Cannabis Use Disorder or Social Anxiety Disorder - Which came first?
Many people talk about “self-medicating” when the topic of substance abuse comes up—this is when an individual uses alcohol or drugs to help themselves cope with the symptoms of a mental health issue. Unfortunately, they often have, or develop, an abuse problem with that same substance. When this happens it is called “comorbidity”, meaning two disorders that occur at the same time. The question many researchers and clinicians have is “which came first?” Understanding this chicken or the egg scenario can help with both treatment and prevention of these disorders.
People suffering from Social Anxiety Disorder (SAD), one of the most common anxiety disorders, feel fear in certain social situations, which negatively impacts how they function in their daily life. Even when these people recognize that their fear and anxiety is excessive, they still have considerable difficulty overcoming it. People with cannabis use disorders (CUD) have a strong desire to use cannabis, difficulty controlling the urge, and they continue to use it despite harmful consequences. In addition to people self-medicating a mental illness with alcohol or drugs, there is also evidence that the use of drugs can precipitate mental illnesses in people who are predisposed to them. Therefore the relationship between drug use and mental illness is more complex than it seems on the surface.
A recent, multi-site study focused on the comorbidity of CUD and SADs. Researchers at Louisiana State University, Columbia University and New York State Psychiatric Institute analyzed data from a large study called the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). The records from approximately 5000 individuals met the criteria for cannabis use disorder, social anxiety disorder, or both, and were included in this study.
The report built upon results from a previously published analysis of the NESARC data, which found that SAD and CUD are associated with each other. The previous study also reported that people with SAD had a greater risk of transitioning from cannabis abuse to developing a dependence on the drug. The more recent study went further, and looked at the occurrence of cannabis abuse, and the more serious condition of cannabis dependence (both forms of CUD), in relation to SAD. They also tried to determine which disorder was more likely to occur first. That is, whether a person with SAD was likely to develop a CUD or the other way around.
When the researchers analyzed the answers to the questionnaire, they found that SAD was more likely to be found in people with cannabis dependence than with cannabis abuse. Also, by looking at the age at which the two disorders began, they found that SAD occurs before CUD in most patients who have both. This suggests that the people in the study who suffered from SAD were likely to turn to cannabis use as a coping mechanism; it also indicates that SAD is not a result of CUD.
So what do we do with this information? Results from this type of study help inform the doctors and other professionals who treat individuals living with these disorders. The information gained from these studies can lead to greater treatment success for comorbid diseases, which are intertwined and therefore should be addressed together as well as individually.
The image is Vincent van Gogh's Sorrowing Old Man ('At Eternity's Gate'), 1890, it is currently housed in the Kröller-Müller Museum, Otterlo in the Netherlands.
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