Physicians use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose mental illnesses. In 1980, the American Psychiatric Association recognized substance use disorder (SUD) as a primary mental health disorder in the DSM-3. Currently, the DSM-5 refers to alcoholism as Alcohol Use Disorder (AUD) or Substance Use Disorder and classifies it as a mental disorder presenting physical and mental symptoms. So is alcoholism a mental illness? Yes.
If you or a loved one are dealing with alcoholism, or any other substance or mental health issue, give us a call to talk about our dual diagnosis treatment centers and how we can help you today.
What is a Mental Illness?
Mental illness has been defined as a health condition that affects mood, thinking, and behavior. Some other common mental health disorders include eating disorders, depression, and addictive behaviors. Recent statistics from the National Alliance on Mental Illness (NAMI) revealed that about 1 in 5 adults in the U.S. experiences mental illness. They also reported a marked increase in mental issues among teenagers.
Why is Alcohol Use Disorder a Mental Health Disorder?
Similar to depression and other mental illnesses, addiction is an actual medical disorder that is grounded in brain changes. However, the condition is more complex than that. The American Society of Addiction Medicine (ASAM) notes that “addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. A malfunction in these circuits leads to psychological, biological, social, and spiritual manifestations.
This appears as a person who pathologically pursues reward and/or relief by using a substance, (in this case, alcohol) and other behaviors. At its heart, addiction isn’t just a social, moral, or criminal problem. It’s a brain problem and it is about the underlying nervous system, not outward actions.
Emotional and mental symptoms appear long before physical symptoms. If mental or behavioral symptoms aren’t treated appropriately, long-term alcohol abuse can result in physical complications such as:
- Chronic brain degeneration
- Cirrhosis of the liver
Why Do Some People Become Addicted and Others Don’t?
Some individuals can drink alcohol, and even over-indulge occasionally, without it becoming a problem. But for others, drinking can turn into mild, moderate, or severe AUD. Risk factors include:
- Social influences
However one feature applies across the board, and that is that alcohol affects the brain’s reward center. Eating good food, listening to music we like, or exercising causes our brain to release bursts of dopamine. Dopamine is a feel-good chemical messenger that prompts us to “do that again.”
Research by biological psychologists has shown that people who are more vulnerable to addiction, along with those who are genetically vulnerable to certain mental health disorders, are likely to have lower levels of dopamine in their brains. Alcoholism is a mental illness because biological differences in brain chemistry are not choices that you can make. Our alcohol recovery program focuses on both the substance dependence, but also the mental health issues that may be present that feeds into the addiction.
The Addiction Cycle
In addition, when the reward centers of the brains of these people are flooded with substance-induced levels of dopamine, the links between drinking, the eventual pleasure, and cues associated with the experience “teach” the brain to seek drugs or alcohol at the expense of healthy activities and goals. Their need for alcohol becomes hardwired in the brain to the extent that the brain can’t tell the difference between healthy rewards and alcohol rewards.
According to the National Institute on Drug Abuse, this is why a person who misuses drugs begins to feel “flat,” lacking motivation, lifeless, or depressed and unable to enjoy things they used to enjoy. The individual needs to keep drinking to experience even a normal level of reward. This only makes the problem worse. It’s a vicious cycle.
Is Alcoholism Recognized as a Disease?
Since 1956, the American Medical Association (AMA) has recognized alcoholism as a disease that features compulsive decision-making, impulsive behavior, and relapse. Their disease theory of alcoholism is based on these standards:
- It is biological in nature (the illness exists in and of itself)
- Alcoholism does not heal or go away on its own
- It shows signs or symptoms that can be observed
- The disease is progressive–it can get worse, even fatal, if not treated
- There is a predictable timeline of development and recovery
How Does AUD Interact with Other Mental Health Issues?
Instead of thinking of “cause-and-effect,” it’s helpful to look at the co-occurring nature of AUD and other mental illnesses. Mental health issues can reinforce SUDs, and SUDs can reinforce the development of mental illnesses. For instance, a person might drink because they feel depressed. They drink to relieve the symptoms of a mental health disorder.
On the other hand, excessive drinking could contribute to the symptoms of depression or anxiety. NIDA has reported that about 50% of all people who have one condition also have the other. When these co-occurring conditions appear, it is referred to as a dual diagnosis or comorbidity. This explains why AUD frequently occurs with other mental health conditions and vice versa.
Common Co-Occurring Mental Health Issues
Beyond question, the most common mental health issues that co-occur with AUD are:
The individual may struggle to maintain their ability to work and carry on interpersonal relationships. The mood disorders most commonly associated with AUD are:
MDD is evidenced by one or more depressive episodes which present with five or more of the following for at least two weeks:
- Low mood
- Low energy
- Loss of interest in most activities
- Insomnia or hypersomnia
- Notable weight or appetite changes
- Loss of ability to concentrate
- Guilty thoughts
- Thoughts of worthlessness
- Thoughts of suicide
- Suicide attempt
Evidence shows genetic links between mood disorders and AUD. Several lines of evidence indicate that AUD and mood disorders aggravate each other through common neurobiological bases along with genetic susceptibility and shared stressors in the environment.
