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Substance abuse, mental illness: A tale of two behavioural disorders

Many Nigerians are living with a mental or substance use disorder and do not pay attention to signs that signal the impairment of personal functioning.

The burden of these disorders continues to grow with significant negative impacts on health, wellbeing, and economic growth.

Nigeria, Africa’s most populous country has the highest caseload of depression on the continent and ranks 15th in the world in the frequency of suicide, according to the World Health Organisation (WHO).

Experts say both substance use disorder and other mental illnesses are caused by overlapping factors among which are genetic and epigenetic vulnerabilities, early exposure to stress or trauma, and issues with certain areas of the brain.

In fact, in 2019, United Nations Office on Drug and Crime (UNODC) found that over 14 million Nigerian adults used drugs at least once and 3 million people are living with a drug use disorder, and one in seven-person aged 15-64years had used drugs and One in four Nigerians – some 50 million people – are suffering from some sort of mental illness, according to the World Health Organisation (WHO).

It is important to remember that asking for help is a normal part of life, and you should never feel like you have to take on the world alone. If you are concerned that you or someone in your life may be drinking too much, using drugs, or dealing with mental illness, there are resources available to help.

Psychiatrists say that the high prevalence of comorbidity between substance use disorders and other mental illnesses does not necessarily mean that one caused the other, even if one appeared first.

However, establishing causality is difficult for several reasons of which behavioral or emotional problems may not be severe enough for a diagnosis (called subclinical symptoms), but subclinical mental health issues may prompt drug use.

Also, people’s recollections of when drug use or addiction started may be imperfect, making it difficult to determine whether the substance use or mental health issues came first.

According to Mayo Clinic is an American non-profit academic medical center, mental illness refers to a wide range of health conditions — disorders that affect your mood, thinking, and behaviour.

Mental illnesses include depression, anxiety disorders, schizophrenia, eating disorders, and addictive behaviours.

“Mental illness is more than stripping naked; it is not limited to such symptoms. There are some silent symptoms that people who have mental health problems are coping with,” said Adisat David Moyo, consultant psychiatrists, Centre for Mental Health Research Initiative.

Moyo says mental illness is all about changes that are so intense that makes an individual unable to do things that are essential to living.

“That level of function is distrusted when one is mentally ill, that where the distress comes in and that is what people see,” she said.

“The country needs to get more attention in increasing awareness among citizens,” she advises.

WHO refers to substance abuse as the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs.

According to the global health agency, psychoactive substance use can lead to dependence syndrome – a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use that typically include a strong desire to take the drug, difficulties in controlling its use, and persisting in its use despite harmful consequences.

WHO says policies which influence the levels and patterns of substance use and related harm can significantly reduce the public health problems attributable to substance use, and interventions at the healthcare system level can work towards the restoration of health in affected individuals.

Research shows that common risk factors can contribute to both mental illness and substance use.

However, determinants of these disorders include not only individual attributes such as the ability to manage one’s thoughts, emotions, behaviours, and interactions with others, but also social, cultural, economic, political, and environmental factors such as national policies, social protection, standards of living, working conditions, and community support.

Also, stress, genetics, nutrition, perinatal infections, and exposure to environmental hazards are contributing factors to mental disorders.

In Nigeria, a country of about 200 million has less than 500 psychiatrists, WHO estimate shows, stating that fewer than 10 percent of mentally ill Nigerians have access to the care they need.

The National Mental Health Bill and National Drug Control Bill is entitled to protect the rights of persons with mental and substance use disorder, while the Establishment of the National Commission for Mental Health and Substance Abuse Services is to ensure effective management of mental health in Nigeria and for other related matters.

Oliver Stolpe, country director, United Nations Office on Drug and Crime (UNODC) said that substance abuse is worsening and spreading due to COVID-19 with its attendant social and economic consequences.

He said this while citing a recent poll conducted in partnership with the United Nations Children’s Fund (UNICEF), adding that over 50 percent of respondents, mainly youths, confirmed they knew somebody who has used drugs in the last 12 months and agreed that the menace got worse since COVID-19 outbreak.

“At the moment, there are not many reasons to be optimistic,” Stolpe said.

Nigeria is currently not creating adequate mental health awareness especially in the stigma attached to mental illness.

Faced with challenges, studies review predominantly indicated that the public holds many stigmatized views towards individuals with substance use disorders and mental illness and that the level of stigma was higher towards individuals with substance use disorders than towards those with other psychiatric disorders.

“Substance abuse and mental illness represents a major societal and health care problem; it thus should be given a high priority in many realms,” said Taiwo Sheikh, president of the Association of Psychiatrists of Nigeria (APN).

Sheikh said there is a need to create an enabling environment for mental well-being because mental health legislation translates to enhanced mental well-being.

He says mental health legislation applies to the assessment, treatment, care, and support of people experiencing a mental disorder.

“A law to provide for mental healthcare and services for persons with mental illness and to protect; promote and fulfil the rights of such persons during delivery of mental healthcare and services and for matters connected therewith or incidental thereto,” he explained.

More all so, these disorders hinder institutional performance too, experts say.

Lower life expectancy discourages adult training, coping with the normal stresses of life, and damages productivity.

Peter Ogunnubi, consultant psychiatrist and team lead EAP Services, Medbury Medical Service said from empirical observation at outpatient clinics, quite a number of employees from various organisations are being managed for stress-related and major physiological problems.

“The most important for the development of mental illness in the workplace is the prevailing unstable socio-economic milieu makes it imperative for any organisation who wants to be on top of its game to either prepare to swim or get drowned,” he said.

“The consequential effects are therefore the tendency for both the organisation and the employee to stretch themselves beyond their elasticity limits thus leading to stress, a precursor to mental illness,” he added.

Mental health is a key part of the United Nations Sustainable Development Goals. The Bill foster advocacy, prevention, treatment, rehabilitation and protects the rights of persons with mental disorders, ensures equal access to treatment and care, discourages stigma and discrimination, and sets standards for psychiatric practice in Nigeria.

“Mental health is as important as our physical health; it is holistic wellness not neglecting the mental health and focusing on your physical health because they are both interwoven, we have to take mental health much more important than physical health,” said Maymunah Yusuf Kardiri, medical director and psychiatrists, a chief medical director, Pinnacle Medical Services limited advised.

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