Hall - Stimulants - Comorbidity and Addictions

 - Stimulants -
Comorbidity and Addictions

[Image] Retrieved from https://www.additudemag.com/general-questions-about-comorbid-conditions/


Overview:

Many people live with comorbidity, as in two or more disorders or illnesses. The disorders or illnesses occur at the same time or one right after the other. This can also be referred to as a “dual diagnosis”. A drug addiction can be one of these illnesses, changing the brain in fundamental ways. Around half of the people who have a substance use disorder also develop other mental illnesses, just as people who are diagnosed with mental illness are often diagnosed with a substance use disorder (NIDA, 2018). Few studies have been done on comorbidity in children, but those that have been conducted suggest that youth with substance use disorders also have high rates of co-occurring mental illness, such as depression and anxiety (NIDA, 2018).


How Comorbidity Can Relate To Stimulants:

Prescribed stimulants are typically used to treat ADHD. While stimulants are considered the first-line treatment for ADHD, they present clear challenges for certain populations, especially in patients with significant antisocial and addiction histories (Bastiaens, Scott & Galus, 2019). Many people with attention deficit disorder (ADHD or ADD) have one or more comorbidity such as depression, a substance abuse disorder, a learning disability, oppositional defiant disorder (ODD), or some other condition (ADDitude Editor, 2019). Several population and clinical-based studies have reported that more than half of ADHD cases have at least one psychiatric comorbidity (Yüce, Uçar, & Gökçe, 2015). Depression is a very common ADHD comorbidity. Adults with other stimulant use (cocaine, amphetamine, methamphetamine) use disorders (SUD) are also reported to have higher rates of other medical conditions (Dela-Cruz et al., 2016).

  • 70% of adults with ADHD will be treated for depression at some time.
  • Some estimates are as high as 50% for those with ADHD living with either alcoholism or some form of substance abuse.
  • Up to 23% of those with ADHD will develop Bipolar Disorder.
  • Tourette’s, Dyslexia, ODD and other disorders are more common among ADHD people than among the general population.
    (ADDitude Editor, 2019).

[Image] Retrieved from https://adultmentalhealth.org/major-depression-isnt-easy-to-spot-in-yourself-or-someone-you-love/


Treating Comorbidity:

Treating comorbidity may be confusing as you question which comorbid condition to treat first. Usually, it depends on which is causing the most problems. Typically, if a person has depression, you would want it to be treated before considering ADHD because depression can look like ADHD, especially ADD without hyperactivity (ADDitude Editors, 2019). The same could be said for substance abuse.

Comorbid disorders may mimic or obscure each others symptoms (ADDitude Editor, 2019). For example, let's say someone is diagnosed with depression. After treatment, the depression is under control, but there is still problems with inattention. So, the diagnosis would change to include ADHD as well as the original diagnosis of depression. The ADHD was there the whole time, but it was overshadowed by the symptoms of depression (ADDitude Editor, 2019).

When dealing with a child who has multiple comorbid diagnoses, it is especially important to make sure that the professionals involved know what the other is treating. For example, if your child is seeing a psychiatrist and a neurologist, make sure that both doctors are aware of what the other is doing, and that they are aware of which medications are being prescribed (ADDitude Editor, 2019).

Rates of medical illnesses may be higher among individuals with substance use disorders, complicating their care (Dela-Cruz et al., 2016). Different behavioral therapies have shown promise for treating comorbid conditions. These approaches should be tailored to patients according to their age, the specific drug misused, or any other factors. They can be used alone or in combination with medication (NIDA, 2018).


Some effective behavioral therapies for treating comorbid conditions include: 

  • Cognitive Behavioral Therapy (CBT) helps to change harmful beliefs and behaviors.
  • Dialectical Behavioral Therapy (DBT) was designed specifically to reduce self-harm behaviors including suicide attempts, thoughts/urges, cutting, and drug use.
  • Assertive Community Treatment (ACT) emphasizes outreach to the community and an individualized approach to treatment.
  • Therapeutic Communities (TC) are a common form of long-term residential treatment that focus on the “resocialization” of the person.
  • Contingency Management (CM) gives vouchers or rewards to people who practice healthy behaviors.
    (NIDA, 2018).

    [Image] Retrieved from https://www.independent.co.uk/life-style/health-and-families/therapy-free-nhs-private-cost-b1844517.html


References

ADDitude Editors. (2019, July 8). ADHD Comorbidity: An Overview of Dual Diagnoses. Retrieved from https://www.additudemag.com/general-questions-about-comorbid-conditions/

Bastiaens, L., Scott, O., & Galus, J. (2019). Treatment of Adult ADHD without Stimulants: Effectiveness in A Dually Diagnosed Correctional Population. Psychiatric Quarterly, 90(1), 41–46. https://doi.org/10.1007/s11126-018-9602-7

Dela-Cruz, A. M., Carmody, T., Greer, T. L., Rethorst, C. D., Warden, D., Walker, R., & Trivedi, M. H. (2016). Baseline medical comorbidities in adults randomized in the STRIDE trial for psychostimulant use disorders. American Journal on Addictions, 25(3), 215–220. https://doi.org/10.1111/ajad.12363

NIDA. (2018, August 1). Comorbidity: Substance Use Disorders and Other Mental Illnesses DrugFacts. Retrieved from https://www.drugabuse.gov/publications/drugfacts/comorbidity-substance-use-disorders-other-mental-illnesses

Yüce, M., Uçar, F., & Gökçe, N. (2015, September 24). Comorbid Conditions in Child and Adolescent Patients Diagnosed with Attention Deficit/Hyperactivity Disorder, ADHD - New Directions in Diagnosis and Treatment, Jill M. Norvilitis, IntechOpen, DOI: 10.5772/61112.

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