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Comorbidity of Substance Abuse and Mental Illness, Associated Complications, and Approaches to Care Essay

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Updated: Jul 23rd, 2021

Substance abuse (S.A.) and mental illness (MI) are some of the most dangerous health issues that can damage one’s health and well-being significantly. What is more aggravating than any of these problems is the combination of the two. The present paper aims to analyze the issue of comorbidity of S.A. and MI, as well as the complications related to these problems, such as stigmatization and a tendency toward suicide. Also, the prevalence of the issue within the forensic system is discussed. Finally, the investigation of recovery and integrated care is performed. All sources used in the project are peer-reviewed articles from reputable scholarly journals written by professionals in the field of health care specializing in various areas. The consulted sources, which have been published within the past five years, are of high quality and allow making relevant conclusions about the research topic. Hence, the purpose of the essay is to provide an extensive analysis of the researcher’s topic taking into consideration different aspects of S.A. and MI co-occurrence.

Co-Occurring S.A. and MI: A Double Jeopardy

Substance use occurs in both mentally healthy individuals and mentally ill people. However, research indicates that patients with psychotic disorders have a much higher risk than the general population for heavy marijuana, alcohol, and recreational drug use, as well as smoking (Hartz et al., 2014). Scholars note that despite a positive change in smoking rates among people under 30, which was gained by public health efforts, no positive alterations are recorded for mentally ill individuals (Hartz et al., 2014). Furthermore, there is a distinction between the potential to S.A. among patients with mild and severe psychotic problems. According to the National Survey on Drug Use and Health performed in 2009-2011, 36% of adult Americans with MI were smokers in comparison to 21% of mentally healthy adults (Hartz et al., 2014). Furthermore, people with MI are less likely to cease their negative habits than those without any psychological distress.

Apart from investigating S.A. among mentally unstable individuals, scholars also analyze the peculiarities of such comorbidity within specific psychiatric disorders. Nesvåg et al. (2015) have compared the prevalence of S.A. in patients with bipolar disorder, schizophrenia, and depressive illness. The authors have found that the highest comorbidity is between S.A. and schizophrenia (25.1%), and the lowest was in S.A. and depressive illness (10.9%). The prevalence of S.A. in bipolar disorder patients constitutes 20.1% (Nesvåg et al., 2015). Middle-aged male bipolar disorder patients are reported to have the highest rate of alcohol use disorder (19.1%), and young males suffering from schizophrenia are most likely to develop a non-alcohol drug use disorder (29.6%) (Nesvåg et al., 2015). Scholars emphasize the significance of finding solutions to preventing the illicit use of drugs among adolescents.

While co-occurrence of MI and S.A. has a highly negative effect on individuals, the influence of these issues may become further aggravated by other factors. For instance, as Walker and Druss (2016) report that poverty can have a rather adverse influence on patients with both MI and SA. Scholars note that multimorbidity has become a defining feature of U.S. health care, which leads to numerous complications and undermines citizens’ physical and psychological well-being. What is more, when a patient with two or more co-existing disorders is below the poverty level, his or her health risks are higher. For any combination of health-related problems, the addition of financial hardships raises the likelihood of poor health (Walker & Druss, 2016). Hence, it is crucial to expand on the conventional definitions of comorbidity and multimorbidity so that they would incorporate social and economic circumstances.

Co-occurrence of S.A. and MI may be recorded within various populations, some of which may sound quite surprising. For instance, the study by Banducci, Bujarski, Bonn-Miller, Patel, and Connolly (2016) is focused on post-traumatic stress disorder (PTSD) and S.A. among veterans, which seems like a relevant issue taking into consideration the types of activities in which these people are engaged. However, the article by Cares, Pace, Denious, and Crane (2015) discusses S.U. and MI among nurses, which is a surprising fact when to think about the primary duty of these professionals – taking care of sick individuals. Still, as research findings indicate, comorbidity of MI and S.A. does not make exceptions for any age, gender, status, or occupation.

