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Mental Illness and Substance Abuse


Mental illness refers to a group of brain disorders that can profoundly disrupt a person’s ability to think, feel, and relate to others and their environment.  Often this results in an inability to cope with the ordinary demands of life.  Symptoms vary and every individual is unique.  All persons with mental illness have some of the characteristics listed below.  While a single symptom or isolated event is not necessarily a sign of mental illness, professional help should be sought if symptoms persist or increase.


This includes hyperactivity, or inactivity, or alternating between the two, deterioration in personal hygiene, noticeable and rapid weight loss, drug or alcohol abuse, forgetfulness and loss of valuable possessions, attempts to escape through geographic change, frequent moves or hitchhiking trips, bizarre behavior (staring, strange posturing), unusual sensitivity to noise, light, and clothing, and social withdrawal.  Often the symptoms of mental illness are cyclic, varying in severity from time to time.  The duration of an episode also varies.  Some persons are affected for a few weeks or months; for others, the illness may last many years or a lifetime.  There is no reliable way to predict the course of the illness.


Coming out of nowhere, unrelated to events or circumstances, loss of interest in once pleasurable activities, expressions of hopelessness, excessive fatigue and sleepiness, inability to sleep, pessimism, perceiving the world as dead, thinking or talking about suicide.


The inability to concentrate or cope with minor problems, irrational statements, peculiar use of words or language structure, excessive fears or suspiciousness.


Hostility from one formerly passive and compliant, indifference, even in highly important situations, inability to cry, excessive crying, inability to express joy, inappropriate laughter.


Accurate diagnosis may take time.  The initial diagnosis is often modified later, perhaps several times.  It takes some time to evaluate response to treatment, a very important piece of information.  It may also be difficult to pinpoint the problem because the individual has more then one disorder; for example, schizophrenia with an affective disorder, or an anxiety disorder such as obsessive-compulsive disorder with schizophrenia, or a
personality disorder.  It is important for the psychiatrist to reevaluate the diagnosis periodically in order to work out the best treatment approach.  In
many cases of apparent mental illness, alcohol, or drug abuse, or an underlying medical disease such as hypothyroidism, multiple sclerosis or brain tumor is found to be the problem.  A through physical examination should be the first step when mental illness is suspected.



The term schizophrenia comes from the Greek terms meaning “splitting of the mind.” People with schizophrenia do not, however, have a “split personality.”  They have a disorder that affects their thinking and judgment, sensory perception, and their ability to interpret and respond to
situations or stimuli appropriately.  There are usually drastic changes in behavior and personality.  Lake of insight about the illness is one of the most
difficult symptoms to treat, and it may persist even when other symptoms (e.g.) hallucinations and delusions) respond to treatment.

Schizophrenia will affect about 1% to 2% of the U.S. population at some time during their lifetime.  It is usually first diagnosed between the ages of 17 and 25.  There may be several psychotic episodes before a definitive diagnosis is reached.

When the disease first appears, the person feels tense and has difficulty concentrating.  He or she begins to withdraw; schoolwork or work performance may begin to deteriorate; general appearance may deteriorate; often friends may drift away.  Parents often think this is just adolescent behavior gone astray, and even doctors may be uncertain about a diagnosis in the early stages.


Alteration of the senses: The senses (sight, hearing, touch and/or smell) may be intensified, especially early in the disease.

Inability to process information and respond appropriately (also known as “thought disorder”): Because the individual has difficulty processing external sights and sounds, and because he or she experiences internal stimuli that others are not aware of, his or her response is often illogical or inappropriate.  Thought patterns are characterized by faulty logic, disorganized or incoherent speech, blocking, and sometimes neologisms (made-up words).  He or she may relate experiences and concepts in a way that seems illogical to others, but which holds great meaning and significance for them.

Delusions: These are basically false ideas which the person believes to be true, but which cannot be, and to which the individual adheres in the face of reason.  Some persons develop excessive religious preoccupation; however, unusual beliefs may be the product of a person’s culture and can only be evaluated in this context.  Two common kinds of delusions are paranoid delusions, characterized by belief that one is being watched, controlled, or persecuted and grandiose delusions, centered on the belief that one owns wealth, has special power or is a famous person, often political or religious.

Hallucinations: Hallucinations are sensory perceptions with no external stimuli.  The most common hallucinations are auditory, hearing “voices,” which the person may be unable to distinguish from the voices of real people.  Delusions and hallucinations are the result of over-acuteness of the senses and an inability to synthesize and respond appropriately to stimuli.  To the person experiencing them, they are real.  Medications can be very helpful in controlling illogical thinking and hallucinations.

Change in emotions: Early in the illness, the person may feel widely varying, rapidly fluctuating emotions and exaggerated feelings, particularly guilt and fear. Emotions are often inappropriate to the situation.  Later there may be apathy, lack of drive, and loss of interest in and ability to enjoy activities.

