Comorbidity of Mental Disorders with Alcohol and Other Drug Abuse
(Regier et. al. 1990)
This was an epidemiological study on the comorbidity of mental disorders and drug and alcohol abuse. The mental disorders concerned in this study are: schizophrenia, antisocial personality disorder, anxiety disorders, and affective (mood) disorders. Previous studies have shown that patients with addictive disorders may appear at different rates within the population than people with addiction disorders and mental disorders in combination. It was also noted that mental disorders are more prevalent in the population than alcohol disorders, and there are even less patients with drug disorders. Weissman et al conducted a study on comorbidity concerning alcohol abuse and various mental disorders. He found that on average alcoholism has a life prevalence rate of 6.7 percent. He also concluded that people with alcoholism have a 70 percent chance of having a mental disorder at some point in their lives.
The current study is a more comprehensive study in that it incorporates data from the Epidemiologic Catchment Area (ECA) of the National Institute of Mental Health (NIMH). The study also incorporates drug abuse (drugs other than alcohol) as well as more mental disorders including Bipolar I, Bipolar II, and Major Depressive Disorder. The authors of this epidemiological study believed that there would be a high statistical association between drug and alcohol abuse and the prevalence of mental disorders.
Trained interviews conducted highly structured assessments on 20,291 participants. The first wave of data collection took place between 1980 and 1984. During the interview participants were asked about present symptoms of mental disorders and drug and alcohol abuse as well as previous symptoms (6 months, 1 year, and lifetime). Symptoms caused by acute drug use or withdrawals (hallucinations, depression, delusions, and anxiety) were not considered symptoms of a mental disorder to avoid skewed data. Participants were selected from mental hospitals, nursing homes, and penal institutions (all above the age of 18). The sample also represented the general population by gender, race, age, etc.
The results from this study are highly conclusive but I will highlight the aspects that I found most interesting. Participants that resided in prison had a high percentage of mental disorders (55.7 percent) compared to participants in nursing homes who only had an occurrence of mental disorders at 14.3 percent. Although schizophrenia only effects 1.5 percent of the population 47 percent of schizophrenics are affected by some type of substance abuse disorder and are 4.6 times more likely to have an addiction disorder. The study also concluded that 83.6 percent of people with antisocial personality disorder have an addiction disorder, but that percentage could be confounded by the fact that substance abuse is considered criteria for diagnosis of the disorder (which I will address later in the paper). People with anxiety disorders abuse alcohol more than other drugs (19.4 percent) which makes sense because of its agonist effects on GABA and opiate receptors. Life long prevalence of solely mental disorders is much higher than that of comorbid combinations (life long prevalence of mental disorders is 16.2 percent, mental disorder and alcohol abuse is 3.1 percent, mental disorder and drug abuse is 1.5 percent).
Although the quantitative data may seem very objective I think that the more you analyze it becomes subjective. I believe that the field of abnormal psychology is inherently enmeshed in societal norms, politics, and philosophy. I can call a television a black, rectangular shaped, image-producing box, that consumes electricity or I can call it a television. We can diagnose a human being with disorders until we are blue in the face but I believe looking at patients (or clients) in a holistic manor, and as individuals, is not only a moral imperative but more useful in treating them. We can say that someone has an alcohol, drug, gambling, or any addictive disorder but differentiating the substance or action is frivolous. In Gabor Mate’s book (who I was lucky enough to meet at conference in New York) “In the Realm of Hungry Ghosts” he explains that the focus should not be on the drug addiction but on the problems causing the addiction. Addicts are simply self-medicate a deeper underlying problem. It should be no surprise then that people with mental disorders use substances to medicate their emotional pain. I think inventing a name for a particular substance abuse is pointless.
I believe that a person’s mental disorder and substance abuse should not be seen as two separate disorders but symptoms of one underlying problem. A good point that was made in the article is the fact that one of the diagnostic criteria for antisocial personality disorder is substance abuse. Abusing a particular drug albeit alcohol or any narcotic should not be seen as a disorder because the usage of any substance is just a symptom of a deeper psychological disorder.
Another interesting point in the study was that alcohol abuse is much more prevalent than drug use. This could be simply explained by its legality and it is more socially acceptable. Does it really matter what the substance of abuse is? Most substances inhibit or excite similar receptors and reward circuits in the brain. It is not the heroin or codeine that makes you feel good but the opioid receptors in your brain. Its not the THC that makes the addict feel better but the increased dopamine. My point is that I don’t think addictions should be differentiated based on substances or even addictions concerning behaviors such as gambling. Whether it is gambling or heroin use the behavior is compulsive, and only an attempt to fill a void or dull some emotional pain. Drug abuse, as well as addictive behaviors are, arguably, equally destructive. I know someone who was diagnosed with PTSD and when his primary care provider asked him at the VA if he uses drugs or alcohol he admitted to drinking a couple beers a night, smoking roughly half a pack of cigarettes a day, and maybe once a week will consume cannabis to help him sleep. The doctor ignored the daily alcohol use, as well as the cigarette use, but put a note in his medical record: marijuana abuse. This is a perfect example of how politics or culture can influence how mental health is approached. Marijuana’s illegality influenced the doctors opinion on what the word abuse means.
