Drugs and mental health – what’s the impact?
Dr David Outridge, a GP of 20 years and now working full-time in Addiction Medicine, offers his insights into the link between drug use and mental health. Dr Outridge is co-located with Samaritans Post Release Programs, where a joint initiative targeting methamphetamine use is being developed.
Drugs and mental health – what’s the impact?
I am sitting with Mike; a tall good-natured man in his 30’s who is an unemployed qualified electrician. He called me because he had been feeling extremely stressed. He has been struggling with ‘Ice’ use for some years, and has lived in half-a-dozen different rented rooms over the 12 months that I have known him.
He says, ‘Hey, I really want to get you to help me write that letter to Tony Abbott about the amnesty’; he then pops out the statement ‘I am a Russian purge’…I have heard this a few times over the past few weeks. It is obvious that he is suffering with psychosis. The tragedy is that he won’t be admitted to a mental health unit if I referred him as he will be dismissed as a drug user, rather than someone with a mental illness.
Society is grappling with a rapidly expanding problem of highly addictive methamphetamine or ‘Ice’ use, but does not have the services or legislation in place to allow the problem to be dealt with properly.
In the year 2000, supplies of heroin dwindled and methamphetamine appeared on the scene, almost as if the drug cartels had changed their business model. Methamphetamine appeals to a wider range of people than heroin does and it can be made in south-east Asia without needing poppy crops. At the time, Oxycontin, an emerging pharmaceutical opioid, had also become competition for heroin in the black marketplace.
Unlike opioids where medications such as methadone or Suboxone can stop the addiction in its tracks, there are no such medications for ice addiction. This was a very clever strategy on the part of the illicit drug king-pins.
What happens in Ice addiction and why is it so destructive to mental health?
Everything we know about the brain shows that we are hardwired to become ‘addicted’. In other words, we are designed to develop habits through a system in our primitive brain (shared with all the animal kingdom), whereby anything associated with pleasure becomes linked to the situation where it occurred.
Like Pavlov’s dogs, if we experience a pleasure such as eating a ‘Big Mac’, then the big yellow ‘M’ becomes pleasurable in itself. The sight of a large yellow ‘M’ on the horizon will start to trigger cravings for the pleasure previously experienced.
Why is the brain like this? If you were designing a robot, and it needed to be plugged in to recharge, it would need to learn and be motivated to find a power outlet and would need to follow the tell-tale signs associated with it, i.e. to a house, not a gum tree.
But unlike a Big Mac, the pleasure from the first shot of Ice is 100 times more intense, leading to a very strong association with wherever/whatever/whoever you were with at the time. Next time you see that person/glass pipe/ house/cash in your wallet, the cravings will start, but so much more intense than that for a greasy burger. The chemical in our brains which is responsible for the feeling of pleasure is ‘dopamine’.
So how does the brain stop us getting addicted to anything that is pleasurable?
Enter the ‘Smart Brain’: in addition to the primitive brain (or ‘animal brain’), we have a highly developed computer called the ‘Frontal Lobe’ where all the weighing up of hard decisions occurs.
Animals have basic frontal lobes, but we have highly developed ones which allow us to have complex societies, rules, social expectations, morals etc. It turns out that a rat can get addicted to Ice and if left to its own devices in a room with a lever to deliver a dose of the drug to its brain, it will keep pressing the lever until it literally dies of dehydration.
As individual humans, we have different inborn brain characteristics and we are influenced during our development- includingwhat happens inside the womb and events of our childhood. All of these things contribute to our vulnerability to various mental disorders, including substance use.
Who is prone to substance addiction?
The basic answer is everyone if they were exposed to the substance enough.
Social structures and laws prevent us from being exposed to too much of anything, e.g. the pricing of alcohol and tobacco are designed to prevent any of us getting too carried away.
Peer pressure is a factor in addiction, but not as important as one might think. Addiction by definition is when rules, relationships and moral considerations go out the window, being overwhelmed by the animalistic brain drives.
Some people are extremely prone to addiction to substance, for example, children of alcohol-dependent people are more prone. People who have experienced childhood abuse and trauma are statistically more prone to opioid addiction. People with untreated ADHD are also more prone to become addicted to all substances. People with PTSD are highly prone to various addictions.
Mental illness is another condition that makes one prone to addiction; Bipolar Mood Disorder is the classic case where 80% of sufferers use substances to ‘self-medicate’ their mood. Essentially, anything that interferes with the role of the ‘smart-brain’ from controlling the ‘animal brain’ will make you prone to addiction. This is where mental health prevention and early access to treatment is so important.
Now here is the source of a conundrum; remember the pleasure chemical in our brains, dopamine? It’s also one of the most important chemicals in our smart-brain, contributing to attention, creativity, initiative, choice and many other things. All addictive drugs release dopamine in larger amounts than we can achieve naturally, and in so doing they deplete dopamine. It’s not unlike spending all your pay up at the start of the fortnight, and finding things hard until next payday; similarly, dopamine gets used up and leaves one with a lack of it for some time.
How this affects the animal brain is a loss of pleasure in natural or ‘normal’ experiences, but, how it affects the smart-brain is complex: it can leave one indecisive, unfocussed, confused and forgetful.
To use a computer analogy, it can also leave the smart-brain ‘smoking’ and ‘short-circuiting’ from over-load, or in medical terms ‘psychotic’. The conundrum here is that mental illness both makes one prone to substance addiction and substance use can cause mental disorders.
Working out which came first can be difficult.
Cannabis use is a classic in this regard. People have been arguing for a long time as to whether ‘pot’ causes mental illness, or whether people with mental illness use it to feel better; but a study in New Zealand has found the proof. Some forward-thinking people started a ‘cohort study’ by studying a group of people from well before the time they started to use cannabis. They found that people who used cannabis before any signs of psychosis had developed, developed psychosis more often than those who never used cannabis.
The reasons why cannabis is a problem is that it interferes with adolescent brain development, the very subgroup that use it the most; in fact if people didn’t smoke cannabis until their mid-20’s we would have fewer cases of psychosis. Again it’s the mental illness-prone people that it affects, but we cannot predict who that is yet.
So substance use is a source of pleasure for mankind that has been around in various forms for thousands of years, but in recent times, some very potent and addictive compounds have emerged.
What can we do about the link between drugs and mental health issues?
Some substances are so addictive they should never even be experimented with.
Ice is one of those substances.
Some substances have a social role in our society and need to be regulated and the fact recognised that some people are highly prone to addiction. This should not be an issue of embarrassment, any more than the fact that some people cannot spend long in the sun before getting burnt.
‘Knowledge is power’, and is protective if we use it the right way.
Let’s be informed about drugs and not be too ashamed to ask for help when they get control of us.