2.3 Substance Use Disorders
Substance use disorders are commonly found in the criminal justice system. At times, it can be challenging to determine if symptoms are related to mental disorders or the effects from substance use. Substance use can have a major impact on the brain, which influences behaviors. It is important to understand the impacts that using substances can have on a person’s mental well being and how long-term use can greatly impact cognitive functioning overtime.
According to the National Institute of Mental Health, a substance use disorder (SUD) is a mental disorder that affects a person’s brain and behavior, leading to a person’s inability to control their use of substances such as legal or illegal drugs, alcohol, or medications. Symptoms can range from moderate to severe, with addiction being the most severe form of a substance use disorder.
Certain substances of abuse vary by age, race, and geographical location. Substances of abuse definitely go through trends depending on many factors including drug trafficking rings, unintended consequences of prescription medication distribution, and accessibility of abusable substances. Most recently, fentanyl abuse and overdose deaths have driven harm reduction and overdose prevention efforts.
2.3.1 Co-Occurring Disorders
According to the National Institute of Mental Health, researchers have found that about half of individuals who experience a SUD during their lives will also experience a co-occurring mental disorder and vice versa. A co-occurring disorder is when someone is diagnosed both with a mental disorder and a substance use disorder. While SUDs and other mental disorders commonly co-occur, that does not mean that one caused the other. Research suggests three possibilities that could explain why SUDs and other mental disorders may occur together:
- Common risk factors can contribute to both SUDs and other mental disorders. Both SUDs and other mental disorders can run in families, suggesting that certain genes may be a risk factor. Environmental factors, such as stress or trauma, can cause genetic changes that are passed down through generations and may contribute to the development of a mental disorder or a substance use disorder.
- Mental disorders can contribute to substance use and SUDs. Studies found that people with a mental disorder, such as anxiety, depression, or post-traumatic stress disorder (PTSD), may use drugs or alcohol as a form of self-medication. However, although some drugs may temporarily help with some symptoms of mental disorders, they may make the symptoms worse over time. Additionally, brain changes in people with mental disorders may enhance the rewarding effects of substances, making it more likely they will continue to use the substance.
- Substance use and SUDs can contribute to the development of other mental disorders. Substance use may trigger changes in brain structure and function that make a person more likely to develop a mental disorder.
2.3.2 SPOTLIGHT: Lorena Bobbitt
In June of 1993, Lorena Bobbitt was suffering. Lorena and her husband, John Wayne Bobbitt, had been married for 4 years and it was nowhere near the fairytale she’d hoped for. John was abusive to Lorena—emotionally, physically, and sexually.
On the evening of June 23rd, 1993, John raped Lorena. When the assault was over and John had fallen asleep, Lorena did the unthinkable. Lorena cut off her husband’s penis.
While this incident took place in Virginia, the story made headlines all over the world. Lorena was charged with the crime of malicious wounding. If found guilty, she faced a maximum of 20 years in prison. However, that is not how Lorena’s story ended.
Lorena’s defense team had her evaluated by a psychiatrist and decided that they would use the insanity defense. Lorena was diagnosed with Major Depressive Disorder (MDD), Post-Traumatic Stress Disorder (PTSD), as well as panic disorder. While most people who experience these disorders, alone and together, never engage in criminal conduct, Lorena’s defense team argued that, here, the presence of these disorders had contributed to her offending conduct. It was the opinion of the defense psychiatrist that Lorena had become temporarily psychotic following that final rape, and she was therefore not criminally responsible for her actions. The jurors were convinced by the evidence and agreed that given the combination of Lorena’s years of abuse and co-occurring psychiatric disorders, the rape on the evening of June 23rd led to an “irresistible impulse” to cut off her husband’s penis. On January 21st, 1994, Lorena was found not guilty by reason of insanity and remanded to a psychiatric facility for care.
The “irresistible impulse test” used in Bobbitt’s case is just one version of the insanity defense, which is handled differently in every state and in the federal system. Chapter 6 of this text provides a detailed discussion of the insanity defense.
2.3.3 Licenses and Attributions for Substance Use Disorders
“Substance Use Disorders” by Kendra Harding is licensed under CC BY 4.0.