In the veteran population, the likelihood of developing S.A. is increased in those who have PTSD. This incidence occurs due to poorer health outcomes in veterans with comorbidity compared to those with no MI. Particularly, low tolerance for emotional distress is related to elevated scores in the Posttraumatic Stress Disorder Checklist, and S.A. cravings are driven by trauma (Banducci et al., 2016). What concerns nurses, the reasons for developing MI, and S.A. are twofold: personal and environmental. Personal risk factors include a family history of alcoholism or depression, a history of sexual abuse, and depression (Cares et al., 2015). Environmental issues involve high expectations from authorities, a disorganized lifestyle, and burnout. Additionally, the prevalence of S.A. differs depending on the specialty in which a nurse operates. The highest likelihood of developing MI or S.A. is in nurses working in critical care, psychiatry, oncology, and emergency units (Cares et al., 2015). To minimize the risk of developing S.A. and MI among veterans and nurses, as well as among professionals from other spheres, it is necessary to pay more attention to early recognition of risk factors.

The Association Between Mortality and the Co-Occurrence of MI and S.A.

It is evident that comorbidity of MI and S.A. deteriorates people’s lives, but there is a more serious outcome of a combination of these two conditions, which is a high mortality. According to Hartz et al. (2014), patients with severe MI are likely to die nearly 25 years earlier than mentally healthy individuals. Furthermore, the reason for such statistics is S.A., which is known to cause more deaths among mentally unstable people than injury and suicide. Hartz et al. (2014) report that about 60% of premature deaths among mentally ill individuals occur because of infections that develop from intravenous drug use, alcohol consumption, and smoking. Bandiera, Anteneh, Le, Delucchi, and Guydish (2015) note that the rate of death among individuals with MI and S.A. amounts to 46.8%, whereas the same rate among the general population is 30.7%. Thus, it is viable to conclude that the incidence of mortality is alarmingly higher in people with S.A. and MI comorbidity.

Out of the different aggravating factors that lead to increased mortality among MI patients, drugs and alcohol have the greatest power. Research by Hjorthøj et al. (2015), based on Danish people, indicates that the standardized mortality ratio among MI individuals with S.A. is 8.46%, whereas, among those without S.A., it constitutes 3.63%. Hence, scholars emphasize, the risk of mortality is much higher in individuals with both MI and S.A. Another study also focused on Danish patients, investigates the likelihood of suicidal attempts among individuals with MI and SA. Østergaard, Nordentoft, and Hjorthøj (2017) remark that S.A. in mentally ill patients raises the risk of suicide in at least three times compared to individuals without S.A. Thus, it is necessary to find reliable solutions to identifying the tendency toward S.A. in mentally ill people and mitigate the risk as soon as it is noticed.

Comorbidity of S.A. and MI in the Criminal Justice System

A prominent place in the discussion of S.A. and MI co-occurrence belongs to its role in the criminal justice system. Scholars note that the incidence of co-occurring substance use and mental disorders is much higher among inmates than among the general population. Research indicates that individuals staying in jails are 4-6 times more likely to develop mental illnesses than other citizens. For those imprisoned, the same rate is 3-4 times higher (Peters, Wexler, & Lurigio, 2015). Therefore, the alarming statistics urge the analysis of the core reasons for S.A. and MI development and comorbidity in people staying in jails and prisons.

Some studies are focused on the investigation of male and female inmates’ tendency toward developing MI and S.A. and their implications. Ogloff, Talevski, Lemphers, Wood, and Simmons (2015) analyze the prevalence of S.A. and MI in Australian male offenders. Scholars note that inmates with both MI and S.A. are responsible for committing more serious crimes than those without S.A. Hence, Ogloff et al. (2015) suggest that specialists working in forensic mental health services should pay more attention to S.A. among prisoners and address substance disorders to reduce the aggravation of MI. Nowotny, Belknap, Lynch, and DeHart (2014) have investigated the comorbidity of MI and S.A. among incarcerated females. The authors have found that the majority of women with co-occurrence of the two investigated issues used to be exposed to drugs and violence at a young age. Also, nearly 33% of such inmates received no treatment for their mental health problems within the year preceding research (Nowotny et al., 2014). Scholars conclude that it is of utmost importance to both incarcerated females and communities to which they return upon imprisonment to enhance the system of mental health care in prisons.

