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A Guide To Substance Induced Mental Disorders

Substance abuse and addiction are ever-growing concerns for health authorities around the world. According to Dr Kima Joy Taylor (director of the CATG Initiative) around 12% of the population, are currently fighting drug or alcohol addiction.[1]

This statistic is worrying enough, but studies are now illuminating the links between substance abuse and mental health issues. Around 50% of adults with severe mental health issues are affected by substance abuse and addiction and 29% of all people classed as mentally ill abuse either drugs or alcohol.[2]

On top of this, 53% of those who abuse drugs and 37% of those who abuse alcohol are struggling with at least one severe mental illness.[3]

The key to understanding the effect that substance abuse has on mental illness, and vice versa, is to first understand how substances affect the brain, and how these effects can cause short and long-term damage.

How the Brain Works 

The brain has 8 distinct parts, each of which is responsible for a set of functions. The cerebrum, for example, is the largest part of the brain and is responsible for most of the work that the brain does while the frontal lobe is the centre of personality, intellect, smell, muscle movement and abstract thinking (amongst other things).[4]

The parietal lobe controls the sensory and motor cortexes, while the temporal lobe houses language, speech, and hearing, and the occipital lobe specialise in language comprehension and facial expressions.[5]

Finally, the cerebellum is responsible for balance, coordination, and movement, the limbic system includes the thalamus, hypothalamus, amygdala, and hippocampus, while the brain stem manages all basic life support systems.[6]

Drugs change your mood and perceptions of the world by affecting specific parts and functions of the brain. Certain drugs impact impulse control, emotional control, memory, cognition, reflex control, mental health, and reward control.

When drugs enter our system they ultimately make their way to the brain through the bloodstream. Once in the brain, they interfere with and alter normal brain chemistry in order to produce the desired effect.

This is true for all drugs of course; painkillers alter brain chemistry in order to suppress pain, for example. Recreational drugs are more likely to become addictive because they activate one or more of the many pleasure centres in the brain.

Common Mood Altering Substances

Substance abuse has never been simple, but it is now more complex than ever before; different drugs are on the market, and the habit of mixing drugs is on the rise. Nonetheless, these are the most common mood-altering substances which people who suffer from substance-induced mental disorders reported using.

1. Alcohol

Alcohol is one of the few addictive substances which is regularly consumed by the majority of the population. This is partly a sociological phenomenon, but also a physical and psychological one; in most people moderate to heavy alcohol consumption resorts in feelings of euphoria and decreased inhibitions.

For those who have anxiety or depression, alcohol can provide welcome relief, but the hangover can exacerbate or even create symptoms such as intense feelings of guilt, anxiety, shame, or depression.

In cases of protracted withdrawal (lasting more than a few days), it can be hard to tell the symptoms of withdrawal apart from those of a separate or co-occurring mental disorder. Intense or protracted alcohol abuse can result in delirium, alcohol dementia, or even brain damage; the first of these can be reversed with sobriety, while the latter two cannot.[7]

2. Cocaine and Amphetamines

Cocaine and amphetamines are stimulants that, when ingested on a mild to moderate basis they induce euphoria, a sense of wellbeing, feelings of strength, pride, and accomplishment, as well as a perceived increase to cognitive powers. Heavy use, however, sees a decline in concentration, function, and ability to focus.

Like alcohol, stimulants can induce paranoia and anxiety, however, cocaine and methamphetamines are far more likely to induce temporary psychosis which can last for days. Chronic usage of methamphetamine may even induce psychotic states which last months or years.

Unlike schizophrenia induced paranoia, however, cocaine-induced paranoia tends to leave people with cognitive capabilities intact. This makes delusions more paranoid and less bizarre. Unlike alcohol-induced symptoms, the fallout of heavy or prolonged methamphetamine and cocaine abuse does not clear up quickly and can often last weeks if not months.[8]

3. Opioids

Opioid abuse is also characterised by euphoria and feelings of intense wellbeing and relaxation, while withdrawal results in agitation, aches, dysphoria, cravings, sleep disturbance, and gastrointestinal issues.

Mental symptoms of withdrawal vary from person to person and can also depend on the severity of consumption. However, for those who have become dependent on opioids such as morphine or heroin ongoing withdrawal symptoms can be so severe as to cause relapse and permanent damage to the brain.

Some opioids, such as PCP (phencyclidine), cause delusional symptoms, hallucinations, and violent behaviour as well as amnesia, or even induce an acute psychotic state which is more likely to recur with repeated use.

4. Sedatives

Sedatives such as diazepam, like alcohol, are depressants which can induce feelings of euphoria, wellbeing, and relaxation as well as withdrawal symptoms such as anxiety, depressive feelings, anhedonic states, dizziness, derealisation, and depersonalisation.

