• Elias Aceves

Substance Abuse, Mental Health, and Co-Occurring Diagnoses

Substance Abuse in the United States

Substance Abuse impacts a significant portion of the population in the United States, affecting 19.7 million Americans in the 2017 cycle. This may arise for many reasons, primarily environmental and sociocultural factors such as the stress of work and/or family, feelings of emptiness and isolation, along with genetic expression and hereditary traits. 



Young adults (18-25) are the most likely to suffer from substance abuse in the United States, where 5.1 million people (14.8% of this particular group) are affected by it, followed by those over 26 (13.6 million people or 6.4% of this particular group), and adolescents (992k or 4% of this particular group). Elderly individuals have the most complex experience with substance use however, where about 1 million suffer from it, yet, two thirds of these individuals had already developed this substance abuse disorder prior to becoming 65. 


Out of the many substances, alcohol is the most abused, with 74% of those suffering from a substance abuse disorder having the substance be alcohol; this was followed by 38% of depending on illicit drugs, with 1 out of 8 Americans suffering substance dependency actually engaging with both alcohol and illicit drug use. 


Intersections of Gender and Ethnicity with Substance Abuse  

Men are disproportionately affected by substance compared to women, with 9.4% of men over the age of 12 experiencing a substance abuse disorder as opposed to only 5.2% of women of the same age range experiencing one. 



This difference is also present among ethnic variations, where it is noted that Native American and Alaskan Native individuals are disproportionately affected by substance abuse, followed by Whites, African-Americans, Hispanics, and Asians being the least affected. 


It is these variations across gender and ethnicity which makes substance abuse treatment complex, for the development of such abuse is again attributed to the environmental, genetic, and sociocultural factors of each individual, which manifests itself differently for each respective individual. Whether they are an Asian man, a Queer Latina, a Disabled White man, a Muslim, Bisexual Black woman, or Native American man, each individual has vastly different factors which contribute to the development of a substance abuse disorder.


Mental Disorder and Substance Abuse: A Co-occuring Diagnosis 

Many times, people may suffer from a mental disorder and substance abuse disorder simultaneously, called a co-occuring diagnosis. A central question within a co-occurring diagnosis is whether one’s mental disorder or substance abuse disorder came first. Many scenarios can occur, such as people using substances to alleviate the plight of an untreated mental disorder or the usage of drugs and alcohol raising the risk of a mental disorder actually developing. 


Co-occurring diagnoses are extremely damaging, especially considering how substance abuse may trigger mental illness symptoms to worsen or even new ones to pop up. Substance abuse symptoms include (via DSM 5):


1. Overusing the substance or using it for too long and in too large of amounts.

2. Being aware of the substance issue but not managing to stop using it. 

3. A lot of invested time meant purely for getting, using, or recovering from use of the substance.

4. Cravings and urges to use the substance.

5. Having the substance use intrude on your daily routine and abilities at work, home, or school.

6. Despite explicit relationship damages because of it, one continues to use it.

7. Giving up important social, occupational, or recreational activities because of substance use.

8. Persistent use of the substance despite the danger.

9. Although one has a mental or physiological problem that could be worsened by the substance, they continue to use it.

10. Yearning for the effect the substance gives one.

11. Development of withdrawal symptoms.


These allow one to diagnose the severity of the substances, with two or three symptoms indicating a mild substance use disorder, four or five symptoms indicating a moderate substance use disorder, and six or more symptoms indicating a severe substance use disorder. And with 7.9 million people having a co-occurring diagnosis, this is an issue that must be addressed with the attention it deserves. 


AYANA and Treatment

Briefly touched upon within the “Intersections of Gender and Ethnicity with Substance Abuse” section, we want to further elaborate upon how AYANA will approach substance abuse and co-occurring diagnoses for our patients. As we mentioned before, substance abuse manifests itself uniquely across ethnicity and gender, along with sexuality and income-level. As part of AYANA’s mission, we are committed to providing everyone the adequate therapy they deserve which will begin to tackle the crux of their issues, which have many factors surrounding them. This way, the complex manifestation of substance abuse and co-occurring diagnoses can be dealt with holistically, and effectively.

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