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Addiction Among Those With Comorbid Medical Conditions
Drugs and alcohol make chemical changes in the brain, slow down or speed up functions of the central nervous system, and may disrupt many of the body’s natural systems and tasks. Several medical conditions commonly co-occur with substance abuse. When both a medical condition and substance abuse disorder are present simultaneously in the same person, the disorders are said to be comorbid.
Comorbid medical conditions and substance abuse are optimally treated in an integrated fashion with medical and substance abuse providers working together to develop and implement a care plan that can manage the symptoms of the medical condition while fostering recovery from substance abuse at the same time.
Common comorbid medical conditions in those battling substance abuse include:
- Heart disease and other cardiovascular conditions
- Respiratory conditions
- Liver disease
- Kidney problems
- Skin Infections
- Infectious diseases, such as HIV/AIDS, tuberculosis, and hepatitis B and C
- Chronic obstructive pulmonary disorder (COPD)
- Gastrointestinal conditions
- Chronic pain
- Mental health and neurological disorders
Many drugs act as central nervous system stimulants, such as cocaine, methamphetamine, and prescription stimulant medications, which raise blood pressure, heart rate, and body temperature. These drugs can also cause irregularities in heart functions and blood pressure levels, which may lead to heart disease, damage to cardiovascular systems, hypertension, or stroke. The longer drugs like this are abused, the more pronounced the damage is likely to be.
Ischemic heart disease is when blood and oxygen levels flowing into the heart are reduced, and this cardiovascular disorder may commonly be comorbid with substance abuse, particularly when substance abuse is perpetuated over a long period of time. Methamphetamine may cause an abnormal immune response, and with long-term use, this can cause a cardiovascular disorder known as vasculitis, which is a blood vessel inflammation, the journal Science Dailyreports.
Cocaine is a known contributor to cardiovascular disease as well. Chronic cocaine abuse may be involved in the onset of a myocardial infarction, or MI, which is a heart attack. Cocaine use can also contribute to arrhythmia (irregular heart rate), endocarditis (inflammation in the lining of the heart), heart failure, and cardiomyopathy (disease of the heart muscle itself). More than half of the emergency department (ED) visits for cocaine that were surveyed, and published in the journal Circulation, involved cardiovascular complications. Cocaine was the most common illicit drug involved in drug-related ED visits in 2011, with more than 40 percent of all illicit drug-involved ED visits related to cocaine, the Drug Abuse Warning Network (DAWN) reports. The American Heart Association labels cocaine as a “heart attack drug,” as it increases blood pressure and may cause aortic stiffening and an increased thickness in the left ventricle wall of the heart. These cardiovascular abnormalities may cause medical heart problems.
Stimulant drugs can wreak havoc on the cardiovascular system, as the constant rapid increase of oxygen and blood flow in the heart and surrounding areas can cause lasting damage and lead to a multitude of cardiovascular disorders. Likewise, sedative and central nervous system (CNS) depressant drugs, like benzodiazepines, alcohol, marijuana, and opioids, also disrupt these functions by slowing everything down. Withdrawal symptoms for CNS depressants may include a rebound effect where all of the functions, like heart rate, respiration levels, blood pressure, and body temperature, that were slowed down as a result of the drug’s interaction are now reversed with the drug’s removal from the body. Some of the same cardiovascular disorders reported with stimulant drugs can occur, the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Treatment Improvement Protocol (TIP) publishes.
Regular substance abuse may cause a chemical dependency to form. One of the side effects of this may be withdrawal symptoms when these substances are removed. Drugs or alcohol may worsen underlying heart conditions that may have existed prior to the initiation of substance abuse. Chronic alcohol abuse can also lead to a weakening of the heart muscle, which necessitates the heart working harder to pump blood. This can cause heart failure, known as alcoholic cardiomyopathy.
Respiratory, or pulmonary, medical conditions that are preexisting may be exacerbated by alcohol or drug abuse. Specifically, drugs that are smoked, such as heroin, crack cocaine, crystal meth, and marijuana, may cause particular damage to the lungs and airways. NIDA publishes that smoking marijuana regularly over a period of time may cause respiratory and pulmonary damage as well as medical conditions that may include chronic bronchitis and problems related to the immunity functions in the lungs. Opioid and other CNS depressants also slow down respiratory functions, lowering breathing to potentially dangerous levels that may result in an overdose.
Smoking drugs can increase the odds for a comorbid lung infection or disease, asthma, bronchitis, pneumonia, or chronic obstructive pulmonary disease (COPD). COPD occurs when the pulmonary immune system is disrupted and inflammation may occur, causing chronic bronchitis or emphysema.
Many of these respiratory conditions are regularly associated with smoking cigarettes, which may be more common in individuals who also abuse drugs or alcohol, TIP reports. Drugs and alcohol can also damage a person’s gag reflux, which may result in aspiration of gastric contents into the airway and can cause aspiration pneumonia, which is a serious medical condition.
