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Mental health and addiction: more connections than you think

People who have experienced trauma or who have mental health problems are more susceptible to addiction: what have researchers found?

People holding wine glasses
Kelsey Chance

Stand up comedian Doug Stanhope once said, ‘There’s no such thing as addiction, only things you enjoy doing more than life.’ And while this is partially true and an amusing quote, it misses out a crucial fact: addiction lasts for much longer than the initial dopamine hit.

The word addiction is usually associated with drink, drugs and gambling, however sex, spending, shoplifting, exercise, gaming and social media can all qualify as addictions too. I believe that any action that temporarily replaces a negative feeling with a positive feeling and is done with regularity can constitute addictive behaviour.

Problems arise when the brain comes to expect the high - and consequently punishes us when we don’t do the behaviour. This, as well as the need to dodge the pain often being avoided in the first place, can lead to a "spiralling dysregulation of brain reward systems"⁽¹⁾, resulting in a compulsive drive toward repetitive and often destructive behaviours.

For those who have grown up in trauma or have ADHD (there is a big overlap here), addictions can take root with lightning speed and efficiency. Both are prone to physiological differences in the brain that can cause a strong pull towards compulsive behaviours.

An analysis of multiple studies in 2018 found that of the people treated for substance use disorders (SUDs), between 35-73%⁽²⁾ had some sort of comorbid personality disorder (PD), with the most prevalent being borderline PD and antisocial PD. These numbers are staggering considering that PDs affect between 10-15% of the general population.

Personality disorders are most commonly caused by traumatic events during childhood (as well as genetic factors) and result in markedly higher prevalence of anxiety, depression or feelings of low self-esteem or self-worth. Bipolar carries one of the highest rates of comorbidity with as many as 60%⁽³⁾ reporting alcoholism or SUDs at some point in their lives. Much like personality disorders, bipolar can come with intensely dysphoric mood states that can feel inescapable without some form of self medication.

ADHD criteria are similarly present in approximately a quarter⁽⁴⁾ of patients admitted for an SUD. Multiple studies have found links between the presence of ADHD and the pull towards gambling, and this is hardly surprising considering the correlation with low impulse control and the propensity for boredom. Many of those with the condition also have their first cigarette much younger than their neurotypical counterparts. Autism is traditionally thought to correlate less, however the capacity for anxiety and depression within autistic people can lead them down addictive paths.

For anyone who might be haunted by feelings of shame, fear, dysphoria, anxiety or depression, it’s only logical that their brain - seeking a return to a sense of stability - would latch onto something that provides temporary comfort. We can feel a yearning towards that feeling of comfort, without which the emptiness can be overwhelming and relentless.

While addictions may often worsen anxious or depressive symptoms, some can also be damaging. Alcoholism and SUDs can create health problems and lead to the individual being in more vulnerable situations. Gambling addiction can lead to bankruptcy as well as long-term financial implications for both the sufferer and people around them.

It is especially worrying that the gambling lobby exerts such control over the government when it comes to issues such as reform and regulation. The all-party parliamentary group (APPG) on betting and gaming in particular has come under scrutiny for its alleged ties to lobbying, with 28 MPs being found to have received a combined £225,000 in "wages and freebies" from the gambling industry.

This all comes at a time when gambling-related suicides are at an all-time high. A Public Health England report estimated over 409 deaths per year were the result of problem gambling. Sheffield-born Jack Ritchie, who tragically took his own life in 2017 at age 24, was one of those people.

In the wake of his death, parents Charles and Liz founded the charity Gambling with Lives in order to campaign for tighter restrictions on gambling. Charles commented: “The industry wants to get away with the minimum change that they can. Surely they must know what damage it causes.⁽⁶⁾

“How many more families need to be shattered by highly addictive gambling products and predatory gambling industry practices before the government acts?”

On the day of his death, Jack wrote, "The point is, I'm past the point of controlling myself and I'm not coming back from this one."

While it is still unclear if Jack Ritchie had any pre-existing mental health condition, it is obvious that those who do are disproportionately affected by predatory gambling practices. People with mental health conditions often have any pathological compulsiveness and impaired decision-making exploited.

What is clear is that an integrated approach to treating these often co-occurring conditions is needed. Using a substance, gambling or indeed any behaviour practised compulsively to the point that it impacts someone’s life ought to be treated for what it is: a mental illness.

References

  1. George F. Koob and Michel Le Moal., Drug Abuse: Hedonic Homeostatic Dysregulation, Science Vol 278 p 52-58
  2. Arpit Parmar and Gaurishanker Kaloiya., Comorbidity of Personality Disorder among Substance Use Disorder Patients: A Narrative Review, Indian J Psychol Med. 2018 Nov-Dec; 40(6): 517–527
  3. F Cassidy 1, E P Ahearn, B J Carroll., Substance abuse in bipolar disorder, Bipolar Discord 2001 Aug: 3(4), p181-8
  4. Katelijnevan Emmerik-van Oortmerssenab, Geurtvan de Glind, Wimvan den Brink, FilipSmitcdCleo L.Crunellebe, MarijeSwetsa, Robert A.Schoeversfa., Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: A meta-analysis and meta-regression analysis, Drug and Alcohol Dependence, Volume 122, Issues 1–2, 1 April 2012, Pages 11-19
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