS, are bound to increase as well.

What Is NAS?

NAS is a condition that occurs when the baby becomes addicted to drugs along with the mother when it’s in the womb. It isn’t just opiate drugs that can lead to it: marijuana, benzodiazepines, cocaine, amphetamines and the use other substances can also result in NAS. The symptoms include excessive or high-pitched crying, fever, irritability, tremors, sweating, sleep problems and sneezing or a stuffy nose.

The researchers also found that the babies born with NAS were over three times more likely to have respiratory problems and over twice as likely to have a low birth weight. Interestingly, they were also notably more likely to be covered by Medicaid, meaning that the issues were more common in low-income families.

Better Treatment or Prevention?

The researchers also looked at the average length of stay for the newborns with NAS, which they noted hasn’t decreased over the last decade. From their perspective, this represents an area in need of improvement for physicians. Since state Medicaid programs bear much of the brunt of the problem, there is a lot of motivation to improve care for opiate-addicted pregnant women. The researchers argue that since there are no standardized clinical guidelines for treatment of NAS, it is possible to improve care for the babies themselves, possibly using a combination of an opiate and another medicine such as clonidine, but breastfeeding can also help.

The other suggestion is to enroll opiate-addicted mothers in methadone programs or provide them with drugs such as buprenorphine, which is often used in cases of opiate addiction. If these interventions were successful, the numbers of babies born with NAS would decrease, rather than just the amount of time they have to spend in treatment as a result of it.

Clearly, prevention of NAS is a considerably better solution than merely determining a better way to treat babies suffering from it, but the problem impacts much more than pregnant women. The rates of prescription painkiller abuse across the U.S. are on the rise, so this research serves as yet another reason to address that problem.

Impulsive behavior, known more formally as impulsivity, is behavior that occurs spontaneously or with only minimal forethought or preparation. For a number of reasons, teenagers generally act impulsively more frequently than adults. Impulsivity in teens with attention-deficit hyperactivity disorder (ADHD) has been linked to increased risks for involvement in alcohol, drug and cigarette use. However, according to the results of a study published in 2012 in the journal Nature Neuroscience, the roots of the impulsive behavior found in teens with ADHD differ significantly from the roots of the impulsive behavior associated with teen substance use.

Teen Impulsivity Basics

The human brain relies on a specific region, called the frontal cortex, to perform and regulate such higher-level tasks as making judgments or decisions, gaining perspective on self-motivation and controlling fleeting or momentary urges. However, during adolescence, the frontal cortex is not completely formed. This lack of brain development goes a long way toward explaining why teenagers tend to act impulsively, even when they receive information from adults that’s designed to offset impulsivity. The authors of another study, published in 2009 in the American Psychological Association’s American Psychologist, concluded that teens age 16 and older actually have enough brain development to reason in a manner similar to adults. However, teens in this age group still generally lack the emotional maturity to adequately or consistently control their impulsive behaviors.

Impulsivity and ADHD

Along with hyperactivity, impulsivity forms one of the two basic symptoms of ADHD. Impulsive urges in a teenager (or younger child or adult) affected by the disorder may manifest as a generally high level of impatience, a tendency to frequently interrupt others, an inability to wait patiently in different situations, a general lack of emotional restraint, a tendency to disregard unpleasant outcomes of one’s actions, or an inability to tailor one’s words appropriately for a given social situation. Some teens with ADHD have prominent symptoms of impulsivity and hyperactivity, while others have little or no problems with hyperactivity/impulsivity and instead have significant problems maintaining focus or attention.

Connections to Substance Use

In the past, researchers have clearly linked the presence of ADHD to increased risks for substance use in teenage populations. In the study, published in Nature Neuroscience, a multinational research team explored this link by periodically examining the brain function of 1,896 adolescents. These teens were all age 14 when the study began, and underwent brain scans at two-year intervals over the next four years. During these scans, all participants were asked to perform tasks that measured their level of self-control. The researchers also used medical histories to determine how many of the study’s participants had symptoms of ADHD. In addition, they periodically asked the participants about their level of involvement with alcohol, drug and cigarette use.