I think this study is an example of the semantic difficulties in the field of psychiatry. In Thomas Zsaz’s book “The Myth of Mental Illness” he details the dangers of the psychiatrists tendency to label behavior. In pathologizing behavior we get distracted by symptoms, which should be seen as forms of language, we also dehumanize and collectivize the individual.
In conclusion I think that differentiating substances either alcohol or other drugs is meaningless. Also, claiming that drug abuse is a disorder within itself is a simplistic way of looking at human behavior. I think it would be more useful to think of drug abuse as a patients attempt to treat himself of his underlying mental disorder. Arguably drug abuse can be seen as a symptom of any mental disorder.
Here I have a conversation with Michael Nelson about how psychedelics have mitigated my PTSD symptoms.
Such a beautiful image by Alex Grey. I want to harness that inner child and its innocence and curiosity!
I find Kierkegaard’s ideas very interesting and existential philosophy is something that I have wanted to learn (or think) more about. He talked about levels of philosophical thinking starting with the aesthetic stage, ethics, and then the religious stage. The aesthetic stage is where I believe most people are at in this society. It’s basically mindlessness and the appreciation of individual pleasure. Deeper meaning, purpose and context aren’t necessarily an issue in the aesthetic stage. Mindlessly browsing the Internet for videos of dogs on skateboards or a person crying because their favorite character from Twilight cheated on his girlfriend are examples of aesthetics. The fact that most people are in the so-called aesthetic stage makes sharing the same species as these people miserable. It is hard to have conversations with people because life is without meaning. I believe when life becomes too easy or luxurious people stop caring about meaning.
I think evolution can be a good analogy when it comes to ideas. Struggle is the main pressure for natural selection to choose good genes. Philosophical ideas must be selected through an experience or of period of struggle. Armchair philosophy is idealistic but philosophy takes fieldwork. When you look at life as a boring and mindless experience the only thing you can derive from it is amusement and quick, shallow pleasures. The next stage is the ethics stage. This is the stage of thought where life does have meaning and guidelines. You try to judge human behavior and its value. This however is not enough; you can passively judge behavior for its value but being an observer does not take much effort or create value. The religious stage incorporates a philosophical set of beliefs and living by them. I think of Henry David Thoreau as living the religious stage of philosophy. In his great book Walden, he lived religiously, without religion, to a set of philosophical guidelines. He lived in the woods of Massachusetts on a pond for 2 years, 2 months, and 2 days, (I believe its been a while). He had very little contact with society, lived off the land, and rediscovered nature and himself and gained a new appreciation for existence. Here again there is a struggle. He talked about how the winters were hard and food required labor but it allowed him to live with pure thoughts and intentions. One funny story from the book was an Irish man was telling Thoreau that meat is necessary for big strong bones. Thoreau tried explaining to the thickheaded Irishman that the Ox that pulls the plow to harvest vegetables eats only grass and is much stronger than the carnivorous human. These are the things that go unnoticed and unchallenged when meat is not a luxury but an expectation. When life presents no struggle why ask questions? Since reading that book I have wanted to live as simple a life as possible and disconnect from society (or at least the evils of it). But being indoctrinated for about 24 year it is hard to get up and leave, and my wife is not to keen on the idea either. I think that it would be a good experience even for a year or six months.
It is interesting that Adam Smith’s theories of free-market economics influenced Darwin’s theories in evolution. There seems to be a tendency in our reality of struggle and selection. In free-markets we have competition and consumers select the products (genes). In biology we have environmental pressures and organisms have to select genes. In philosophy we have ideas produced by experience (struggle) and better ideas of have be selected. I wonder if this type of existence is unique to earth.
Genetic engineering has to be approached with caution in my opinion. Biological beings have been genetically modified since the beginning of time but through modes of natural selection. Nature, the environment, and ecology were the dictators of gene selection by influencing certain organisms to reproduce. This created a natural and most efficient way of selecting genes. Scientist have now discovered how to modify genes resulting in different levels of immunity and morphology, gender, intelligence, etc. Because humans cannot plan for, or predict, things that nature or our world naturally regulates, the dangers of selecting genes based on current needs is irresponsible. The Ice nine bacteria which could prevent frost from growing on plants has been used irresponsibly to make profit. This sounds like a practical option to increase produce yields but it can have unintended consequences if implemented. GMOs are now being heavily used in the food industry but we are running into problems with lack of genetic variation which can cause extinction. The banana is likely to be extinct in the near future (possibly ten years) because of lack of genetic variation.
