8.4 Medication abuse or dependence

A Family Guide to Concurrent Disorders - Part III: Treatment

Health professionals have a very important consideration when prescribing pharmacological treatment for mental health problems in clients with a history of a substance use disorder. That’s the possibility the client may abuse or become dependent on the medication being prescribed.

Abusing a medication means taking more of the medication than prescribed to try to get other effects (e.g., to get “high”). Dependence means that a person becomes tolerant to a medication’s effects, and needs to use more and more of the medication to get the effect. This person will also experience withdrawal if he or she stops using the medication suddenly. Becoming dependent on a medication may not be due to abusing a medication. Anti-anxiety medications, stimulants and opioids are the prescription drugs that are most likely to be abused. The minimal reinforcing properties, along with troublesome side-effects, usually limit the abuse liability of antidepressants, antipsychotics and mood stabilizers. The following variables influence the likelihood of someone abusing or becoming dependent on medications:

• Substances vary in their ability to produce good feelings or pleasant effects (reinforcing effects). Someone is more likely to abuse a drug if its effects are felt quickly.
• A drug’s potency or purity can influence its potential to be abused.
• A drug’s cost and availability can also influence its potential to be abused.
• In general, drug effects vary greatly from one person to another. Because each person’s genes are different, the drug is metabolized differently in different people. People may even respond differently to the same drug taken at the same dose.
• People may also self-medicate to cope with symptoms of a mental health problem, such as depression and anxiety.
• Starting and continuing to use and abuse substances (including abusing prescribed medications) is influenced by peer pressure and societal norms. Employment and education and the availability of other pleasurable activities (e.g., sports, socializing, club activities, recreation) have also been shown to be protective factors against drug-taking behaviour.

Benzodiazepines

There is still no agreement about the best approach to take with clients with anxiety and substance use problems. Some researchers strongly oppose prescribing benzodiazepines unless they are being given to people who are going through detoxification or who are in the acute stages of an anxiety syndrome. These researchers believe that people should stop taking benzodiazepines once another class of effective medication takes effect, as benzodiazepine use can lead to physical dependence, misuse and increased drug use. Other investigators believe that although such drugs should be avoided in many cases, the decision to prescribe benzodiazepines must be made based on each client’s individual circumstances.

Anyone who takes benzodiazepines should have a complete medical and mental health assessment. The clinician should consider whether the client has tried alternative medication and whether a psychosocial approach to treatment might be enough to help the client recover, manage his or her anxiety, or prevent relapse. Clients should be told about risks such as seizures if alcohol or benzodiazepines are stopped abruptly.

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