Drugs and alcohol can lower inhibitions and impulse control, impair judgment, and increase the likelihood that an individual will engage in potentially risky behaviors, such as hazardous sexual encounters that may increase the risks for contracting an infectious disease that is often transferred through contact with bodily fluids.
Injection drug use also increases these risks as injection drug users (IDU) often share dirty needles that may be contaminated. Hepatitis B (HBV) and hepatitis C (HCV) are the most common forms of viral hepatitis commonly comorbid with substance abuse, NIDA reports. Hepatitis is an inflammation of the liver caused by a viral infection. Untreated, it may become a lifelong medical condition or cause additional liver problems, such as cirrhosis, liver disease, or liver cancer.
Human autoimmune deficiency virus, or HIV, is another infectious disease spread through sexual contact or the sharing of dirty needles. The Centers for Disease Control and Prevention (CDC) publishes that about 8 percent of new HIV transmissions were caused by IDU in 2010. HIV, at this point, has no cure and may develop into acquired immune deficiency syndrome, or AIDS, which is often life-threatening. The World Health Organization (WHO) reports that globally about one out of every 10 new HIV cases annually is due to injection drug abuse, and out of the 16 million injection drug users in the world, about 3 million live with HIV.
Another infectious disease that may be spread through the sharing of drug paraphernalia, or the poor environmental conditions that drug abusers may be in, is an airborne bacterial infection, tuberculosis(TB). Often TB may lie dormant in individuals, meaning that they will not even know they are sick and therefore continue to spread the disease unwittingly. The journal Clinical Infectious Diseases reports that between 10 and 59 percent of drug abusers may have dormant TB. Drug use can weaken the immune system, which may cause dormant TB to rise to the surface and become an active infection of the lungs, causing wheezing, and coughing. Sexually transmitted diseases, or STDs, may also be comorbid with substance abuse.
Gastrointestinal and Poor Nutritional Conditions
Alcohol and drugs can interfere with digestion, eating habits, and the gastrointestinal system in the body. Stimulant drugs decrease appetite, for example, while alcohol and marijuana may increase it, which may lead to unhealthy weight loss or gain and malnutrition. Metabolic syndrome may be present in as many as 5-31 percent of substance abusers, which may be the result of poor nutrition, hypertension, hyperglycemia, and abnormal cholesterol levels, the journal Today’s Dietician publishes.
Diabetes may be more difficult to control with substance abuse as blood glucose levels may be harder to manage. Anemia, which is caused by low iron levels, may be present. Other essential vitamins or minerals may be out of balance due to substance abuse and subsequent poor nutrition, which can heighten gastrointestinal and other medical conditions.
Drugs may cause stomach ulcers or damage to the esophagus, especially if they are ingested regularly. Alcohol may increase the levels of gastric acid and lead to the onset of gastritis. SAMHA’s TIP postulates that around 60 percent of all pancreatitis cases may be the result of high levels of alcohol consumption.
Liver disease is also a common side effect of chronic high levels of alcohol consumption, as alcohol changes the fatty tissue in the liver. Chronic heaving drinking may lead to alcoholic hepatitis about 35 percent of the time and scarring, or cirrhosis, which around 10-20 percent of all heavy drinkers will develop, the American Liver Foundation publishes. Long-term opioid narcotic usage may create a medical condition known as narcotic bowel syndrome (NBS) indicated by nausea, constipation, bloating, and abdominal pain, the journal Clinical Gastroenterology and Hepatology reports.
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Drugs and alcohol interfere with the normal functions of the brain’s chemical messengers and, over time, may actually make changes in the way the brain is wired, or its circuitry. In many cases, this damage is reversible with prolonged abstinence to these psychoactive substances; however, there are some neurological disorders that may be irreversible.
Alcohol abuse that is perpetuated over a period of years may lead to a condition known as wet brain, or Wernicke-Korsakoff syndrome. This condition is actually two different disorders, Wernicke encephalopathy (WE) and Korsakoff syndrome (KS). Wernicke encephalopathy is often underdiagnosed but is thought to be present in close to 15 percent of heavy drinkers. Wernicke encephalopathy comes from extreme thiamin deficiency, which may be caused by alcohol abuse and may be at least partially recoverable around 75 percent of the time. Wernicke-Korsakoff syndrome is considered a form of dementia as Korsakoff syndrome is indicated by severe memory disturbances that can impair daily life functioning.
The use, or abuse, of benzodiazepine medications for longer than three months can increase the risk for developing Alzheimer’s disease, which is a form of dementia, up to 32 percent for elderly individuals over age 66, the BMJ (British Medical Journal) publishes. Using or abusing a benzo, such as Valium, Ativan, Klonopin, or Xanax, for longer than six months increased the risks to more than 80 percent for developing Alzheimer’s in older individuals.