After reviewing their findings, the authors of the study concluded that the presence of ADHD itself does not reduce teenagers’ ability to control their impulsive urges. Similarly, they concluded that teens who use substances also don’t generally have a reduced ability to control their impulses. This does not mean that teens who have ADHD or use substances don’t act impulsively; it simply means that teens with these issues apparently don’t typically act impulsively any more often than teens unaffected by these issues. Critically, the authors of the study also concluded that when teens with ADHD do act impulsively, their behaviors are triggered by different brain pathways than the pathways that trigger impulsive participation in substance use. This finding suggests that the presence of ADHD-related impulsivity is not as likely to contribute to substance use risks as scientists once commonly believed.

Considerations

Interestingly, the authors of the study in Nature Neuroscience also concluded that the brain pathways that contribute to impulsivity-related substance use kick into gear even when some teenagers use only minimal amounts of a given substance. This finding strongly suggests that substance use itself does not lead to increased impulsivity in adolescents. Instead, the reverse is likely true, with the preexisting effects of impulsivity contributing to increased participation in substance use. In real-world terms, this means that some teenagers may have longstanding or built-in impulsive tendencies that make them much more susceptible to substance use (and subsequent problems with substance abuse or addiction) than other teenagers who come from similar backgrounds, belong to similar peer groups and participate in similar sorts of daily activities.

“The take-home message is that impulsivity can be decomposed, broken down into different brain regions,” says Hugh Garavan, one of the study authors. “The functioning of one region is related to ADHD symptoms, while the functioning of other regions is related to drug use.”

Gangs are known for the physical and social threats they pose to rival gang members and their general communities. However, gang membership itself apparently poses a significant threat to mental health. According to the results of a study reported in 2013 by researchers from Queen Mary, University of London, gang members have substantially increased risks for developing harmful psychological symptoms or a diagnosable mental illness when compared to the at-large population.

Gang Membership Basics

Teenagers and people in the early stages of adulthood form the majority of gang members in the U.S., the American Academy of Child & Adolescent Psychiatry reports. However, increasingly, preteens and younger children also become involved in gang activity. While public perception commonly links the presence of gangs to large urban areas, these organized units also appear in smaller urban areas, isolated towns and rural regions. Known consequences of gang participation include increased chances of committing violence or being a target of violence, as well as heightened chances of substance abuse/addiction or incarceration, heightened chances of involvement in risky sexual activity and lowered chances of developing useful work skills or receiving useful academic training.

The presence of certain mental health problems—including attention-deficit hyperactivity disorder (ADHD) and a conduct-related condition called oppositional defiant disorder—can increase a person’s chances of getting involved with a gang. Other known risk factors for joining a gang include living in an area populated by gangs, lack of appropriate adult supervision, exposure to music or other cultural influences that applaud gang participation, lack of work or educational opportunities, a violent home environment and a home environment or family background that includes gang members. A lack of self-esteem or role models also increases gang participation risks. Many individuals cite their gang affiliation as a “home” or stabilizing influence in their lives.

Mental Health Risks

In the study reported by Queen Mary, University of London, a team of British researchers examined the connections between gang involvement, violence and mental illness in a group of over 4,600 men between the ages of 18 and 34. Roughly 2 percent of these men identified themselves as current gang members, while slightly more than 27 percent identified themselves as recent perpetrators of physical assault or some other form of violent activity. The remaining 70.4 percent of the participants described themselves as being non-violent in the five-year period prior to the start of the study.

After reviewing their findings, the authors of the study concluded that both gang members and violent men not affiliated with gangs have significantly increased risks for developing a range of specific mental disorders or symptoms common to several different mental disorders. In the case of gang members, especially prominent illnesses include alcohol or drug addiction, antisocial personality disorder or some other personality disorder, and various types of anxiety disorder. Prominent symptoms common to a number of mental illnesses include hallucinations and/or delusions (also known as psychosis) and suicidal behaviors that culminate in a suicide attempt.

Significance and Considerations

The authors of the Queen Mary, University of London, study believe that they are the first researchers to assess gang members for mental health problems other than substance use disorders. They attributed the increased risks for anxiety disorders and psychosis in gang members to violence-oriented thinking, exposure to violence at the hands of others and fears about future violence exposure. In many cases, these problems manifest in the form of post-traumatic stress disorder (PTSD), a condition once viewed as an anxiety disorder in the U.S., but now classified along with several other illnesses as a trauma- and stressor-related disorder. The authors of the study attributed the rate of suicidal behavior and suicide attempts in gang members to both the psychological strain of mental illness and the impulsive nature of violent behavior, which can turn inward in some individuals.

