Altare: Stimulants- Comorbidity and Addictions
Psychiatric
comorbidities and amphetamine use can cause serious morbidity, studies have
shown that depressive disorder symptoms are a common pre-existing mental health
disorder and can co-occur with amphetamine dependences. In fact, The National
Epidemiologic Survey on Alcohol and Related Conditions accessed the psychiatric
diagnosis’s from a sample of 43,093 subjects with amphetamine dependence and found
that the lifetime prevalence of mood disorders such as depression was 64% (Ruth Salo,
2010).
The
sad truth is that these patients can be the most difficult to treat and are
less likely to have a successful outcome compared to patients who have only one
disorder. The reason being is that amphetamines increase dopamine, this neurotransmitter
that allows feelings of motivation, pleasure and increased energy (Meth Addiction and Mental Health Problems, 2020). For a person with
depression, using amphetamines can be quite motivating and uplifting for them. Self-medicating
is common in amphetamine users because they feel that they are blocking their problematic
psychiatric symptoms. When they discontinue the use of amphetamines it can reveal
even more severe depressive symptoms than before and require psychiatric
treatment or hospitalization due to suicidal ideations and or attempts.
A
report from the Journal of Neuropsychiatry showed reported psychiatric symptoms
from individuals who were currently amphetamine-dependent comparing them to individuals
who denied the use of amphetamines. The percentages showed that the individuals
who were amphetamine dependent were in need of or were currently seeking
psychiatric treatments, were experiencing suicidal ideations, having issues with
anger and had experienced depressive symptoms (Ari
Kalechstein, 2000).
Photo
1: Shows the association between psychiatric symptoms and self-reported methamphetamine
dependence (Ari Kalechstein, 2000).
Sadly
women with amphetamine dependence were more likely to report psychiatric problems
such as depression, anger and suicidal ideations. Initially studies showed that
anger and temper issues were associated with amphetamine use, later studies
show that amphetamine dependence is associated with psychosocial outcomes such
as loss of employment and lack of health insurance. Because of the further studies
it was determined that the resulted outcomes are were contributing to the
distress and anger not the actual drug itself (Ari Kalechstein, 2000).
Many
individuals who use amphetamine with co-morbiding psychiatric disorders end up
in hospital emergency rooms versus receiving routine psychiatric treatment. Studies
show that these patients are high risk for hospital readmission and often receive
poor treatment responses in both the drug dependence and co-occurring psychiatric
disorder (Ruth Salo, 2010). ER physicians
should be properly educated on the DSM criteria for substance-induced disorders
to ensure that patients with both substance abuse problems are getting the
treatment that they deserve. This could prevent suicide and contribute to substance
abuse treatment.
Photo
2 Shows the DSM criteria for substance-induced disorders (Ruth Salo, 2010).
Below
is a video that discusses amphetamine intoxication and withdrawal symptoms, finding,
causes and mnemonics (MLE, 2013). Th
References
Ari Kalechstein, P. T. (2000). Psychiatric
Comorbidity of Methamphetamine Dependence in a Forensic Sample. Retrieved
from The Journal of Neuropsychiatry and Clinical Neurosciences: https://neuro.psychiatryonline.org/doi/full/10.1176/jnp.12.4.480
Meth Addiction and Mental Health
Problems. (2020). Retrieved from
Mental Help . Net: https://www.mentalhelp.net/substance-abuse/meth/mental-effects/
Ruth Salo, K. F. (2010). Psychiatric
Comorbidity in Methamphetamine Dependence. Retrieved from US National Library
of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058719/
Very informative blog on stimulant comorbidity. For those with mental disorders and substance use disorders, it is difficult to sort out which disorder is occurring at a time or if it is both. A risk factor for preexisting psychiatric disorders is stimulant use (Ruglass, et al., 2014). The self-medication hypothesis is a fundamental principle for substance abusers. Warden et al. (2016) stated that lifetime rates of mood disorders for methamphetamine comorbidity account for 32.3-64.3% while anxiety disorders comprise 24.3-50.3%, cocaine mood disorders were 12.3-62.5% with anxiety disorders 20.7-45%. Characteristics of the stimulant user from a sample by Warden et al (2016) concluded that 40% were female, 50% white, 46% black, average age 39, 53.3% never married, average education high school graduate, and 31.5% currently employed. Of the percentages of stimulant use, cocaine was 59%, other stimulants (primarily methamphetamine) 11%, cocaine and other stimulants combined was 31% (Warden, 2016). I found that the most frequent mood disorders comorbid with stimulants in all groups was major depressive disorder (MDD), then generalized anxiety disorder (GAD), followed by social phobia and dysthymia (Warden et al., 2016). Warden et al (2016) added that those in the other group (meth) were more likely to also have comorbid panic disorders.
ReplyDeleteMethamphetamine use disorder frequently co-occurs with psychiatric symptoms, psychosis, anxiety and depression, with a higher likelihood of producing psychotic symptoms than other drugs (Stuart, et al., 2019). Those who use meth and experience depressive symptoms have a poorer prognosis for both outcomes, have a higher risk of suicidal ideation and suicide attempts (Stuart, et al., 2019). At the opposite end of that, psychotic symptoms associated with meth use resemble symptoms of schizophrenia, masking the true disorders making it even more difficult to treat (Stuart, et al., 2019). In addition to mood disorders being comorbid with stimulant use, posttraumatic stress disorder (PTSD) has been well established in heavy stimulant users (Ruglass, et al., 2014). Classic characteristics of PTSD comorbid with stimulant use are women, average age of 41 years, and had experienced sexual and physical assault during adulthood (Ruglass, et al, 2014). Studies show that heavy stimulant users had greater symptoms of PTSD, benefit from interventions, proving that relief from PTSD symptoms will lead to reduced substance abuse (Ruglass, et al., 2014). With no pharmacotherapy found to be effective for treatment of methamphetamine, therapy is often challenging and difficult. Stuart et al (2019) reported that the most effective treatment plans are motivational interviewing (MI) and cognitive behavioral therapy (CBT) for stimulant comorbidity. Stuart et al (2019) noted that further research into contingency management (CM) as a useful intervention for stimulant comorbidity treatment is encouraged. I enjoyed reading your blog. Nicely written.
References:
Ruglass, L., Hien, D., Hu, M., & Campbell, A. (2014). Associations between post-traumatic stress symptoms, stimulant use, and treatment outcomes: a secondary analysis of NIDA’s Women and Trauma study. American Journal on Addictions, 23(1), 90–95. https://doi.org/10.1111/j.1521-0391.2013.12068.x
Stuart, A., Baker, A., Denham, A., Lee, N., Hall, A., Oldmeadow, C., Dunlop, A., Bowman, J., & McCarter, K. (2019). Psychological treatment for methamphetamine use and associated psychiatric symptom outcomes: A systematic review. Journal of Substance Abuse Treatment, 109, 61-79. https://doi.org/10.1016/j.jsat.2019.09.005
Warden, D., Sanchez, K., Greer, T., Carmody, T., Walker, R., dela Cruz, A., Toups, M., Rethorst, C., & Trivedi, M. (2016). Demographic and clinical characteristics of current comorbid psychiatric disorders in a randomized clinical trial for adults with stimulant use disorders. Psychiatry Research, 246, 136-141. https://doi.org/10.1016/j.psychres.2016.09.007