Substance-Induced Disorders: When Substances Cause Mental Illness

Theresa entered an alcohol detoxification program following an emergency room visit due to extreme alcohol intoxication. She told the hospital staff that she had been “just fine” a week ago and had not been feeling depressed at that time. In fact, she felt that “life was good.”

However, since relapsing four days ago, Theresa said she had been feeling depressed and was having fleeting thoughts of suicide. She also noticed increasing trouble with her concentration and a sharp decrease in her physical energy.

Theresa entered treatment and was diagnosed with substance-induced depressive disorder, which is a category of substance induced disorders, or SIDs.

What are SIDs?

Substance-induced disorders are conditions or illnesses that are caused by substance use. They are different from “co-occurring” or “dual diagnosis” substance use disorders in that the mental impairment is not present in conjunction with a substance use disorder (as found in cases of co-occurring conditions), but it is instead directly caused by the substance use itself.

In other words, if substance use was not present, there would be no SID, but there still might be another mental condition present.

Types of SIDS 

As described in the Diagnostic and Statistical Manual of mental diseases in its 5^th edition (DSM-5; 2013, American Psychiatric Association) there are 11 categories of substance-induced disorders:

• Intoxication: Clinically significant psychological changes due to substance use, such as slurred speech, lowered inhibitions, euphoria, impaired balance, impaired thinking
• Withdrawal: Clinically significant physical and/or psychological symptoms resulting from the cessation of substance use, such as depressed mood, nausea/vomiting, muscle aches, diarrhea, fever, insomnia
• Substance-induced psychosis: Hallucinations and/or delusions occurring as a result of substance use and not typically present when substances are not being used
• Substance-induced bi-polar disorder: Alternating manic, or “high,” and depressed mood swings, induced by substance use and not typically present when substances are not being used
• Substance-induced depressive disorder: Symptoms of depression–sadness, hopelessness, suicidal thoughts, low energy, difficulty concentrating, social withdrawal–that are induced by substance use and not typically present when substances are not being used
• Substance-induced anxiety disorder: Generalized anxiousness, panic, irritability, and insomnia that are induced by substance use and not typically present when substances are not being used
• Substance-induced obsessive-compulsive disorder: Feelings of being “compelled” to carry out certain behaviors or actions, for example re-checking locked doors, repeatedly washing hands, etc., usually carried out in an attempt to reduce stress, that are induced by substance use and not typically present when substances are not being used
• Substance-induced sleep disorder: Sleep disturbances–insomnia, or the inability to get to sleep or stay asleep; hypersomnia, or excessive sleepiness; or parasomnia, a combination of both–that are induced by substance use and not typically present when substances are not being used
• Substance-induced sexual dysfunction: Problems with sexual desire, arousal, orgasm, or pain beyond that which is associated with intoxication, that are induced by substance use and are not typically present when substances are not being used
• Substance-induced delirium: Mental confusion, disorientation and blurred awareness that is induced by substance use and not typically present when substances are not being used
• Substance-induced neuro-cognitive disorders: Disturbance of cognitive function, such as memory impairment, aphasia or the loss of ability to understand speech; or apraxia, the inability to perform purposeful actions, that is induced by substance use and that is not typically present when substances are not being used

Criteria for Diagnosing SIDs

To be diagnosed as a substance-induced disorder, the symptoms must be clinically significant, meaning that they cause significant distress and/or interfere with the person’s ability to take part in normal, daily activities.

To be diagnosed as a substance-induced disorder, the symptoms must be clinically significant, meaning that they cause significant distress and/or interfere with the person’s ability to take part in normal, daily activities. -Rita Milios

Also, the symptoms must have developed within one month following the abuse of the substance.

To determine whether a mental condition is strictly substance-induced and not part of a co-occurring condition, an abstinence period of weeks or months may be required to see if symptoms are present in the absence of the substance thought to be causing the symptoms.

If you suspect that you may be experiencing a substance-induced mental condition or disorder, it is important to have your condition clinically monitored by either a physician or a psychotherapist, or both.

Substances That Can Cause Substance-Induced Mental Illness

The most common substances that give rise to symptoms of SIDs are:

• Alcohol – associated with substance-induced mood disorders (depression, anxiety, bi-polar), substance-induced sleep disorders and substance-induced psychotic disorders
• Caffeine – associated with substance-induced anxiety
• Cocaine –  associated with substance-induced anxiety and panic
• Methamphetamines – associated with substance-induced depression, anxiety, and hallucinations
• Hallucinogens (Marijuana, LSD) – associated with substance-induced depression, anxiety, delusions and hallucinations
• Nicotine – associated with substance-induced anxiety, irritability and nausea
• Opioids – associated with substance-induced anxiety/irritability and depression
• Sedatives/Benzodiazepines (Xanax, Valium, Ativan, Klonopin) – associated with substance-induced anxiety, substance-induced mania, substance-induced sleep disorders and substance-induced sexual disorders

Treatment of Substance-Induced Disorders

Fortunately, substance induced-disorders are readily treatable. First, the intake of the substance must be ceased. Then detoxification must be initiated to rid the person’s system of the drug. Many substance-induced disorder symptoms disappear once the substance has been completely cleared from the body.

Specific treatment depends on the drug that was being used. For substance-induced depression, antidepressants such as Paxil, Prozac, Cymbalta, Effexor or Elavil may be prescribed to elevate mood.  For substance-induced psychosis, treatments may include antipsychotic medication, such as Risperdal or Seroquel. In severe cases, hospitalization may be required.

Psychotherapy or counseling and behavioral intervention programs are used in the treatment of most substance-induced disorders. Family support and peer support groups are also important elements of treatment. The aim of all treatments is to help the person remain abstinent from substance use, develop positive habits positive coping strategies, and to create a healthier, more meaningful lifestyle.

 

 

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