Generally speaking, gang members and non-gang members who engage in violence are younger than non-violent men and also have a higher rate of unemployment. In the U.K., which has a socialized medical system, gang members also seek access to mental health services more often than non-violent men.  The authors of the study note that the men in the participating age range are typically gang “lifers;” they don’t know if the same problems with mental illness appear in short-term or younger gang members.

Amelia liked to think of herself as a survivor—soft but strong, able to persevere. Raised by a mother with mental illness, she knew a lot about how to handle difficult people and delicate events; it seemed she’d been walking on eggshells for as long as she could remember. Her father had left when she was 12 and the care and keeping of her mother, who only grew more unstable as a result, had fallen exclusively to Amelia.  By the time she was 17, she was an expert on her mother’s medical records, how and when she needed to take her medication, and was working to support the two of them. She never made it to college. Maintaining a full-time job and the constant attention required in the care of her mother didn’t leave time for school.

As anxiety settled in throughout her 20’s and with the occasional “dark moods” that lasted months sometimes, Amelia found herself less and less capable of enduring not the physical hardship, but the psychological. Still, she wanted nothing to do with therapy; why should she spend upward of $100 an hour talking about herself? Life was just the way it was. When headaches started to overtake her, she finally saw a doctor.

Offering her full history to the small town general practitioner, Amelia was persuaded to provide a background. She discussed not only her unrelenting headaches but also the steady sense that things simply weren’t right—how she shook nervously and sweated. Her GP prescribed benzodiazepines to be used for acute episodes of anxiety and opiates for what he determined were migraines.

For a while, Amelia found comfort in the hypnotic quality of the drugs. It was as if she were floating somewhere just outside herself and nothing could harm her there. As weeks and months wore on, however, Amelia discovered that the recommended dosage no longer treated her anxiety or her pain. She began to increase her dosage. When she was threatened with eviction after one of her mother’s “incidents”—she’d taken after the neighbor with a garden hoe—it all became too much. Amelia made it through the experience relatively unscathed, but she’d discovered something useful to her: her medications were more powerful when combined with wine.

It wasn’t until a friend noticed how much Amelia was taking that she questioned it herself. She realized she’d been relying exclusively on the medication and the sense of escape it gave her, taking it every four hours whether she needed to or not. But when she tried to quit she discovered something even more alarming—she couldn’t.

Gendered Differences in Addiction

The CDC reports that between 1999 and 2010, opioid overdose deaths among women increased fivefold, while the numbers for men increased three times. Since 2007, more women have died from prescription overdose than in car accident related injuries, cervical cancer or homicides. Further studies reveal that while women tend to become addicted later than men, they do so more quickly. Once addicted, women are more vulnerable to relapse, and are less likely to seek treatment than men. According to Constance Scharff, Ph.D., “Women most often use drugs to deal with stress and regulate moods.” Women are prescribed potentially addictive medications more often than men, and for longer periods. This may be because women are speaking more openly with their doctors about both physical and psychological complaints, but the reasons are not entirely understood.

Prescription drug dependence may go unnoticed even to the user—many believe that because the medications are prescribed, they are safe. When more than the recommended dosage is being used and for longer than is required and when symptoms of withdrawal (such as nausea, agitation and sleep disturbance) occur at the cessation of the medication, addiction should be considered.

High-Risk Group

Recovery from prescription drug dependence is as important as any other addictive substance or process. The White House considers women to be among the top three high-risk groups for addiction, and looking at the numbers for accidental overdose deaths, it is no wonder. Long term abuse of certain addictive prescription medications, such as the benzodiazepines, carry potential consequences: “over sedation, impairment of memory, balance and learning, depression and emotional blunting.”

Treatment for Prescription Drug Addiction

Treatment for prescription drug addiction is similar to other treatments for addiction; it consists of a behavioral component wherein addicts learn to cope with life stress or physical pain without the use of medications, and where previous users are taught to become self-observant and proactive when cravings arise. There is evidence that psychotherapy in combination with NA group attendance, or another form of collective substance abuse support, can be effective in helping women recover. Given the high pressure lives that so many modern women contend with—where work outside the home is a foregone conclusion even while work inside the home does not diminish—the stress and pain that lead many down the slippery slope of secret addiction is unsurprising. What is most important is that women like Amelia find the help they need to recover—including doctors who better understand the risks of prescribing medications known to create dependence.

Across the U.S., public school health classes and counselors continue to teach about the dangers of drugs like alcohol and cocaine. In the last few years, however, students have begun to learn about what public health officials are identifying as a much larger problem: prescription drugs.