Changes in behavior:  Slowness of movement, inactivity, withdrawing are common.  Motor abnormalities such as grimacing, posturing, odd mannerisms, or ritualistic behavior are sometimes present.  There may also be pacing, rocking, or apathetic immobility.  There is no cure for schizophrenia, but there are many medications available which can reduce the symptoms.  Finding the right medication therapy is a very complex process that demands a working relationship with a doctor that is based on trust.  The outcome is very successful when the individual is
treated appropriately with medications, has access to rehabilitation services, and has a supportive living environment.


Mood disorders or affective disorders include major depression and bipolar disorder (manic depression) and are the most common psychiatric problems. The terms mood and affective refer to the state of one’s emotions.  A mood disorder is marked by periods of extreme sadness (depression) or excitement (mania) or both (bipolar disorder).  If untreated, these episodes tend to recur or persist throughout life.  Even when treated, there may be many repeat episodes.

Beyond persistent depressed mood, the symptoms of depression include:

-. Loss of interest in daily  activities, loss of energy and excessive tiredness
– Poor appetite and weight loss, or the opposite, increased appetite and weight gain.
–  Sleep disturbance, sleeping too little sleeping too much in an irregular pattern.
–  Feelings of worthlessness or guilt that may reach unreasonable (delusional) proportions.
–  Recurrent thoughts of death or self harm,
–  Poor concentration.
–  Wishing to be dead or attempting  suicide.

Symptoms of hypomania or the more severe state of mania include:

– Euphoric, expansive mood or irritable mood. Boundless energy, enthusiasm, and  activity.
– Decreased need for sleep.
– Rapid, loud, disorganized speech
– Short temper,
– Argumentative.
– Delusional thinking.
– Activities, which have painful consequences such as spending sprees or reckless driving.

Bipolar may appear in childhood or adolescence, although the majority of cases appear in young adulthood.  There is believed to be a genetic
component to the illness, since bipolar illness and major depression often run in families.

Ironically, some if the symptoms of mania lead affected people to believe that, not only are they not sick, but that they have never felt better.
The euphoric mood may continue even in the face of sad or tragic situations.  Even when the person continues to feel swept up in mood of
excitement, family and friends may notice serious problems.  For example, people with mania often go on spending sprees, become promiscuous, or abuse drugs and alcohol while being unaware of the serious consequences of their behavior.

Fortunately, bipolar disorder is one of the most treatable illnesses, generally with some of the newer atypical medications.  In addition to medications, many people with bipolar disorder find individual behavior modification therapy and peer support groups helpful.

Many of the symptoms of mania may also occur in schizophrenia, which complicates diagnosis.

Depression in some degree will affect between 10% and 20% of the population at some time during their lives, some as often as once or twice a year, with episodes that may last longer then six months each.  People with the most severe depression find they cannot work or participate in daily activities, and often feel that death would be preferable to a life of such pain.

Depression and bipolar disorder is highly correlated with suicides and suicide attempts.

Probably more than with any other illness, people with depression are blamed for their problems and told to “snap out of it,” “pull themselves together,”
etc.  Often other will say a person “has no right” to be depressed. It is critical for family and friends to understand that depression is a serious illness.  The person with this illness can no more snap out of it than a person with diabetes can will away that illness.

Depression is a very treatable illness.  Approximately 70% to 75% of people properly diagnosed respond to treatment.


This illness is a combination of psychotic symptoms such as hallucinations or delusions and significant mood symptoms, either depression or mania or
both.  The psychotic symptoms persist when the mood symptoms resolve.


Anxiety Disorders include the phobias, panic disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder. Symptoms may be so severe as to be disabling, but these illnesses seldom involve psychosis.  Panic attacks come “out of the blue” when there is no reason to be afraid.  Symptoms may include sweating, shortness of breath, heart palpitations, choking, or faintness.  With OCD, the individual may have only obsessive or only compulsions, but most have both.  Obsessions are repeated, intrusive, unwanted thoughts that cause extreme anxiety. Compulsions are excessive ritual behaviors that a person uses to diminish anxiety.  Examples are hand washing, counting, repeated checking, and repeating a word or action.

Personality Disorders such as borderline personality disorders and behavior disorders can also be debilitating.  The individual may receive some benefit from medications and/or psychotherapy.

Dual Diagnosis of Mental Illness and Substance Disorder: This combination of mental illness and substance abuse is very common.  Drug
and alcohol abuse may seriously complicate mental illness, but are not the primary cause of the illness. People with mental illness often use alcohol or
other substances to obtain relief from symptoms and from feelings of despair and loneliness associated with their disease. Their drug and alcohol abuse may merely be a separate means of coping with mental illness.

