PETALING JAYA: The dual diagnosis of drug addiction and mental illness should be treated concurrently, say experts.
They said drug abuse, especially those that have spanned over long periods, can cause mental illness or exacerbate existing conditions.
Malaysian Mental Health Association president Prof Datuk Dr Andrew Mohanraj said synthetic drugs are particularly dangerous because they act directly on brain chemicals responsible for thinking, feelings and behaviour.
“Unlike traditional drugs, synthetic drugs are manufactured illegally with constant change in their chemical composition. Most of the time, users do not know what they are actually taking.
“These synthetic substances can cause hallucinations, paranoia, violent behaviour and psychosis.
“After the ‘party’ is over, users can develop severe anxiety and depression in what is known as the ‘crash period’. They can even become suicidal at this time.
“In chronic users, they can develop persistent psychiatric illnesses even after quitting using the drug for some time,” he said.
Dr Andrew said even though chronic use of traditional drugs can also cause persistent psychiatric illness, synthetic drugs are far more potent and are even seen as stronger stimulants.
“Synthetic drugs can also be modified to avoid legal detection and mixed with multiple unknown substances. Therefore, synthetic substances are much more unpredictable compared to traditional drugs.
“Even after one or two uses, it can cause extreme aggression, severe paranoia, violent psychosis and suicidal behaviour,” he said.
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Mood disorders like major depression, mood instability, anxiety disorders which include panic attacks, generalised anxiety as well as severe insomnia are some of the conditions that could develop from chronic drug use, he said.
Methamphetamine can resemble the symptoms of schizophrenia and psychosis, like hearing voices and paranoid delusions and bizarre behaviour.
“Repeated drug use also causes cognitive impairment, affecting memory, concentration, impulse control and decision making,” he added.
Dr Andrew said the dual diagnosis of addiction and mental illness must be treated simultaneously, adding that individuals who are being admitted to rehab must undergo a comprehensive mental health screening.
He said an integrated model of treatment to address the addiction and the underlying psychiatric diagnosis must be administered once the diagnosis has been established.
“This approach should include psychological therapy which is specific for addiction with an emphasis on relapse prevention. Medication should also be used when necessary, particularly in addressing the underlying psychiatric diagnosis,” he said.
Recovery for those with an addiction problem is not solely about quitting drugs. It involves rebuilding mental health, relationships and daily functioning,” he added.
Dr Mohd Fadzli Mohamad Isa, a Consultant Addiction Psychiatrist at Sunway Medical Centre, said psychoactive substances can cause temporary psychiatric disturbance – known as substance-induced mental disorder.
He said this can occur during intoxication as well as during withdrawal.
“In the long run, with continuous use of the substance, a person can develop primary psychiatric disorder like schizophrenia or mood disorder, which is permanent.
“Common substance-induced mental disorders include substance-induced psychosis, depression, mania, anxiety, sleep disturbance and even sexual dysfunction.
“On the other hand, individuals suffering from mental illness like schizophrenia can be regarded as having dual diagnosis when he or she started using substances.
“It happens due to several reasons, such as trying to reduce the severity of the psychiatric symptoms through self-medication using the substance, or reducing the side effects of the medication the person is taking,” he said.
Those who are already dependent on substances and later develop mental illness due to other factors are also considered dual diagnosis cases, he added.
Concurring with Dr Andrew, Dr Fadzil said psychiatric illness and substance use should be managed concurrently.
“Assessment and management for both conditions should run together at the same time by the same personnel or facility. It needs specialised addiction treatment because dual diagnosis cases are usually complex and difficult cases.
“They must continue to remain in the treatment system. Both pharmacological and non-pharmacological interventions must be continuous,” he said.