Last year, the pharmaceutical industry released a statement saying that 4.02 billion prescriptions were written in the U.S. in 2011. This comes out to about 13 prescriptions for every American, an all-time record in the U.S. But are all these prescriptions fueling the current prescription drug addiction and overdose rates?

The Statistics

• U.S. doctors wrote 4.02 billion drug prescriptions in 2011.
• According to the CDC, nearly half of the U.S. population has taken at least one prescribed drug during the last month, and more than 20 percent of the U.S. population has taken three or more.
• More than 75 percent of doctor office visits involve prescription drugs.
• More Americans die from prescription overdose than from cocaine and heroin combined.
• Since 2008, more Americans die from prescription overdoses than from car accidents every year.
• In 2011, 16,500 Americans died from prescription painkillers alone.
• Since 2000, the number of prescription overdoses has more than doubled among men, and more than quadrupled among women.
• Americans consume 80 percent of opiate painkillers produced worldwide.
• An estimated 36 million “serious adverse reactions” to prescribed medications in the U.S. every year.

A Growing Epidemic

The dramatic rise of drug prescriptions written every year in the U.S. seems to mirror the alarming rise of prescription drug overdoses, and many experts, including doctors and public health officials, are looking at the issue more seriously. These drugs are very beneficial, but at what cost? Some of the more popular prescribed drugs happen to be some of the most familiar, appearing in magazine, radio and television ads across the country. A recent report released by a London medical journal states that for every $1 spent on researching a particular drug, an additional $19 is spent on promotion and marketing.

The Country’s Most Popular Prescribed Drugs

The numbers of prescriptions written have risen for many drugs across the board in the last decade, and certainly in the last several years. Note that many of the county’s best sellers are not often involved in many overdose deaths (with the exception of hydrocodone). As of 2010, the most popular prescribed medications include:

• Hydrocodone (opiate combined with acetaminophen/Tylenol): pain reliever
• Zocor: drug treating high cholesterol
• Lisinopril: drug treating blood-pressure
• Synthroid: synthetic thyroid hormone
• Norvasc: drug treating blood-pressure

In 2011, the figures changed somewhat, with the anti-depressant Zoloft taking the top slot, followed by the cholesterol medication Lipitor. Sales of drugs treating attention-deficit hyperactivity disorder also jumped, rising 17 percent from 2010.

Most Dangerous Prescribed Drugs

As fatal prescription drug overdoses continue to climb, scientists have been focusing their research on the main drivers behind the epidemic, trying to find which drugs are most likely to cause harm. Opiate painkillers, with their powerful addictive and sedative properties, continue to top the charts and include popular painkillers like OxyContin, Hydrocodone and Vicodin. However, doctors have been aware for some time that taking multiple prescription medications heightens the risk of an overdose.

Medical News Today, for example, reports that many reported fatal overdoses have involved multiple prescription drugs or alcohol. A group of anti-depressants known as benzodiazepines (which includes brand names such as Xanax, Valium and Ativan) seem to be a major contributor, and are involved in about 30 percent of opiate painkiller deaths. This is the first study to point toward a particular group of medications as a dangerous combination with opiates. The danger of alcohol in conjunction with opiates, however, is very well documented.

Of all prescription overdose deaths in the U.S., the ones most commonly involved, alone or in combination with others, are listed below:

• Opioid painkillers: found in about 75 percent of overdoses
• Benzodiazepines: found in about 30 percent of overdoses
• Anti-depressants: found in about 17 percent of overdoses
• Drugs for epilepsy and Parkinson’s: found in about 8 percent of overdoses

The Industry’s Response

The pharmaceutical industry greeted the latest numbers on written prescriptions with enthusiasm. After all, it’s a sign that the industry is growing. When confronted about the alarming rise in prescription drug deaths, manufacturers like Purdue have so far responded with statements about their labeling practices and commitment to working with government officials.

Medical News Today has pointed to unethical online pharmacies as part of the problem. It’s true that recent studies show a link between Internet access and an increase in prescription drug abuse, but doctors are still wary, stating that more studies need to be done. Most likely, online pharmacies (like some corrupt pharmacies elsewhere) comprise just one of many venues that addicts use to get their drug of choice.