With or without depressive episodes, BP is marked by cycles of:
- Mania (Core symptoms of mania are abnormally elevated or irritable mood and consistently increased energy and activity.)
- Hypomania (Less severe than mania but still considered serious.)
Anxiety disorders are the most widespread psychiatric disorders in this country. The prevalence of AUD among people treated for anxiety disorders is about 20- 40%. Environmental and genetic factors add to the co-occurrence of AUD and anxiety disorders. Because alcohol is easy to get, it is commonly used to deal with anxiety.
Even people without an anxiety disorder can have anxiety-like symptoms after a single heavy drinking episode. This is sometimes described as “hangxiety.” It can increase between drinking episodes and reach high levels during alcohol withdrawal, underscoring the importance of anxiety therapy and support.
PTSD is one of the most common stress disorders and it affects millions of people each year.
PTSD may also promote the development of AUD because alcohol is often used to numb the memories of a traumatic event or cope with PTSD symptoms.
The wide availability of alcohol leads to its common use with other substances–legal and illegal. More than 47% of women with AUD and more than 40% of men have had another SUD in their lifetime. Having AUD raises the probability of having another SUD. Sadly, the co-use of drugs and alcohol also increases the probability and severity of overdose.
Symptoms of psychotic disorders include:
- Strong false beliefs
- Hallucinations or perceiving something that isn’t there
- Disorganized thinking
- Disturbed cognition that affects the person’s ability to communicate
The two main psychotic disorders are:
- Schizoaffective disorder
These disorders affect up to 3% of the population in total. However, among people being treated for schizophrenia, the prevalence of AUD is about 11%. The same as with other psychiatric disorders, AUD can also worsen the course of psychotic disorders.
How is AUD Treatment Different from Mental Health Treatment?
Many of the same treatment methods and therapies are used to treat SUDs and mental health disorders. In fact, many treatment professionals are all-inclusive providers, trained in both addiction and mental health treatment. A multidisciplinary team can also deliver a comprehensive approach to treatment by clinicians and professionals working together on an individual’s treatment plan.
However, integrated treatment for mental health and substance use disorders includes a focus on body, spirit, and mind. Elements that are typical of the treatment of SUDs and mental health disorders usually include:
The treatment provider administers an initial assessment which includes a mental and medical screening and a full medical history. This is used to create an individualized treatment plan. A timeline of behaviors and symptoms is an important tool for diagnosis. To be able to guide treatment, it’s helpful to learn whether the psychiatric symptoms are absent or present during periods of abstinence to understand whether they’re alcohol-related or separate conditions.
Detoxing from alcohol can be extremely uncomfortable and even life-threatening when unsupervised. Treatment providers may provide medical supervision and medication during the detox process. Stabilization with medication and possibly hospitalization is a crucial first step in focusing on co-occurring mental health conditions.
The severity of the AUD and the comorbid mental health disorder decides the
appropriate care level. Individuals with less severe AUD and mental health issues might
be able to recover in an outpatient program, while more severe conditions might require care from a mental health or addiction specialist, or both. Still, the likelihood of recovery from both disorders is greater if both the AUD and mental health issues are treated together.
Understanding the diseases of AUD and comorbid disorders is important to eliminate the myths about these diseases. It also helps people with these disorders cast off their feelings of guilt and shame.
Behavioral therapy is the term for methods of therapy that treat mental health disorders. It is an evidence-based treatment that is based on the theory that all behaviors are learned, therefore, they can be “unlearned” or changed.
Both types of psychotherapy can help people explore their issues and find the underlying causes of their disorders, They examine ways of thinking to help understand their behaviors and positively influence future behaviors.
Since mental health and substance use disorders are chronic diseases, they require ongoing management of symptoms. This is an important part of the recovery process. Although there isn’t any cure, they can be managed effectively like other diseases.
Comprehensive Help is Available at Bayview Recovery
Bayview Recovery Center in Tacoma, WA is available for you or someone close to you when you are ready to make the vital decision to get help for your conditions. We can provide you with several levels of care, which include withdrawal management and medically assisted treatment. For your ongoing support, Bayview also has the advantage of sober living residences.
Our licensed psychiatric professionals are experienced in many types of therapy including behavioral, group, individual, and family therapies. In addition, we can offer you a specialized dual-diagnosis program–a necessity for people with co-occurring conditions. Bayview Recovery offers an integrated approach to your wellness. Contact us today. Your life just might depend on it.