Mental Health

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Mental health problems can take many forms: The Fortune 500 executive with mood swings who drinks martinis to get through the day; the college senior struggling with depression who snorts cocaine to get through the semester; the housewife riddled with fear who needs a carton of cigarettes and bottle of tranquilizers just to leave her house.

Although the problems -- and the people -- are vastly different, they share a common bond: They all suffer from both a mental health problem and substance abuse.

And it's a combination that doctors are increasingly noting in people from all walks of life. Today, experts estimate that at least 60% of those battling one of these conditions are battling both.

"Mental health problems and substance abuse are often seen together because one makes you more vulnerable to the other," says Alan Manevitz, MD, a psychiatrist with New York-Presbyterian Hospital, Cornell University campus, in New York.

Mental health problems are common in the U.S. An estimated 1 in 5 adults in the U.S. suffers from a diagnosable mental disorder, according to the National Institute of Metal Health.

When there is a biological or genetic vulnerability to any type of mental health problem, regardless of how big or small, Manevitz says, substance use often triggers the onset of that problem.

"The substance is not really causing the mental health problem, but it can be a precipitating factor that causes the condition to manifest," Manevitz tells WebMD.

Likewise, he says, the brain chemistry involved in many types of mental health problems can, in some respects, appear to be neutralized by certain addictive substances. This, he says, can cause many folks to "self-medicate" problems they don't even know they have, often beginning years before obvious symptoms appear.

"In this respect, the mental health condition is already actively present when the substance abuse begins, but the patient just doesn't know it -- the problem is driving the addiction, it just hasn't yet been recognized or diagnosed," Manevitz tells WebMD. It is, in fact, the increasing awareness of this dual diagnosis that has opened the door to a whole new line of thinking about both substance abuse and mental health problems. Indeed, some researchers contend that certain forms of mental illness and some addictions may, in fact, be a single disease.

Among the areas where this research is most prominent is a condition known as bipolar disorder -- a disease characterized by cycles of extreme mood swings between deep depression and high elation, or mania. During periods of mania, patients show extreme irritability, racing thoughts, little need for sleep, poor judgment, distractibility, abuse of drugs, and denial that anything is wrong. Depressive periods are associated with feelings of hopelessness, guilt, too much sleep, and thoughts of death or suicide.

"What we have found is that people with bipolar disorder, particularly women, have an enormously high rate of alcoholism -- up to seven times that of the general population," says Mark Frye, MD, director of the UCLA Bipolar Disorder Research Program in Los Angeles.

This is also true, says Frye, when both male and female bipolar patients are compared to those with other forms of mental illness.

And while the reason remains unclear, Frye tells WebMD that there is at least some evidence that the two conditions share many similarities -- emanating from the same area of the brain and controlled by somewhat the same brain chemistry.

Indeed, as the age of "brain science" continues to mature, a number of researchers have begun to note some startling similarities within the brain chemistry patterns of various types of mental health problems and substance abuse. Some of the more interesting discoveries had to do with animal models of addiction.

"Research on rats showed us that there were certain pleasure centers of the brain that, when stimulated, elicited such a powerful response, the animal would opt for stimulation over food," says Francis Hayden, MD, associate director of the division of Alcohol and Substance Abuse at Bellvue Hospital in New York.

This discovery, he says, led many researchers to question whether there was something different about the brains of substance abusers that "causes them to kind of feel not quite right -- so that when they happen upon a substance, it kind of normalizes them in a way," says Hayden.

That feeling of "not quite right," he says, may be the mental health problem at work.

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