Most of these symptoms will reduce or disappear entirely within a week of stoppage, but some can last up to one year if the abuse has been chronic. No dementia-type syndromes seem to be connected to sedative abuse, but those who have consumed them heavily over a long period often report chronic anxiety symptoms and a lack of responsiveness to other treatments.

Substance-Induced Mental Disorders

According to the Diagnostic and Statistical Manual, there are 11 categories of substance-induced disorders. These disorders include:

  • Intoxication: slurring, low inhibitions, euphoria, impaired balance, and thinking
  • Withdrawal: depressed mood, fever, aches, diarrhoea, insomnia, nausea
  • Psychosis: hallucinations and/pr delusions
  • Bi-Polar Disorder: alternating highs and lows (‘manic’ and ‘depressed’)
  • Depressive Disorder: low mood, hopelessness, suicidal thoughts, low energy
  • Anxiety Disorder: panic, irritability, anxiety, insomnia
  • OCD: feelings of compulsion to undertake certain behaviours such as hand-washing
  • Sleep Disorder: excessive sleeping or inability to sleep
  • Sexual Dysfunction: problems with libido, ability to orgasm, or arousal
  • Delirium: confusion, disorientation, blurred awareness
  • Neuro-Cognitive Disorders: memory impairment, apraxia, loss of ability to understand speech

These symptoms can occur following substance abuse of any kind. However, a mood or mental disorder is more likely to be caused by intense, prolonged abuse.

Mood Vs Mental Disorders

Substance-induced mood and mental disorders share many characteristics, and certainly a root cause, but they do differ in key ways. A mood disorder is most likely to affect the way you feel; depression, anxiety, and bipolar disorder are just some examples of ‘mood’ disorders which can be caused by severe substance abuse.[9]

A mental disorder, by contrast, is a disorder that affects the way you think or perceive the world. Schizophrenia and psychosis are the most obvious examples of mental disorders that can be induced by substance abuse.[10]

Substance-Induced Disorders and Brain Damage

Given that drugs produce their effects by altering brain chemistry, it should be no surprise that long-term, heavy use can cause damage to this delicate and complex organ. The long-term effects of substance abuse on the brain include:

  • Disruption of nutrient delivery and absorption
  • Damage to neurotransmitters and receptors
  • The death of brain cells
  • Alternations to brain chemistry
  • Deprivation of oxygen

The reality of substance-induced brain disorders is, of course, complex, but generally speaking, alcohol is most likely to cause dementia, depression, or Wernicke-Korsakoff syndrome while stimulants are most likely to cause anhedonia.

Opioids and marijuana, by contrast, have a higher likelihood of causing psychotic disorders, delusions, and paranoia as well as hypoxia (which leads to the brain not getting enough oxygen).

Some damage may be transient, that is temporary, whilst other types of damage may be permanent; only a doctor can identify whether the damage done to the brain is likely to be permanent. If a doctor determines that the damage is transient, recovery depends on a number of factors including:

  • The severity and length of abuse
  • The type(s) of drug used
  • The method of detox completed
  • The number of drugs taken
  • The availability of support and therapy sessions

Things like overall bodily health, diet, and hydration also affect the speed and level of recovery from a brain injury caused by substance abuse and the mental and mood disorders that are connected to such damage.

How to Identify Substance-Induced Disorders

For those who have no medical background, it can be hard to know whether you or someone you love has a substance-induced mood or mental disorder, or even a problem with substance abuse. In practical terms, substance abuse and mental illness are complex issues that often fail to reveal their causes to all but true experts.

For this reason, it can be hard to tell whether you or your loved one is facing a substance-induced disorder, or if substance abuse is instead a way of self-medicating a pre-existing disorder.

In any case, the symptoms of substance abuse or addiction include but are not limited to:

  • Withdrawal from social life in order to consume alcohol or drugs
  • Anxiety and irritability when unable to consume alcohol or drugs
  • Hiding levels of consumption
  • Anger when confronted about consumption levels
  • Unusual need for money
  • Continued consumption after promises or resolutions to stop
  • Inability to moderate consumption

Symptoms of mental or mood disorders include but are not limited to:

  • Low or unstable moods
  • Confusion and disorientation
  • Excessive fear, worry, or anxiety
  • Consistent low energy or sleep disruption
  • Detachment from reality, delusions, paranoia, or hallucinations
  • Inability to cope with daily problems or stresses
  • Suicidal thoughts
  • Excessive anger or hostility

If you notice more than one or two of these symptoms, either over a long period or in tandem, within yourself or someone you love please seek help from a doctor or local support group.

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