The relationship between psychiatric disorders and substance abuse

Substance abuse greatly impacts many, if not all, aspects of an individual's life and is typically linked to behavioral, economic, educational, legal, medical, psychological, public health, and social problems. In the past 10-15 years, attention has been increasingly focused on the correlation between psychiatric disorders and substance abuse. Numerous researchers have discovered a strong contemporaneous relationship between psychiatric disorders and substance abuse in both clinical and general population samples of adolescents (Boyle and Offord, 1991; Brook and Brook, 1990; Kessler et al., 1996) and adults (Breslau et al., 1993; Helzer and Pryzbeck, 1998; Kessler et al., 1996). For example, Kessler et al. (1996) found that psychiatric disorders generally preceded the development of addictive disorders in individuals with both co-occurring psychiatric disorders and substance abuse. Other researchers have found a correlation between the diagnosis of behavior or psychiatric disorder and the frequency of alcohol and tobacco use (Boyle and Offord, 1991).

This paper analyzes and examines substance abuse and substance dependence. In Part II, the general causes and effects of substance abuse and substance dependence are addressed. Part III examines the psychiatric aspects of substance abuse. In Part IV, the relationship between substance abuse and crime is outlined. Finally, this paper concludes with a way to improve the awareness and treatment of psychiatric disorders and substance abuse.

II. GENERAL CAUSES AND EFFECTS OF SUBSTANCE ABUSE

Substance abuse is a pattern of use that displays many adverse results from continual use of a substance. (Carson-DeWitt). Characteristics of substance abuse include a failure to satisfactorily meet family, school, or work obligations; continual use under situations that present a hazard (i.e., driving an automobile); financial difficulties resulting from increased money spent to fuel the addiction; and legal problems such as arrests. (Carson-DeWitt). Use of the drug persists despite personal problems caused by the effects of the substance on an individual and/or others.

Substance dependence is a group of behavioral and physiological symptoms that indicate the continual, compulsive use of a substance in self-administered doses despite the problems related to its use. (Carson-DeWitt). Increased amounts are needed to achieve the desired effect or level of intoxication so an individual's tolerance for the drug or substance rises. Withdrawal is a physiological and psychological change that occurs when the body's concentration of the substance declines in an individual who has been a heavy user. (Carson-DeWitt).

While there is no single cause of substance abuse, researchers are increasingly convinced that some individuals possess a genetic predisposition that may impact the development of addictive behaviors. (Carson-DeWitt). One theory is that a particular nerve pathway in the brain (dubbed the "Amesolimbic reward pathway") contains specific chemical traits that may increase the likelihood that substance use will ultimately lead to substance addiction. (Carson-DeWitt). However, other social factors are involved such as family difficulties and peer pressure. Primary mood disorders such as bipolar and manic depression, personality disorders, and the role of learned behavior may also influence the likelihood that an individual will become a substance abuser. (Carson-DeWitt).

IV. CRIME AND SUBSTANCE ABUSE

The correlation between substance abuse and crime has been well-documented over the past 25 years and may be explained by Gottfredson's and Hirschi's general theory of crime. According to their theory, the criminal act and the criminal offender are separate concepts. The criminal act is perceived as opportunity; illegal activities that people engage in when they perceive them to be advantageous. Crimes are committed when they promise rewards with minimum threat of pain or punishment. Crimes that provide easy, short-term gratification are often committed. The number of offenders may remain the same, while crime rates fluctuate due to the amount of opportunity (Siegel 1998).

In a mid-western study done by Evans et al. (1997, pp. 475-504), there was a significant relationship between self-control and use of illegal drugs. The problem is once these people get into the criminal justice system, it is hard to get them out. After they do their time and are released, it is much easier to be sent back to prison. Once they are out, they revert back to their impulsive selves and continue with the only type of life they know. They know short-term gratification, the "quick fix" if you will.

Being locked up with thousands of other people in the same situation as them is not going to change them at all. They break parole and are sent back to prison. Since the second half of the 1980's, there has been a large growth in prison and jail populations, continuing a trend that started in the 1970's. The proportion of drug users in the incarcerated population also grew at the same time. By the end of the 1980's, about one-third of those sent to state prisons had been convicted of a drug offense, the highest in the country's history (Reuter 1992, pp. 323-395).

Seven out of every ten men and eight out of every ten women in the criminal justice system used drugs with some regularity prior to entering the criminal justice system (Lipton 1998, pp. 106-109). With that many people in prisons that are using drugs and the connection between drug use and crime, then if there was any success at all it seems like it would be a step in the right direction. Many of these offenders will not seek any type of reform when they are in the community. They feel that they do not have the time to commit to go through a program of rehabilitation. It makes sense, then, that they should receive treatment while in prison because one thing they have plenty of is time.

In most therapeutic communities, recovered drug users are placed in a therapeutic environment, isolated from the general prison population. This is due to the fact that if they live with the general population, it is much harder to break away from old habits. The primary clinical staff is usually made up of former substance abusers that at one time were rehabilitated in therapeutic communities. The perspective of the treatment is that the problem is with the whole person and not the drug. The addiction is a symptom and not the core of the disorder.

The primary goal is to change patterns of behavior, thinking,