Heroin & Mental Health
Learning The Difference Between Causation And Correlation
post written by Anne Martlew
The issue of heroin use and mental health problems is a vexed one. The psychiatric community is divided over whether heroin abuse causes mental illness, or vice versa. All are agreed that heroin use is A Very Bad Thing, and all are deeply fond of the idea that heroin use and mental illness are co-morbid, but none are entirely sure of the precise relationship between the two. Many psychologists appear to believe that heroin abuse can both cause and be caused by mental illness. This allows the label ‘mentally ill’ to be applied to people at both ends of the equation. The problems arise when the authorities are presented with a patient who shows no signs of present or past mental illness (other than their addictive disorder). Such people are puzzling to rehab specialists, and present the world of established addiction psychology with a troubling quandary.
> Cause Or Catalyst?
Like alcohol, heroin and other opioids are likely to exacerbate the symptoms of any mental health issues you are currently experiencing. Any heroin forum will quickly tell you that your state of mind when shooting up makes a huge difference to the experience you get from the drug. As there is no such thing as ‘absolute normal’, and we all have our little quirks, it is easy for people to present as ‘mentally ill’ while high due to the exaggeration of these quirks and the loss of inhibitions. The same is true of drunk people, yet we are not nearly so swift to categorize everyone who’s had one too many as an asylum-case. Some scientists also believe that prolonged opioid abuse can affect one’s neurological makeup, rendering heroin use a cause of mental illness rather than just a symptomatic catalyst. Increasingly, the medical community is beginning to focus on the idea that heroin abuse can both cause and exacerbate mental illness. This is a convenient idea. It’s one-size-fits-all, and it makes it much easier to apply labels to addicted patients.
> Convenient Labels
Of course, if someone has a pre-existing psychosis and a correspondingly flawed sense of judgement then they MAY be more likely to seek out mood-altering drugs than someone of a more ‘stable’ mind-frame. In such situations, mental illness could be said to be a factor within heroin abuse. It’s not unknown for heroin users suffering from psychoses to report that their more personally traumatic symptoms feel lessened while high – although they may return with a vengeance during withdrawal. But, of course, anyone suffers intensely during withdrawal. It’s very easy for a psychologist to look at the mental contortions one goes through while withdrawing and pick out any number of psychotic symptoms, which can be either retrospectively applied as a ‘pre-existing condition’ or described as issues caused by heroin. The problems really begin when a patient turns up who presents with no symptoms of mental illness. This is a problem for the medical community. Such people are much harder to label, and our current roster of treatments depends very much upon labelling people and then applying the treatment relevant to that label. Patients are rarely looked at as individuals beyond the process of trying to fit them into a treatment box. When someone turns up without an obvious neurosis or psychosis, then the authorities try instead to classify them as having a social or traumatic disorder. This is arguably a waste of time.
> Social Determinants
It’s definitely a good idea to tackle the social determinants of opioid use, but this should really be done at the source rather than after the event. Removing the supply and challenging the kind of conditions which cause some vulnerable people to turn to drugs would make a huge difference. But the authorities should also acknowledge that doing heroin is fun, and some people simply do it because they enjoy it. Bad for you, sure. Bad for society, definitely. But still fun. It’s all too easy for psychiatrists to concentrate too hard on constructing a mental illness or a sob-story for each patient and fail to recognize the fact that getting high is enjoyable, and enjoyment is a powerful motivational force. This all too often leads to them failing the patient, as they’re trying to treat a fabricated illness or trauma rather than help them to get clean and stay clean. While it may well be true that certain external factors like mental illness and social conditioning can make one more vulnerable to opioid abuse, if we try too hard to put people into the ‘mad’ or ‘traumatized’ boxes then we will never get to the real root of the problem. Doing opioids is fun, and it makes you feel good. Whether or not it makes you mad or bad is a secondary issue which should be treated as and when it arises, not as the rehab be-all-and-end-all. If we’re really going to get anywhere with tackling the problem of opioid abuse, we need to stop worrying so much about causation or correlation, and acknowledge that some people shoot up simply because they enjoy it. How we deal with that motivation is another issue – but it’s certainly something which needs to be acknowledged rather than brushed under the carpet.
I, NZFiend, have a lot to say. So much so that people constantly accuse me of pushing my own barrow. Gladly, there are people in the world without their own barrows that they perceive to clash with mine…
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A little about me…
I worked in business management in the healthcare industry after studying literature.
On becoming a mother, I took a step back and decided to indulge my love of writing.
Since then I’ve written on a wide variety of subjects.
post written by Anne Martlew