The problem of accommodating to communities after being released is rather acute both for men and women. Begun, Early, and Hodge (2016) note that the level of services provided by correctional facilities is not sufficient. Furthermore, Begun et al. (2016) remark that barriers for re-entering society after incarceration are higher for people leaving jail than for those released from community-based correctional facilities or prisons. Research indicates that without appropriate support and engagement activities, individuals released upon imprisonment are unlikely to avoid the development or aggravation of MI and S.A. problems.

The Stigmatisation of Vulnerable Groups

Unfortunately, while the comorbidity of MI and S.A. is already a large burden in any individual’s life, there are factors that make such patients’ existence even harder to bear. The issue of discrimination is prevalent among individuals suffering from S.A. and MI. Particularly, stigmatization concerns African Americans and Latinos as some of the most vulnerable populations. Research findings provided by Mays, Jones, Delany-Brumsey, Coles, and Cochran (2017) indicate that 15% of California adults experience discrimination when addressing health care facilities. Furthermore, 4% of individuals participating in the study admit that discrimination occurs during visits associated with MI and S.A. The most common cause of such bias for Latinos and blacks is ethnicity or race. Meanwhile, for whites, the most frequent reason for discrimination is the insurance status (Mays et al., 2017). HIV-positive mentally ill African Americans constitute another vulnerable community that requires comprehensive, synergistic methods of treatment (Robinson, Knowlton, Gielen, & Gallo, 2016). Thus, out of all the individuals suffering from comorbidity of MI and S.A., there are some who need more attention on the part of healthcare providers.

Some specialists come up with solutions to deal with stigma and barriers when managing the health problems of mentally unstable people with substance use disorders. McGinty, Pescosolido, Kennedy-Hendricks, and Barry (2018) remark that the most successful strategy which may be employed to increase the public’s support of treatment for MI and S.A. people is communication using personal narratives. Particularly, narratives incorporating personal experiences with obstacles to MI and S.A. disorder treatment are likely to reduce stigma toward these patients. Another viable solution is behavioral therapy that might be employed in addiction treatment (Priester et al., 2016). It is emphasized that the level of prejudice can be alleviated with the help of carefully selected tools. When these methods are applied, individuals suffering from comorbidity of S.A. and MI will be able to mitigate their symptoms and communicate in society with less apprehension of stigma.

The Integration of Care and Recovery

Finally, it is crucial to discuss the approaches to care for people with MI and S.A. Since the investigated health issue has a double nature, scholars remark that treatment and care should also be integrated. Crowley and Kirschner (2015) note that the synthesis of behavioral health care and primary care is the most viable solution for MI and S.A. Lewis et al. (2014) support this opinion and argue that primary care and behavioral health treatment should be combined in institutions managing MI and S.A. However, scholars report that currently, the level of such integration is too low. While such an approach has the potential to improve patients’ health, it is necessary to promote the inclusion of behavioral therapy in primary care settings.

Scholars note that the recovery process for people with both S.A. and MI is more complicated than for those with a single disorder. Green, Yarborough, Polen, Janoff, and Yarborough (2015) mention that non-judgmental support can enhance individuals’ recovery and promote a healthy lifestyle. Corrigan, Larson, Smelson, and Andra (2019) note that peer support is another crucial element of successful recovery. Overall, scholars consider it important to promote recovery by offering a friendly attitude and explaining the possible complications of continuing the present lifestyle.


The essay offers an analysis of the most crucial issues related to the co-occurrence of MI and SA. Specific vulnerable groups have been discussed, and the implications of the two disorders for them have been mentioned. The mortality rates and stigmatization aspects related to comorbidity have been outlined. The integration of care and recovery for the patients in questions has been mentioned. The paper’s main aim of a versatile analysis of the key problem has been reached.


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