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Depression & Anxiety in Substance Abusers

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Depression & Anxiety in Substance Abusers

What is Depression & Anxiety?

Do you know what is common in Jim Carrey, Johnny Dep, Chris Evens, Angelina Jolie, Michel Phelps, Brad Pitt, J.K Rowling, and many more? Yes all of you know them, they are celebrities but that’s not the only common factor in them. They all are survivors and some still fight with the disorders of depression and anxiety. World Health Organization (WHO) defines depression as “a common mental disorder, characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness and poor concentration.” The depressive disorder involves feelings of depressed mood, loss of interest in enjoyment, decreased mental and physical energy.

Depression can be divided into mild, moderate, and severe based on the number and severity of the symptoms. Dysthymia is a continuous and chronic form of mild depression. Dysthymia has less intense effects but it lasts longer.

Whereas anxiety is an emotional state where one has feelings of tension, worrying with or without a reason, and physiological changes like increased blood pressure. Anxiety disorder is a group of mental disorders that involves the feeling of anxiety and fear that includes phobias, social anxiety disorder, obsessive-compulsive disorder (OCD) generalized anxiety disorder (GAD), panic disorder, and post-traumatic stress disorder (PTSD).

Worldwide it is estimated 4.4 % of the population gets affected by depression and anxiety disorder affects about 3.6% of the world’s population. WHO reports 322 million people get affected by depressive disorder and about 264 million people get affected by an anxiety disorder. Both depressive disorder and anxiety disorder affects females more than males. About 7.7% of the female population in America suffers from an anxiety disorder. Even though all age groups get affected by depression and anxiety, it is noted that a less prevalence of both in the older age group.

WHO reports about 1.5% of world death is due to suicide. Suicide remains the second leading reason for death in the age group of 15-29 years. The most common reason for suicide is mental illness mainly depression. There are different causes for depression, it can be the past experiences of physical, mental, and sexual torture or due to relationship break or due to sudden demise of an important person in life or serious illness that make one mentally weak or it can be due to substance abuse such as alcohol or drug abuse.

Depression caused an economic burden of more than $210 billion in the year 2010 alone as reported by the Centers for Disease Control and Prevention. This figure includes direct costs, workplace costs, and suicide-related expenses.

One-third of patients with depression have trouble with alcohol dependency. About 30% of the people who are on substance abuse reported having symptoms of major depression. These people depend on drugs or alcohol for temporary relief from the symptoms of depression. Symptoms of alcohol disorders that lead to depression are drinking too often, drinking in large quantities at a time, severe craving for alcohol, avoiding your routine life for the sake of drinking. For treating such people it is an advantage to treat the alcohol disorder that could resolve both problems of alcohol disorder and symptoms of anxiety and depression.

Drugs and alcohol can affect brain health

Alcohol is a depressant. Chronic alcohol user’s brain tends to get adapted by changing its chemistry. Drinking more often and in large amounts causes depression. Drinking alcohol increase the neurotransmitter called dopamine. Dopamine gives a pleasurable effect and relaxation to the brain. The brain will experience an impairment of memory and reasoning capacity. This gradually leads to memory loss, disorientation, and depression. Alcohol reduces the GABA neurotransmitters causing lethargic movements, slurred speech, and reduce reaction time.

Heavy alcohol consumption can have dangerous effects on the brain. It may not kill the brain cells as a whole but it can damage the neuronal end called the dendrites. Damage to dendrites causes it difficult for the neurons to relay messages to one another. Regions of the hippocampus in the brain can get damaged in chronic alcohol users leading to memory loss where the brain cannot restore the new memories. So why alcohol causes anxiety and depression? Alcohol itself won’t be a primary factor for developing anxiety. Alcohol affects the levels of serotonin in the brain. This can worsen anxiety. The anxiety reappears to one when the effect of alcohol wear off. This will lead one to use alcohol on a routine basis to cover up his/her anxiety disorder. Alcohol-induced anxiety lasts for several hours even a whole day.

Drugs like cocaine, crystal meth, heroin, MDMA, morphine, methadone are some of the common drugs that are used to get pleasure.

Cocaine used in any form such as snort, smoked, or injected will reach your bloodstream rapidly. This drug rapidly affects your brain by altering dopamine levels. This drug gives the kick feeling by the dopamine build up. Dopamine acts by dopamine receptors in the brain cells. This causes the cell to function according to the electric impulse it receives on stimulation of dopamine receptors. The cell’s activity changes according to the number of dopamine molecules it receives on its receptor.

Cocaine inhibits dopamine transport and causes it to build up. This, in turn, causes the cells to overreact once their receptors receive the accumulated dopamine and one gets the feeling of pleasure. During long-term uses, it changes the physical nature of the nerve cells and there will be a decrease in the dopamine level. This causes one from deprived of the positive effect he/she used to get while using cocaine. This leading to depression and causes addiction.

Effect of drug abuse in overall health.

Drug abuse and chronic alcoholism hampers your immunity and makes your body exposed to various illnesses. The euphoria associated with many intoxicating substances, especially alcohol, cocaine, and narcotics, can lower inhibitions, which increases the chance of taking sexual risks. Some drugs, like cocaine, directly impact the immune system’s ability to create white blood cells, which reduces the immune response to infection.

