Many self-medicate with substances and develop addiction
In this article, Taru Nissinen, the communication specialist at Sininauhasäätiö, explores the challenges of addiction, mental health, and homelessness. Originally published on Sininauhasäätiö's website, the piece provides an informed perspective on these pressing issues. We are pleased to share Nissinen's thoughtful work with our readers.
Which comes first, substances or mental health problems?
"It's probably that basic question, which comes first, the chicken or the egg," says Anssi Eriksén, substance abuse services team leader at Sininauha Oy. He is responsible for the clinical work of the Ruusulankatu substitution therapy clinic.
It's known that substances cause mental health symptoms, just as mental health symptoms predispose one to substance abuse. Many mental health disorders emerge in adolescence, around the same time young people start experimenting with drugs.
"I had my first drink when I was 11 or 12," says a homeless youth we'll call Pekka here. Pekka discusses the topic with Miikka Niemelä in KatuCast.
Pekka has been seriously depressed for a long time. His mental health issues began around the turn of the millennium. At that time, he was diagnosed with ADHD, but the treatments were ineffective.
By age 15, Pekka had an alcohol problem. He self-medicated with substances, leading to addiction. Pekka believes that substance abuse was the reason for his homelessness. Both homelessness and depression have haunted Pekka.
"I've battled depression for so long that I can't take it anymore. If I don't get help soon, I might kill myself," he says.
Once addiction takes hold, quitting becomes difficult, and treating mental health issues gets more challenging.
"Many treat depression with drugs and then find it hard to get [treatment] when they have a history of substance abuse and must be sober for three months. Nobody can do that, especially if they're using something like Subutex," says Pekka.
Pekka recognises that he suffers from depression, but sometimes the reasons for substance use can be hard to pinpoint.
"People don't always recognise what the problem is. They feel bad in one way or another and then start using drugs to alleviate those symptoms, which is pretty normal since no one wants to feel bad," explains Eriksén.
"All of us look for relief from distress in one way or another, whether it's through sports or whatever, but unfortunately for many, it's drugs."
Pekka believes that the right medication could help him quit drugs: "If the antidepressant works, I won't need substances."
On the other hand, substances can act as a trigger for the onset of mental illness. Although the effects of alcohol and opioids differ significantly, both are known to cause depression, anxiety, and premature deaths.
"Most people with an alcohol problem also have a diagnosis of depression. If you mix alcohol with antidepressants, the drug's effect isn't optimal, and alcohol essentially negates the effect of the mood stabiliser," says Eriksén.
Seeking treatment becomes difficult
One challenge in getting substance abusers into mental health treatment is the requirement to quit drugs. The purpose of three months of sobriety is to break free from the immediate effects of the drugs so that a psychiatric diagnosis can be made. Drugs cause psychiatric symptoms, and in diagnosis, it's crucial to distinguish withdrawal symptoms from long-term symptoms.
Those with substance dependence might also find it challenging to commit to treatment. The life of a homeless, substance-dependent person can be very chaotic, making it difficult to attend treatment sessions at specific times, resulting in treatment discontinuation.
"If you want help, it's essential to try to attend those appointments, as our healthcare system is currently in a crisis. Appointment times are limited, and resources are scarce everywhere. This system's problem is that practitioners have many patients and a high patient flow. There aren't many available slots, so if someone cancels or misses their slot, it might be weeks before they get another," says Eriksén.
From the viewpoint of those with substance problems, motivation for treatment may appear inconsistent, even if the internal motivation remains.
"Few substance users want to be addicted, but the situation is interpreted as 'they lack motivation for treatment' if they miss an appointment or relapse," says Eriksén.
Despite these challenges, he advises accepting whatever treatment is available.
Pekka wishes to receive medication for his depression:
"I need to book a doctor's appointment to start antidepressant treatment because I can't take this any longer. I'm scared of this depression, and my resources are running out."
Pekka visits the Youth Meeting and Support Point and receives assistance in seeking treatment there.
"I believe I'll get help when the staff get involved, support and stand by me. Thankfully, I don't have to be alone."
The Sininauha Foundation (Sininauhasäätiö) is a value-based, non-profit foundation established in 1957. They are experts in homelessness and substance abuse work. The Sininauha Foundation is part of the Sininauha Foundation Group in Finland.