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Common Co-Occurring Issues: Exploring the interaction between mental health, physical health and addiction
Instructor: Dr. Dawn-Elise Snipes
Executive Director:, Counselor Education and Training
Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery
~ Review what a healthy person needs
~ Review how different addictions may cause or be caused by
~ Mood disorders
~ Physical health issues
What Does a Healthy Person Need
~ Nutrition
~ Sleep
~ Pain control
~ Access to regular medical care
~ Prevention
~ Early intervention
~ Social Support
~ Safe housing
Why do I care about co-occurring issues?
~ 35% of people with anxiety disorders have abused opiates
~ Of opiate or alcohol dependent patients, 20% have major depressive disorder
~ Depression in opioid dependent patients (including pain management) has been associated with poorer physical health, decreased quality of life, increased risk-taking behaviors and suicidality
~ Prevalence and severity of depression tend to decline within the first few weeks after treatment initiation
~ Withdrawal from depressants (including alcohol), opioids, and stimulants invariably includes potent anxiety symptoms.
~ Many people with substance use disorders may exhibit symptoms of depression that fade over time and that are related to acute withdrawal.
Mental Health: Chicken or Egg
~ Depression & Anxiety
~ Associated with addiction because…
~ Stimulant withdrawal/recovery / depression
~ Stimulant use
~ “Medicate” depression
~ Causes anxiety
~ Alcohol/opiate use
~ Numb/forget: Deal with physical pain
~ Detox from opiates /depression
~ Detox from alcohol /anxiety
~ Life circumstances as the result of addiction

Mental Health: Chicken or Egg
~ Bipolar disorder
~ Triggered by drug use
~ More common for people with bipolar to use:
~ Stimulants when depressed
~ Anything when manic
~ Self medication
~ Disrupted neurotransmitters after use
Mental Health: Chicken or Egg
~ Borderline Personality
~ More likely to use addictions to cope with lack of a sense of self and emotional lability
~ Antisocial Personality
~ May use addictions for the high or stimulation

~ Eating disorders (especially bulimia and binge eating disorder)
~ Nutritional deficiencies which can cause mood issues
~ Physical exhaustion which can disrupt sleep
~ Depression as a result of use
~ Depressant effects
~ Neurochemical imbalances
~ Sleep disruption
~ Anxiety
~ As a result of use
~ Neurochemical imbalances

~ Mental Health
~ Anxiety and Depression
~ 70% more likely in smokers
~ Nicotine triggers dopamine release
~ Blood vessel changes can mimic depression related fatigue/confusion
~ SPMI 2-3 times more likely than the general population to use nicotine
~ ADHD (increases in concentration and attention—short lived)
~ Physical Health
~ COPD /Emphysema
~ Lung cancer
~ Stroke (smoking narrows blood vessels increasing BP and reducing circulation)

Opiate Abuse
~ Physical
~ Blood and injection site infections
~ Collapsed veins (stroke, dementia)
~ Endocarditis
~ Hepatitis (pain, disability)
~ HIV (depression, anxiety, medication side effects)
~ Liver damage from acetaminophen
~ Decreased pain tolerance (depression, disrupted sleep)
~ Mental Health
~ Depression & Anxiety
~ Used in some trials to treat depression
~ Can cause depressive symptoms due to pharmacological properties
~ Serves to reduce anxiety and increase energy in some

Eating Disorders
~ Commonly co-occur with:
~ Mental Health
~ Depression or Anxiety
~ Caused by nutritional deficiencies
~ “Cause” ED due to fear of fat, low self-esteem, sense of lack of control
~ PTSD (24% prevalence)
~ Body dysmorphic disorder
~ Addiction
~ Alcoholism (especially with bulimia)
~ Smoking (appetite suppressant)

Eating Disorders
~ Physical health
~ Irregular heartbeats / Cardiac arrest
~ Loss of bone mass / Osteoporosis
~ Kidney damage from diuretic abuse and low potassium
~ Potential damage to adrenals
~ Liver damage causing toxin buildup and possibly pain
~ Anemia which can cause symptoms of depression
~ Infertility
~ Cathartic colon from laxative abuse / Laxative dependence
~ Cathartic colon includes bloating, a feeling full, abdominal pain which increases anxiety and depression
~ Chronic ulcers
~ Pancreatitis

Pathological Gambling
~ Addiction
~ Stimulant abuse (cocaine, meth, Ritalin) to stay focused
~ Disrupted sleep
~ Rebound depression
~ Alcoholism
~ Calm nerves
~ Culture
~ Rebound depression and/or anxiety
~ Smoking
~ Focus
~ Anti-anxiety properties
~ Culture
Pathological Gambling
~ Mental Health
~ Anxiety
~ Stimulant use
~ Tension-Release
~ Bipolar– Especially during manic phases
~ Depression
~ Due to losses
~ Gambling due to financial stress/depression
~ Obsessive Compulsive Disorder
Internet Addiction
~ 8-2% to 38% of the general population
~ Can cause anxiety or depression due to:
~ Eye strain and chronic headaches
~ Circadian rhythm disorder which can trigger depression, fatigue, reduced stress tolerance
~ Carpal tunnel (pain, sleep disruption)
~ Backache (pain, sleep disruption)
~ Poor nutrition (lack of building blocks)
~ Reduced immunity due to exhaustion
~ Job or relationship problems
Sex Addiction
~ Health
~ Hepatitis: (Pain, disability acceptance)
~ STDs
~ Herpes
~ Gonorrhea
~ Chlamydia
~ Mental health
~ Anxiety or Depression
~ May begin behavior to feel connected or loved
~ Psychological withdrawal can cause anxiety or depression
~ Reflection on behaviors can prompt anxiety about spouse finding out or STDs or depression/guilt.


~ Mental health issues can be caused by or trigger addictions or physical health issues
~ Addictions can cause or trigger mental health or physical health issues
~ Physical health issues can be caused by addictions, mental health issues
~ Common issues seen in all 3
~ Changes in sleeping
~ Changes in nutrition
~ Fatigue
~ Grief
~ Effective treatment requires addressing the underlying causes as well as the “ripple effects”