Opiate Addiction and Mental Illness Comorbidity

By Anne Watkins

In addiction treatment, the term “comorbidity” refers to the presence of one or more other mental illnesses that make the addiction worse.

Addiction is a complex issue on its own, and it’s thought of as a symptom of a larger, more complicated problem that can only be treated, but never cured. That’s why so many addicts require continuous long-term therapy and support groups. The problems that underlie addiction may be too deep to ever fully go away.

But if you have a comorbid illness, addiction is even more complex, and thus more difficult to deal with. In many cases, the problem is that other illnesses (such as depression or anxiety) usually aren’t as obvious as addiction. Thus, when a patient seeks opiate addiction treatment, if she’s not open and honest about other mental illnesses she may have, her doctors and therapists may fail to make the dual diagnosis. As a result, she may receive treatment for her addiction only. Her other mental illness will go untreated, which greatly increases the chances, sooner or later, of a relapse.

Heroin, Prescription Painkillers and Comorbidity

While all types of addicts display high rates of mental illness comorbidity, opiate addicts are set apart by the severe mental and physical effects of their drug of choice.

With heroin in particular, not only is it one of the most addictive drugs, but it’s also illegal, highly socially stigmatized and incredibly risky. Serious heroin addiction makes it almost impossible to be a functioning member of society, and it can do serious damage to a person’s body and personal life. Usually, only certain types of individuals are drawn to a lifestyle of heroin addiction, namely those who have serious self-destructive streaks stemming from an underlying mental illness.

Such underlying mental illnesses also frequently go along with prescription opiate addiction, although the specifics may be different. Often, prescription opiate addicts are not the type of people whom we typically think of as drug addicts: they may be working professionals, doctors, nurses, managers or high-powered business people.

In the most common scenario, a patient is prescribed an opiate like OxyContin or Vicodin after a medical procedure, and then he or she becomes hooked to the drug as a way of dealing with anxiety, stress or depression. They may not have the self-destructive streak of heroin addicts, but they nevertheless suffer from personal issues that cause them to develop an addiction rapidly and with a high level of intensity.

Most Common Mental Illnesses Comorbid with Addiction

With certain types of mental illnesses, the effects can be painful and debilitating enough to cause the individual to turn to drugs to deal with the negative effects. While comorbid disorders can take any number of forms, here are just a few of the illnesses most commonly associated with an addiction to opiates:

  • Anxiety and panic disorders
  • Depression
  • Alcoholism
  • Sleep disorders
  • Bipolar disorder (Manic Depression)
  • Adult Attention Deficit Hyperactivity Disorder
  • Post-Traumatic Stress Disorder
  • Schizophrenia

Each of these illnesses on its own warrants extensive treatment. Many require long-term medication, along with therapy. And more serious illnesses like prolonged depression, bipolar disorder and schizophrenia can even be chronic issues. That’s why, when the individual also has substance abuse problems that stem from or are closely associated with the other illness, there’s a perpetual danger of falling back into addictive patterns.

In the most severe cases, the two comorbid disorders can dangerously feed off of each other. For instance, say an individual takes prescription medications for schizophrenia or bipolar disorder, but falls into an extended bout of substance abuse and thus fails to regularly take his medication. In this scenario, the underlying mental disorder goes untreated while the addiction rages unchecked.

The problem may become even worse in cases where the individual is incapable of seeking treatment due to poverty or homelessness. For some people, particularly those who lack insurance, getting access to drugs such as heroin can be easier and cheaper than seeking medical care.

Treatment on Multiple Fronts

There are many reasons why relapses occur. Sometimes the addict relapses only temporarily due to stress, a high-pressure life situation, repeated temptation or peer pressure. In these cases, the relapses are likely to come during fleeting moments of weakness, after which the recovering addict gets back on track.

But when it comes to relapses that are associated with a separate mental illness, they can occur again and again until the individual gets treatment for the separate issue.

This is why it’s important for thorough physical and psychological exams to be a part of every addiction treatment process. Addicts need to be honest with their doctors about their feelings, and it’s also important for the addict’s family to be involved, if possible, to inform treatment professionals of any illnesses in addition to the substance abuse.

However, some addicts may enter addiction treatment without even knowing that they suffer from an illness like depression or anxiety. That’s why every recovering addict should commit to deep consultation with a licensed therapist to get to the bottom of any previously undetected mental problems that may cause or worsen their addiction.

Ideally, treatment of the comorbid illness should begin as early as the detox stage of treatment. This way, while the patient begins transitioning from heroin or prescription painkillers to replacement drugs like Suboxone or methadone, her treatment professionals will be aware of any additional mental problems that may come up as a result of the change.

In the best of circumstances, the patient will have all problems diagnosed, and treatment will begin as early as possible. With an all-encompassing combination of opioid replacement therapy, drug therapy to address the mental illness, psychotherapy and ongoing participation in a support group, the recovering addict will have the best possible chance of success.