High doses of methamphetamine may cause psychosis with symptoms that can last for months or even years after stopping the drug. Abusing hallucinogenic drugs like LSD or peyote may lead to persistent psychosis or hallucination persistent perception disorder (HPPD) that may produce “flashbacks” without warning long after the drug’s effects have worn off, NIDA reports.
Drug withdrawal syndromes often include psychological or neurological disturbances that may include overactive nerve firings, leading to anxiety, depression, insomnia, seizures, restlessness, and paranoia as well. Delirium tremens (DTs), for instance, is caused by alcohol withdrawal and may be a life-threatening condition without proper treatment. The National Alliance on Mental Illness (NAMI) publishes that between a third and half of all substance abusers may also suffer from some form of mental illness as well. Substance abuse is commonly comorbid with psychiatric issues; substance abuse may be used as a coping mechanism to deal with mental health symptoms.
Cancer and Other Medical Conditions
Alcohol abuse may increase the odds for developing certain forms of cancer, including esophageal, liver, breast, head and neck, and colorectal cancer, possibly as the result of these substances damaging the immune system, creating nutritional deficiencies, or disrupting DNA, the National Cancer Institute reports. Smoking drugs may introduce potential carcinogens to the body and raise the risk for the onset of cancer.
Skin infections may also be commonly comorbid medical conditions in those abusing substances, particularly individuals who inject drugs or those abusing meth. The use of dirty needles or not properly cleaning the injection site may cause bacterial infections or cellulites. Meth abusers may pick at their skin, while under the influence of the drug, potentially causing infections. Chronic abusers of meth may also suffer from dental disease, often called meth mouth, about 40 percent of the time, a study published in Today’s Dietician published.
Individuals who suffer from chronic pain may turn to drugs or alcohol as a way to self-medicate and temporarily block pain sensations. Opioids, marijuana, alcohol, and benzodiazepines may temporarily help someone to relax, and narcotic drugs may provide short-term relief from pain. Opioid drugs are commonly prescribed for pain relief; however, these drugs are often abused, or used beyond their medicinal scope, as an individual may develop a tolerance to these drugs and need higher doses in order to keep feeling their effects. As dosage increases, so does the likelihood of developing a chemical dependency on opioids, and behavioral, physical, social, and psychological problems may be compounded.
Medical conditions may be the result of substance abuse, or substance abuse may be perpetuated because of a medical condition. Regardless of the reason these conditions are comorbid, help is available. A primary care provider may be able to provide treatment and referrals for the care of and recovery from comorbid medical conditions and substance abuse. The following is a list of resources that also may be helpful:
- The American Heart Association provides a lot of information on heart disease and cardiovascular disorders, including how to prevent them, treatment options, tips for recovery, and support resources.
- The American Cancer Society offers online support groups, information on screening, symptoms, treatment, education, and help for individuals and families battling cancer.
- The American Liver Foundation has local divisions and online resources for help, treatment information, and a professionally staffed helpline for questions about liver disease.
- gov is a government website with information on the care and treatment of HIV/AIDS, where to find local HIV testing sites, education about the disease, prevention methods, and links to federal resources.
- The American Lung Association has tips for quitting smoking, information on lung disease, a helpline, local support resources, and advocacy programs.
- The National Helpline is operated by SAMHSA 24/7 by highly trained professionals who are available to answer any questions or concerns relating to substance abuse or mental health concerns.
- The National Council on Alcoholism and Drug Dependence (NCAAD) strives to provide current information on substance abuse prevention, treatment, and recovery, with education and resources for families and individuals struggling with substance abuse.
- Alcoholics Anonymous (AA) is a 12-Step support group program with local chapters that hosts meetings for all types of people, and their loved ones, who wish to recover from alcohol abuse through sustained abstinence and fellowship.
- The Behavioral Health Services Locator, operated by SAMHSA, provides the option for individuals to input a local zip code, state, or city in order to find substance abuse, mental health, or co-occurring disorder treatment services nearby.
- The North American Syringe Exchange Network (NASEN) is a nonprofit organization that provides a directory searchable by state of local programs that participate in needle exchange programs as a method to prevent the sharing of dirty needles and potentially stem the spread of infectious diseases. This is considered a harm-reduction effort and not supported by all local state governments.
- The National Institutes of Health (NIH) is a division of the U.S. Department of Health and Human Services (HHS), providing information on healthcare in the United States, clinical trials, treatment resources, educational materials, general health, local community resources, a health services locator, and cutting-edge research and advancements in science.
County, city, and individual state health departments are also likely to provide public health and substance abuse treatment services as well as information on local resources. In addition, these resources often provide tips on how and where to receive treatment or referrals to the necessary services. Individuals can search for behavioral health services by state, city, or county specifically.