Perhaps simply stating that patients and doctors need better communication, or that patients need to read labels more carefully, isn’t enough to combat the problem. After all, Americans consume 80 percent of the world’s supply of opiate medication every year—does this really mean Americans are in more pain than everyone else, or is this a reflection of a broader problem? Whether or not the pharmaceutical industry has any responsibility in the rise of overdose deaths, the problem remains and affects everyone, from preteens to the elderly. Unlike the scary drugs we all learned about in school, these drugs are used and abused by almost every demographic. Complicating the issue even further, these same drugs also help save and improve lives. The question now should be: how do we lower abuse and fatality rates of prescription drugs without restricting access to the patients who really need them? It really is a tough question to answer.

Of all of the recent designer drugs that have hit the market, few have attracted the level of attention as bath salts. The drugs were initially blamed for the zombie-like, cannibalistic attack in Florida last year, but it was later found that marijuana was the only drug in the attacker’s system. Regardless, the addictiveness of bath salts and the risks associated with their use have become more well-known, leading to a U.S. ban of many of the drugs. Their potency, however, has meant that many users still take them and expose themselves to these risks. They might not turn users into cannibals, but new research suggests that the drugs are actually much more addictive than methamphetamines.

What Are Bath Salts?

They definitely aren’t chemicals you use when you take a bath—they’re just marketed as such in order to make legal punishment more difficult to rain down on the producers. Bath salts are essentially stimulant drugs that have comparable effects to amphetamines and MDMA. In essence, there are several different types of bath salts, and they can be more accurately described as synthetic cathinone compounds—like the active substance in the drug khat. You can’t really know which chemicals are in the substance you’re taking.

There are many risks associated with the drug, with reports of chest pain, rapid heartbeat, aggressive behavior, hallucinations, delusions, paranoia and high blood pressure. Studies on the substances are limited, however, because they’re relatively new, and it’s merely assumed that the long-term effects are comparable to those of methamphetamines because of the chemical similarities. In 2012, there were more than 2,600 calls to poison control centers about exposure to bath salts.

The Study

These issues (and the relative scarcity of studies addressing the drugs) led some researchers to look at one specific cathinone compound, 3, 4-methylenedioxypyrovalerone—or simply MDPV. The researchers used rats—which have similar neurological “reward” pathways to humans and are therefore useful for studying addiction—that had been trained to press a lever for a reward. They initially received food for their lever-presses, but the researchers had them hooked up to an intravenous infusion of drugs, which became activated for the study period. The rats received MDPV or methamphetamine, with the aim of investigating the differing effects of both drugs.

The Findings

The most shocking result from the research is the finding that the rats who were hooked up to the MDPV pressed the lever for a dose significantly more often than those who had methamphetamine. The researchers point out that the number of lever-presses is analogous to the amount of effort the rats are willing to put in to get a dose of the drug. The rats pressed the lever an average of 60 times to get access to meth, whereas for MDPV the number was 10 times higher, at an average of 600 presses. The results seem to show that bath salts are exponentially more addictive than methamphetamine, with some rats pressing the lever up to 3,000 times for a single dose.

Additionally, the researchers also looked at the repetitive behaviors that are common in humans who take bath salts. They found that the rats receiving higher doses of MDPV displayed many similar behaviors, such as excessive licking, skin-picking and teeth-grinding. The researchers reported that some of the MDPV-dosed rats were so intent on licking the transparent walls of their cages that they were unable to interrupt them.

Conclusion

These findings serve as evidence that bath salts could be notably more addictive than meth, according to the researchers, and they concluded that the potency of the drug means that it’s likely to stick around despite its now illegal status. In other words, the study suggests that bath salts are so addictive that they may join the ranks of commonly abused illegal drugs, rather than being replaced by another temporarily legal designer drug.

Of course, the major problem when it comes to bath salts is in the wide variety of substances and the fact that long-term studies are currently unavailable. The researchers are moving on to both of these areas for future studies and plan to investigate the long-term behavioral impacts of bath salt abuse and the different effects of the newly produced cathinone drugs. The story comes as a stark reminder that legality doesn’t equal safety when it comes to drugs—in fact, the changes made to their chemical structures in order to skirt existing legislation could make them even more dangerous. Bath salts are particularly susceptible to this, because there isn’t one “formula” for the drug—one batch could be drastically, fatally different from another and the user would have no way of knowing.

Daphne sat across the table from her husband and mouthed the words, “I hate you.” Then she painted a charming smile on her face and ordered a salad. She and Sam were out to dinner with his family, something they did only rarely because of what Sam’s mother referred to as “Daphne’s drinking problem.” What no one at the table knew was that Daphne had a gram of cocaine in her clutch and no plans to drink more than one cocktail. To everyone’s surprise, a single margarita is all she had that night.

