Drug Use and Mental Illness Literature?

January 20, 2008 5:21 PM

Does literature exist that describes a relationship between adolescent "hard" drug use and later development of mental illness? I am interested in peer-reviewed journal articles and reputable websites.

I have known some friends and family to develop mental illnesses and be briefly institutionalized (e.g. for schizophrenia or bipolar disorder.) Each of these individuals has a history of abusing narcotics in their teenage years that was months or years previous to their psychotic episodes. The drugs in question that were used were meth, excessive hallucinogens, and coke (not so much marijuana.)

I'm want to read about how use of these drugs may have lead to (or increased the development rate of) the mental illnesses that later manifested. I am also interested in learning if the early stages of mental illnesses can actually lead someone to start using narcotics - perhaps as some misplaced attempt to address their cognitive deficiencies. Thanks for any resources you can provide.

posted by dendrite to health & fitness (8 comments total)

By 'Literature', do you mean 'Peer reviewed, academic studies from well known institutions' or 'The pamphlet from the Sheriff's department'? I'm sure there's plenty of the latter available for googling. As far as the former, The American journal of Drug and Alcohol Abuse might be a good starting place for a dig.
posted by Orb2069 at 6:23 PM on January 20, 2008

I have nothing to base this on, but I do side with the theory that troubled people will self medicate. Completely put-together people with no issues aren't generally looking to get wasted. Obviously a huge generalization. I'd also venture to guess that the lifestyle that goes with the drugs will tend to break people with tenuous grips with reality.
posted by gjc at 6:31 PM on January 20, 2008

Since you don't mention it in your post: you might want to check out information on dual diagnosis or concurrent diagnosis. Basically, it refers to someone with both a mental illness and a substance abuse problem. Those terms may lead you to the information you are looking for. Although there are things like drug induced psychosis or mania, it is more common for the mental illness to predate the substance abuse, often subclinical or undiagnosed.
posted by milarepa at 7:09 PM on January 20, 2008

The data goes both ways-- mostly, it looks like whatever predispositions cause addiction *also* tend to cause mental illness. Sometimes there is self-medication-- sometimes it's more like, the illness makes you impulsive and risk-taking and that also predisposes you to try many kinds of drugs and so...

Also, for example, childhood trauma increases the risk of all known mental illnesses including addiction. But whether the addiction comes first or the mental illness often has to do with the age of onset of the particular mental illness.

For a good source of data on childhood trauma and addiction and mental (and incidentally, physical) illness risk, check out
http://www.acestudy.org/

There are also some particular pharmacological effects due to particular drugs. For example, alcohol is often used to self-medicate depression but alcohol can also cause depression so it's very hard to sort out causality. [Note: they always phrase this as "alcohol is a depressant" as if that means it makes you depressed as opposed to an antidepressant. Actually, the sense of the word "depressant" when used in regard to alcohol is used as opposite of "stimulant" -- as in, it makes you tired and slowed down, not speeded up. end pedantic point].

Similarly, marijuana may exacerbate symptoms of schizophrenia. Although some researchers claim that it increases the risk of predisposed people developing schizophrenia in the first place, the epidemiology really doesn't support this. Marijuana use has risen exponentially in the last 50 years around the world and yet schizophrenia prevalence remains steady at about 1%

And since both schizophrenia onset and age of heavy marijuana use amongst the population occur at about the same time, it's really hard to know what's causing what.

Methamphetamine can cause "methamphetamine psychosis"-- but typically, this is only short-lasting and resolves with abstinence.

Gender may also be an influence: women seem more likely to bear out the 'self medication' hypothesis in studies than men do.

Bottom line: about 50% of addicts also have a mental illness and about 50% of the mentally ill also have a drug problem. There are genetic and environmental influences that increase the risk for both. No one has clearly delineated cause and effect but it doesn't seem likely that preventing drug use (if that were actually possible) would prevent a lot of mental illness.

I have followed the addictions literature for about 20 years in writing about it for various publications, including my book, Recovery Options: The Complete Guide, which I co-wrote with a leading researcher at the University of Pennsylvania. It includes a chapter on dealing with co-existing mental illnesses
posted by Maias at 7:19 PM on January 20, 2008 [1 favorite has favorites]

Seconding milarepa. The term 'comorbidity' can also be used to describe situations of dual diagnosis.

There is a glut of research on your question; I don't really know any of it, but citations abound online. The text of this article, from the American Journal of Drug and Alcohol Abuse that Orb cites above, is available here (I give you the first link because "BNET" might not appear to satisfy your reputability requirement at first glance).