There are subtle effects on the psychology of humans because of genetically modified foods. Americans especially are used to perfect looking foods. They expect tomatoes to be perfectly round, and red. Banana’s to be a perfect crescent shape and yellow. In the wild these traits would be rare. I saw an apple sit on the table of my work place for close to a week because it was slightly deformed and everyone was afraid to eat it. So because we are used to unnatural perfection of food we have a tendency to waste. People sometimes forget that an apple comes from a tree and is a plant, not manufactured in a “plant”.
Government does not fund research of environmental causes of certain diseases. The government and some researchers bias towards the genetic research which allows environments to stay the same or deteriorate even further, while focusing on changing the genetic makeup and allowing the organism to be more adapted to the deteriorating environment. Epigenetics are genetics that operate almost like light switches and are triggered by the environment. These may prove that research on environmental factors should be more heavily studied. I think modifying the environment i.e. (family structures, drug use, politics, housing etc.) is a much safer way of creating healthier people than modifying their genes (generally I think epigenetics are discussed with plant organisms but can be applied to humans too). Modifying human’s genes can have permanent and irreversible impacts whereas environmental changes like the ones I mentioned are modifiable.
Making crops genetically uniform to combat certain insects or other threats is also a risk. Genetic variation acts as a combatant towards random parasites: some plants will survive and some will not the ones that do pass on genes that are resistant to the parasite. One thing that we have found out is that bacteria evolves and can morph very fast. Insects also evolve very quickly to niches. Therefore it could be a constant battle. I can think of a dystopian novel on genetic engineering where insects, bacteria, and scientists are constantly battling each other: scientists trying to modify genes to create plants that are resistant to new bacteria and insects that adapt daily while the scientist needs to sleep and when he wakes up he has a new set of problems.
This week’s lecture was very interesting because we talked about the evolution of human intelligence. One theory was that the hand or probably more specifically the thumb is what propelled human intelligence. The thumb may have allowed us to grasp things, which allowed us to manipulate the environment rather than submis to it. However, I think that the mind would have to come before the thumb because we would need the desire to manipulate the environment before we start selecting certain mates with that mutation (thumb). There was also talk about language separating humans from other species. I agree with this to some extent. We are, as far as we know, the only species that can use what Noam Chomsky calls transformational grammar, which is the ability to explain the deep structures of a sentence in many different ways. There has been a lot of research done on primates regarding language that is very shocking. One study is with a gorilla that has learned American Sign Language (over 1,000 words and she also understands over 2,000 spoken words). This gorilla can express past events and also make novel statements, which we thought only humans could do. Animals, and especially primates, have a very sophisticated language that we may not be able to understand and simply and arrogantly say they don’t possess. Their language may not be as “productive” as the human language but the word productive is very subjective. Studies also show that primates learn by emulation rather than imitation. Humans tend to imitate while learning but primates tend to go after results rather than specific behaviors. This is because of our highly social environments.
One pretty interesting but not very empirically based theory on human evolution is Terrance McKenna’s “Stoned Ape Theory”. His theory goes something like this: Primates lived in trees in Africa until it started drying up and they had to move done to the prairie lands. Living in the prairie lands required more attention because of predators and an adaptation in the foods they ate. When primates were foraging for food on the ground they stumbled upon mushrooms that gathered around herbivore dung, specifically the Psilocybin mushroom, which is psychoactive. These mushrooms were desirable because they increased sociability and eased communal tensions as well as increased awareness to the spatial environment. So he thinks that the mushroom is what inevitably increased intelligence. This is a pretty loose theory but still entertaining to think about. Also in high doses of psilocybin spontaneous vocalizations occur which McKenna believes to be the foundation of language.
Primatologists have found positive correlations between the neocortex size and group size of all primates. So if a certain species has larger social groups they tend to have a larger neocortex: showing a positive correlation. This is not true for all species though because the wasp lives in large numbers but has a small brain. One argument that I have is that maybe it isn’t the brain size that is increasing our intelligence. Our brain size hasn’t increased that dramatically over the past 1,000 years but I feel that our intelligence as a species has grown. So maybe intelligence grows separate of the brain. Maybe intelligence has more to do with cultural transmission. Or maybe our teaching practices and technologies have increased the ability to learn. Maybe humans haven’t become smarter but technology or cultural practices have allowed our ape-minded intelligence to surface.
Another issue with intelligence is that a lot of times we think of intelligence as productive. We think of intelligence in only ways that we see human intelligence evolving i.e. technology, science, and innovation. Intelligence can also be emotional and spiritual rather than physical. We think because we can explain nature so well that we are intelligent but at the same time what is it doing to human nature. I think as intelligence grows so doe’s mental illness and stress. You don’t see to many aborigines suffering from narcissistic personality disorder or whatever other disorders smart psychologists come up with. People who are intelligent often have issues with depression and drugs, stress and anxiety. So we have to look at the value of intelligence. I’m not saying intelligence is bad but trying to say that maybe its not the only type of intelligence. Other species or even cultures have different types of intelligence.
Terrance McKenna’s Stoned Ape Theory about 10 minutes long