For the next four weeks, Daphne’s behavior was erratic. She didn’t find herself sneaking bottles of wine or vodka, passed out on the sofa in front of the television or lying in the floor of their shared walk-in closet, crying her eyes out over every conceivable wrong done to her in the past. Instead, she was scarce, hardly ever at home. When he did see her, she was wild with energy and ideas, frenetic to dress and shower and be off again. Her already thin frame appeared unusually slight. It didn’t look as though Daphne had been eating, or really doing anything but moving, fast.

Then on a Sunday afternoon, just like it had started, Daphne was suddenly home again—collapsed on the lawn, so drunk Sam could nearly smell the alcohol from the front door. Ever the co-dependent faithful partner, he walked to his wife and bent to scoop her into his arms. And just like clockwork, Daphne began to slur a litany of praise for her husband, how she could not live without him, how he was perfect in every way.

Days into Daphne’s return, however, she was threatening to stab herself with a kitchen knife if Sam didn’t give her access to all of her pain medication. Daphne received prescription opiates for a cracked cervical vertebra, and Sam sometimes hid them when Daphne’s drinking binges got especially bad. When she took the knife and started carving shallow cuts into the inside of her arm—something Daphne had done many times before, but always in private—Sam knew it was time to do what he had not yet done. He had his wife involuntarily hospitalized. An emergency hospital stay turned into a longer, voluntary in-patient psychiatric stay, and it was there that Daphne was formally diagnosed.

She was an alcoholic. She was a drug addict. She had anorexia. She had bipolar disorder. And she had borderline personality disorder. No one had expected this outcome, least of all Daphne.

Mental Disorders and Addiction

When a person has both a problem with addiction and a mental disorder, he or she is said to have a dual diagnosis (or comorbidity). Many times, substance abuse can mask the signs of mental illness. Traits or characteristics of mental illness, which may otherwise be quite noticeable to close family members and loved ones, cloak themselves in the depressed behavior brought on by excessive alcohol use (alcohol is itself a depressant), or the erratic behavior others exhibit whether using alcohol excessively or when high or seeking drugs.

People with certain mental disorders may seek to “self-medicate” the anxiety or depression that arises as a result of the disorder by consuming alcohol or using drugs, or a combination. One such disorder is bipolar disorder. About 56 percent of people with bipolar have experienced drug or alcohol addiction.  The personality disorders, such as borderline personality disorder (BPD), also share a high rate of dual diagnosis. According to the Center for Drug and Alcohol Programs at the Medical University of South Carolina, “Over 50 percent of drug abusers and almost 40 percent of alcoholics have at least one serious mental illness.”

Besides bipolar and BPD, depression, anxiety disorders, schizophrenia and other personality disorders frequently co-occur with substance abuse. Psychiatric issues can begin before or after the onset of substance abuse.

Treatment for the Dual Diagnosed

There is no question that adding disorders and substance issues to the mix significantly compounds an individual’s stress and further complicates treatment options. Those who have co-occurring mental disorders have a higher rate of relapse when it comes to getting sober. But even people with mental disorders and co-occurring substance abuse issues can begin to heal. What helps is an integrated therapeutic approach—where mental health treatment and addiction recovery are not thought of as separate, but fused into an integrated whole. Compartmentalizing too many areas of her life is often how an addict with mental health issues gets to the place in which she desperately needs recovery, so seeing her life as a working whole is important.

Thinking, “I cannot attend to my sobriety if I do not attend to my bipolar disorder” and vice versa is a good way to think about it. It’s quite true, in fact—not simply a bromide offered by practiced faces in the business of therapy.

While Daphne’s situation may seem extreme, it is likely that the deeper part of her issues are connected. When she begins to do the work to unravel what the deeply held beliefs and long-held stories that most affect her mental state are, she may begin to find herself experiencing better balance—and an ability to deal with the boat-rocking experience of finding herself with a half-dozen labels, all too frightening to think about in the beginning.

Becoming educated about the nature of addiction and the reality of mental illness is a good place to start. Choosing to look at one’s life carefully is the opposite of what addiction means. When you wrestle the hydra of addiction and mental illness, you know you’re only going to get more of the same. Better not to go in swinging but with clarity, a willingness to learn and possibly, maybe, a little bit of room for something like hope.