Preventing Substance Use Disorders in People With Mental Illness

A researcher at Harvard Medical School is studying which substance use disorders are more common among people with different types of mental illness, and when they tend to develop. He hopes his research will one day be used to prevent drug and alcohol disorders among people with mental illness through early counseling, detection and treatment.

Ronald C. Kessler, PhD, the McNeil Family Professor of Health Care Policy at Harvard Medical School, is investigating at what age people tend to develop mental health problems and substance use disorders. “I am looking at when these problems develop, and at interventions to try to prevent a pileup of problems,” he says. “Often, when a person comes in for mental illness treatment, they already have several problems. For instance a young person with social phobias, depression or anxiety may start using alcohol to self-medicate, so by the time we see them, they have mental health issues and a drinking problem.”

Dr. Ron Kessler

At the recent American Psychiatric Association annual meeting, Dr. Kessler discussed his goal of reaching people with mental health issues before they develop alcohol or drug disorders, known as secondary prevention. “If a person comes in for treatment of depression, social phobia or anxiety, we need clinicians to warn them they may also be at high risk of substance use disorders because of self-medication. We need to look at children, adolescents and young adults being treated for mental illness, and examine their risk for substance use. Find out if they are using drugs or alcohol as a crutch, and if they aren’t, give them the tools to prevent them from starting. Clinicians don’t normally think this way.”

Dr. Kessler analyzed data from the World Mental Health Survey Initiative, which includes several hundred thousand people from 28 countries. He analyzed patterns of when mental health disorders and substance use disorders unfold over the course of a person’s life, to try to find why some people abuse substances and are able to stop, while others become dependent.

For instance, he explained, some people start abusing marijuana in their teens and stop by their early 20s, while for others, marijuana use becomes central to their lifestyle. “We found that in people with anxiety problems, marijuana use is less likely to disappear, while juvenile delinquents tend to grow out of it.” People suffering from anxiety are also more likely to abuse alcohol chronically than those who are not anxious, he added.

The survey looked at “internalizing” mental health disorders including depression, phobias, obsessive-compulsive disorder, anxiety, separation anxiety disorder, bipolar disorder, and post-traumatic stress disorder. The researchers also evaluated the prevalence of common “externalizing” disorders including drug and alcohol abuse, conduct disorder, attention-deficit disorder and intermittent explosive disorder.