There are many concerns about comorbidity as expressed by health stakeholders including medics, parents and patients. Unfortunately it is an area where no much information is availed hence the need to prioritize it when it comes to research. For a better understanding of comorbidity, it is important to appreciate that drug addiction is a mental disorder. Not many people treat it as such but drug addiction is a mental disease that is explained as a complex brain disease. It is characterized by an uncontrollable drug craving and seeking that ignore their devastating effects ( Shulamith, Ashenberg, Brown, 2002 ).The uncontrollable brain behaviors are as a result of the changes that occur in the brain structure and functioning as a result of the drugs. The changes occur in areas that are disrupted in different mental disorder cases such as depression schizophrenia and anxiety. This explains why according to research, there are numerous correlations of occurrence of comorbidity with other mental disorders and addiction. It may be impossible to prove this occurrence or the causality; it is known that having certain mental disorders increases the risk of drug addiction and abuse. The opposite is also true where drug addiction could be a trigger of certain mental disorders.
Comorbidity is therefore defined, as the occurrence of more than two mental disorders at one time. It is a problem that has been noted as a major clinical, research and public health issue in the past several decades. This may be attributed to the fact that there have been many changes in the psychiatric department with the focus being on naming the number of disorders that an individual may present at a given time. Psychologists are no longer diagnosing single disorders in isolation of others. In the current state, mental disorders are believed to be part of the contributing factor of distress, disability and loss of individual freedoms. In fact, in severe cases it is a leading factor of deaths in the affected victims. All these effects arise from the dysfunction of an individual. The disturbances in turn manifest in different ways including substance abuse, anxiety, problems with perception and mood disturbances just to mention a few. According to the current psychological nomenclature, mental disorders are classified based on the operational diagnostic standards. In certain cases, more than one disorder is diagnosed hence the subject of comorbidity. It is important therefore to understand the definitions of comorbidity, itsimplications for mental health theories, likelihood of occurrence and potential treatment after diagnosis .
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Definition of comorbidity
Early scholars described it as a distinct clinical entity of any type that co-exists or occurs during a patients clinical course whose disease is under study. In psychiatry however, comorbidity refers to an overlapping of two or more mental illnesses. However, in past few decades, the comorbidity between the substance use disorder and other mental disorders has gained immense popularity and attention in psychiatry. Scholars have gone ahead to draw distinctions between the possible comorbidity namely the homotypic comorbidity and heterotypic comorbidity. Homotypic comorbidity is when mental disorders occur within a specific diagnostic grouping. On the other hand, heterotypic comorbidity is when there is a co-occurrence of mental disorders from different diagnostic groupings. An example of homotypic comorbidity is the abuses of two different substances say alcohol and cannabis since the two disorders are in a similar diagnostic grouping. A homotypic comorbidity could be when there is a co-occurrence of substance abuse and say anxiety or depression.
What is the significance of studying comorbidity?
Comorbidity has a number of implications on the theories, diagnosis and treatment of mental disorders hence the need to study it.
Significance on the theories
It becomes a major concern when mental disorders are likely to occur among individuals with substance abuse disorders. This raises the concern on the need to study the causes of these mental disorders. Several proposed hypothesis and theories exist trying to explain the reason why comorbidity occurs. Common theories include the fact that there is a casual relationship that exists between these two components. Another argument is that there are specific common factor that increase the occurrence of both disorders’ third theory suggest that there is a spurious relationship, which could come from the methods of sample collection. Before unraveling the reasons of the comorbidity occurrence, it is important to document the nature of association thus giving insight to the potential mechanism of association (Shulamith et al, 2002).
Significance for treatment
In case it is established that problematic substances users are likely to have other mental disorders, then there is need to consider all the disorders in the assessment and potential diagnosis. Comorbidity becomes significant especially if the co-occurrence of the disorders is likely to suggest differential clinical consequences. It is also possible to improve the treatment outcomes tremendously when there is more focus on comorbid problems. For instance, it is possible to improve the efficacy of treating nicotine and alcohol dependence if the treatment for depression is also included.
Significance on prevention
Prevention has always existed in isolation. It is almost impossible to find a prevention program that combines addressing of multiple problems. However, the increased interest in prevention in psychiatry is likely to see this traditional trend change. Comorbidity is a concept that has a broad implication on prevention. First, if the comorbidity is believed to be real then the prevention should be on a broad scale. Secondly, when the nature of comorbidity is understood, then the targets for prevention will be clearly marked thus making it easy to address. In the event that comorbidity occurs because the disorders in question share a risk factor then interventions when addressing the said risks will be reduce the prevalence of the multiple problems from occurring (Shulamith et al, 2002).
Importance on general research of comorbidity
Studying the general patterns of comorbidity between different mental disorders is important using general population samples. It is impossible to know the patterns observed in clinical samples will reflect those in the entire community. This occurrence is because of significant biases. There are many reasons why comorbidity may be common in clinical samples. These varied patterns are likely to come about due to varied areas of interest, clinicians’ expertise and areas of interests. Here could also be factors that may influence a person’s decision to seek help. These factors influence accurate decision making on the treatment needs of a general population. Advances in theories are also hindered by comorbidity because it is not known whether this comorbidity is because of sampling details or biases form referrals. It is only through studying representations of a whole population that we can ensure that findings are a reflection of the general co-occurrence patterns in different mental health issues (Shulamith et al, 2002).
Explaining comorbidity
There are several main reasons why two mental disorders may co-occur. First, there must be a direct causal relationship between the two disorders whereby the presence of one disorder may trigger the occurrence of a second one. A second reason could be that there is a causal relationship between the two but this happens indirectly whereby one disorder is going to affect a third variable that in turn causes the occurrence of a different disorder. Thirdly, comorbidity may occur when there are similar risk factors that trigger the occurrence of more than one mental disorder. It is important to understand these relationships if you are to understand how comorbidity actually happens and its potential effects.
References;
Shulamith, L., Ashenberg, S. Brown, S. (2002). The handbook of Addition Treatment for Women: Theory and practice. Jossey Bass. ISBN: 13: 978-0787953553