Substance Use Disorders 

Substance Use Disorders include abuse and dependence. Abuse is defined as repeated use of substances despite adverse social consequences, such as failure to meet family, school, or work responsibilities, interpersonal conflicts, legal problems, or using substances in potentially dangerous situations.  Substance dependence, commonly known as addiction, is characterized by the presence of several physical and behavioral symptoms, such as the need for increased amounts of substances to achieve the desired effects (tolerance) or withdrawal symptoms when not using.  The person may devote increasing amounts of time and resources to getting and using drugs or alcohol, and may give up other interests and responsibilities.  People who are addicted might try unsuccessfully to control their use, take more of a substance or use it more often than they plan to, or continue to use despite knowledge of related health problems.

Substance dependence can appear without previous substance abuse, while some people meet criteria for substance abuse without ever transitioning to dependence.  However, studies tend to indicate a better-than-average chance that people who become substance dependent progressed from abuse.

Substance use disorders have at times been thought of as caused by moral failings or a lack of willpower.  However, research indicates that there are identifiable genetic, psychological, and social risk factors that make some people more vulnerable to abuse or dependence.  Over time, substance
dependence appears to lead to changes in the brain that create continued risk of relapse despite a person’s sincere desire for sobriety.  Substance
dependence is now generally considered to be a chronic condition.  A relapse is not a sign of failure but rather, just as with heart disease or diabetes, is a possibility and the person should develop a plan in advance for returning to recovery as quickly as possible.  The relapse can provide the person
and their family, concerned friends, and professionals with useful information to help strengthen the person’s recovery support system.

Co-Occurring Disorders 

Estimates are that about a third of adults with mental health diagnoses have a co-occurring substance use disorder, while more than half of adults with
substance use disorders have co-occurring mental health disorders.  Mental health and substance use disorders’ symptoms often interact to precipitate, mimic, mask, or worsen each other.  Co-occurring disorders tend to interact in ways that negatively affect a person’s ability for self-care and
successful functioning.

Accurate assessment and treatment designed to address co-occurring disorders offers the best opportunity for recovery, but treatment systems may be divided between substance abuse and mental health.  According to the National Survey on Drug Use and Health (2005), 5.2 million adults had both serious psychological distress and a substance use disorder; of that number, 53% received no treatment.  Of the 47% who did get treatment, 34.3% received only mental health care, and 4.1% only substance abuse services.  Only 8.5% received specific co-occurring treatment.  Without an integrated
system of care, people with co-occurring disorders may receive “parallel” or “sequential” treatment, moving between mental health and substance abuse treatment providers depending on which disorder is more acute at the time.  Professionals, as well as concerned family members or friends, may
not get a complete understanding of the person and their individual needs.

People with co-occurring disorders benefit most from treatment with the flexibility to address both disorders.  Continuity of care and a full range of services including psychiatric, social, recreational, vocational, and cultural needs, as well as specialized counseling to address life skills, relapse prevention, and any trauma or abuse issues, are important components of treatment.  Recovery support groups such as “Double Trouble” that welcome persons with co-occurring disorders are also helpful.


Suicide may be a manifestation of mental illness, but not all persons who commit suicide are mentally ill.


Signs of depression and warning signals of suicidal thoughts can include:

Change in personality: Usually sad, withdrawn, irritable, anxious, tired, indecisive, apathetic, or moody.
Change in behavior: Difficulty concentrating on school, work or routine tasks, change in eating habits – loss of appetite and weight or overeating, or crying.
Change in sleep patterns: Oversleeping or insomnia, sometimes with early waking.
Loss of interest: Reduced interest in friends, sex, hobbies, or other activities previously enjoyed.
Fear of losing control: Fear of “going crazy” or harming oneself or others.
Worries about money or illness: Either real or imagined.
Feelings of helplessness and worthlessness, overwhelming guilt, shame or self-hatred.
Sense of hopelessness about the future.
Drug or alcohol abuse.  

Recent loss: Loss through death, divorce, separation or a broken relationship, also loss of a job,  money, status, self-confidence, or self-esteem.
Loss of  religious faith.
Agitation, hypertension, restlessness may indicate masked depression. 

Do not be afraid to ask the person showing such symptoms if he or she is thinking about suicide.

Just about everyone has contemplated suicide, however fleetingly, at one time or another.  Raising the question of suicide shows you are taking the
person seriously and responding to the potential of his or her distress.

If the answer is “Yes, I do think of suicide,” you must take it seriously.  Ask questions like: Have you thought about how you’d do it?  Do you have the means?  Have you decided when you’ll do it?  Have you ever tried suicide before?  What happened then? Depending on their response, do not hesitate to contact your local 24-hour mental health crisis service, or your emergency 9-1-1 telephone service for help.


NAMI refers you to the following websites for more in depth information on this topic: 

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