Drugs that are injected intravenously can cause an increased risk of infections such as HIV, Hepatitis B, and bacterial infections that spread from contagious needles. Drug abuse can alter your heart rate and make you prone to cardiovascular diseases. Those who are alcohol abusers increase the risk of pneumonia, tuberculosis, respiratory viral infections, acute respiratory distress syndrome. Alcohol can alter the effect of the medications you use to take. Alcohol can cause a serious effect on your digestive system. Chronic use of alcohol causes gastrointestinal reflux disease (GERD), can damage the esophagus causing pain during eating certain drugs. This in turn causes malnutrition due to reduced eating. Opioid abusers will have side effects of constipation, malabsorption of nutrients, nausea, and vomiting. Chronic drug users will develop memory loss leading to Alzheimer’s disease.

Alcohol and drug pave the way to kidney damage. Kidney filters the toxins of our bloodstream. Some drugs can cause a condition known as rhabdomyolysis that causes the breakdown of muscle. This causes large proteins like myoglobin to flood the bloodstream. This prevents the kidney from filtering the toxins effectively. Leading to kidney damage. Respiratory depression caused by drugs causes decreased oxygen content in kidney tissues, leading to kidney damage. Alcohol, heroin, and steroids can damage the liver and leads to liver cirrhosis or drug-induced hepatitis. Alcohol usage is the main reason for liver damage. It ranges from mild hepatitis known as fatty liver to severe alcoholic hepatitis condition that causes fibrosis and scarring of liver tissues. These progressive changes can lead to liver cancer.

How to treat depression drug abusers?

The key to treating the drug abusers lays in the decision making or decide to stop the habit. Treatment for depression and drug abuse goes hand in hand. If you get treated for drug abuse your depression too gets cured. The main concern in treating a drug abuser is the withdrawal symptoms such as anxiety, vomiting, nausea, insomnia, shaking hands, sweating, and hallucination.

People with severe drinking habit should seek treatment from rehabilitation centers. This is because you have to go through severe withdrawal symptoms and anxiety. This makes one turn back again to the usage of drugs. In rehabilitation centers, doctors would treat systematically. Doctors will give you proper medication that will help you to stop the habit and to control the withdrawal symptoms.

Make up your mind and see a therapist. Your therapist makes you learn skills to plan your day to day life. Your psychologist makes you ready to face the stress, will help you to change the behavior, set your goals which help you to deviate from thoughts of drugs. You will have multiple sessions of counseling to deal with your depression and anxiety. Your chronic drug/ alcohol habits would have hampered family relations. Family counseling helps to get rebound with the family members.

There are various medications used to recover from the disorder. Disulfiram, acamprosate, naltrexone, gabapentin, baclofen, and topiramate. Medications help not only to stop drinking but stops the craving for it. This helps to recover from the addiction.

Disulfiram is used in chronic alcohol users. One would experience headache, nausea, vomiting, chest pain, blurring of vision, mental dilemma, apnea episodes, and anxiety if he/she drinking alcohol even in small amounts while on disulfiram therapy.

Acamprosate is used to treat alcohol dependence. Due to chronic drinking habits, there are changes in the brain. Accaprostate works by stabilizing the chemical signals in the brain. Acamprosate alone cannot relieve one from alcohol dependence but along with psychosocial support, it helps to control alcohol dependence.

Naltrexone is an opiate antagonist. It works by preventing opiate effects such as pain relief, feeling well being. It is used to treat alcohol abusers. It works by decreasing the craving for alcohol when used along with counseling and other treatment programs.

Gabapentine is an anticonvulsant used to treat withdrawal symptoms in alcohol abusers. It works by reducing craving, anxiety, and insomnia. It works by giving a calming effect on the brain reducing the hyperactive state of the brain. This reduces anxiety, gives relaxation to the body, and sleep. This helps to reduce the craving and dependence on alcohol.
Baclofen is a GABA agonist. It reduces the craving for alcohol and prevents relapse.

Benzodiazepines are now used to treat alcohol withdrawal symptoms. Benzodiazepines are now used as a first-line drug. The benzodiazepines like diazepam and chlordiazepoxide, are commonly used in the treatment of alcohol withdrawal symptoms. Benzodiazepine has a similar action to alcohol on GABA –A receptors. When alcohol is withdrawn from the system, benzodiazepines substitute for it. Benzodiazepine reduces the severity of alcohol withdrawal symptoms and incidence of seizures that use to happen during alcohol withdrawal.

While on this medication, you should become a part of a group that is led by a therapist. This will be a group of people that has alcohol disorder. While involving in activities one will get the support to leave the habit and gets the assurance that he/she can come back to normal life.

You should develop self-confidence and reframe your life. You should find new activities such as going to the gym, cycling, meditation, yoga to which you can cling to. This helps you to prevent relapse and help you to improve your social norm.

You have to set long term goals. You should list out the reason for quitting your habit. By doing this you can focus on your life, career, help to become a better parent or family member. You can appreciate the changes that come in life.

Quitting drugs or alcohol is not an easy process. There will be setbacks, points where you feel to restart the habit. Don’t get discouraged by this. Take examples of people who have succeeded in quitting their habits. Get their valuable advice and strategies. Whenever you feel setbacks, interact with your therapist, and always feel free to have an open conversation with your therapist. Most important don’t give up because you are going to have a better life and a better start than you wished for.

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