From the first page of the article:

Whereas schizophrenia is a devastating disorder by itself, the high occurrence of comorbid substance use with this illness poses a very real challenge to both basic and clinical researchers. Roughly 50% of patients diagnosed with schizophrenia also meet criteria for substance abuse and/or dependence (1-5).

...

A number of theories have been put forth to explain why such a high percentage of schizophrenia patients use drugs (2, 5). For each of these theories, there is a small amount of supporting data. Nevertheless, research in this area is in its early stages, and more studies characterizing the nature of the drug use in schizophrenia patients are warranted.

One early theory for the association between drugs and schizophrenia held that schizophrenia was caused in some patients by the psychotomimetic features of drugs of abuse, most notably LSD (lysergic acid diethylamide), PCP (phencyclidine), amphetamines, and cocaine (10-12). However, when subsequent episodes of illness have been examined in schizophrenia patients whose initial episode of illness was precipitated by ,drugs, there were frequent instances in which drugs were not involved (10), and symptom presentations were typical of the illness, indicating that, while drug abuse may be capable of precipitating schizophrenia in vulnerable individuals, there are few data to support the idea that drugs actually cause schizophrenia (13). A related, but important, distinction, however, is that patients who use drugs have more frequent exacerbations, as evidenced by more frequent hospitalizations (2, 5, 7, 14, 15); therefore, while drugs may not cause schizophrenia, they appear to be associated with a more malignant course of the illness.

Citations from the above passage:

(1.) Regier, D. A., Farmer, M. E., Rae, D. S., et al., Comorbidity of mental disorders with alcohol and other drug abuses, JAMA 264:2511-2518 (1990).

(2.) Westermeyer, J., Schizophrenia and substance abuse, in Review of Psychiatry, Vol. 11 (A. Tasman and M. R. Riba, Eds.), American Psychiatric Press, Washington, D.C., 1992, pp. 379-401.

(3.) Drake, R. E., Osher, F. C., Noordsy, D. L., et al., Diagnosis of alcohol use disorders in schizophrenia, Schizophr. Bull. 16:57-67 (1990).

(4.) El-Guebaly, N., and Hodgkins, D. C., Schizophrenia and substance abuse: prevalence issues, Can. J. Psychiatry 37:704-710 (1992).

(5.) Selzer, J. A., and Lieberman, J. A., Schizophrenia and substance abuse, Psychiatr. Clin. North Am. 16:401-412 (1993).

(7.) Inderbitzin, L. B., Scheller-Gilkey, G., Lewine, R. R. J., et al., A double-blind dosage reduction trial of fluphenazine decanoate in chronic, unstable schizophrenic patients, Am. J. Psychiatry 151:1753-1759 (1994).

(10.) Vardy, M. M., and Kay, S. R., LSD psychosis or LSD-induced schizophrenia? A multimethod inquiry, Arch. Gen. Psychiatry. 40:877-883 (1983).

(12.) Hanson, G. R., Singh, N., Merchant, K., et al., Responses of limbic and extrapyramidal neurotensin systems to stimulants of abuse: involvement of dopaminergic mechanisms, Ann. N.Y. Acad. Sci. 668:165-172 (1992).

(13.) Silver, H., and Abboud, E., Drug abase in schizophrenia: comparison of patients who began drug abuse before their first admission with those who began abusing drugs after their first admission, Schizophr. Res. 13:57-63 (1994).

(14.) Bartels, S. J., Teague, G. B., Drake, R. F., et al., Substance abuse in schizophrenia: service utilization and costs, J. Nerv. Ment. Dis. 181:227-232 (1993).

(15.) Turner, W. M., and Tsuang, M. T., Impact of substance abuse on the course and outcome of schizophrenia, Schizophr. Bull. 16:87-95 (1990).
posted by holympus at 7:31 PM on January 20, 2008

The drugs did not cause the illness. The illness caused the drugs. Self medication is a well known phenomena. That being said, the drugs used to avoid the pain can easily make the underlying situation worse.
posted by caddis at 8:07 PM on January 20, 2008

Psychotic episodes are the caboose on the mental illness train. The people you knew almost certainly were crazy already. Bipolar disorder, at least, is pretty much genetically caused, and manic episodes are very often synonymous with drug/alcohol binges.
posted by herbaliser at 1:53 PM on January 21, 2008

Ah the green comes through again, thank you all for such fantastic answers!
posted by dendrite at 11:09 PM on January 27, 2008