The vicious cycle: The link between substance misuse and mental health disorders

'Concurrent disorders' is the term used to describe a situation where a single individual is living with both a mental health disorder and a substance use problem. Concurrent disorders are very costly to the Canadian taxpayer and are associated with severe disability and poor response to treatments. Many theories have been proposed to account for the fact that patients with mental illness are more likely to use substances improperly. One idea is that patients may be treating their own symptoms with legal or illegal drugs. A second possibility is that substance misuse causes mental health problems. Another suggests that substance use disorders and mental health problems represent abnormalities in very similar regions of the brain. A further suggestion is that the two problems become linked in a vicious cycle (e.g., a person with depression using alcohol to treat mood symptoms with the alcohol subsequently increasing the depression). Whatever the reason, we know that substance misuse is very common in those with mental disorders. Within the Canadian health care system, it has been the tradition to treat either the mental health problem or the addiction, with poor coordination of patient care across services. Consequently, high rates of under-treatment of one or both conditions have been observed. Given the evidence that mental health problems and addictive behaviours are closely inter-connected, coordinated and integrated treatment services are required in order to improve patient outcomes. The Café will involve an interactive discussion amongst speakers, panellists, and the audience. Our objectives are to: ?increase awareness of the high prevalence and costs associated with concurrent disorders; ?share and discuss recent scientific information regarding the potential causes of concurrent disorders; and ?critically examine current options for the treatment of concurrent disorders in Canada and debate the relative merits of alternate treatments.