Canadians with a history of drug dependence more likely to have mental illness, finds study

New research published online in the International Journal of Mental Health and Addiction found that Canadians with a history of drug dependence are much less likely to have flourishing mental health and are more likely to have mental illness.

Researchers compared a nationally representative sample of 460 Canadians with a history of illicit drug dependence (excluding cannabis) to 20,305 Canadians with no history of illicit drug dependence using data drawn from Statistic Canada's Canadian Community Health Survey-Mental Health.

While 80% of those with a history of drug dependence were in remission, more than half (52.1%) were still experiencing mental illness. Further, only 37.9% were in excellent mental health, which is markedly lower than the 74.1% of Canadians without a history of drug dependence who had excellent mental health.

To be considered in excellent mental health, participants had to report: 1) freedom from mental illness in the previous year (i.e., substance dependence, psychiatric disorders, suicidality); 2) almost daily happiness or life satisfaction in the past month; and 3) high levels of social and psychological well-being in the past month.

Remission from dependence is an important factor in the recovery process, but we also want to consider mental health outcomes beyond abstinence.We want to think about how we can support the psychological and social well-being of people recovering from drug dependence."

Andie MacNeil, Study First Author and Master of Social Work Graduate, University of Toronto

The current study found several factors that were associated with excellent mental health among those in remission from drug dependence, including older age and social support.

"As people age, they often experience declines in impulsivity and increased role responsibilities in their personal and professional lives," says senior author Esme Fuller-Thomson, professor at the University of Toronto's Factor-Inwentash Faculty of Social Work and director of the Institute for Life Course and Aging. "Older individuals often move away from the social circles and contexts where drug use is more prevalent, which in turn can help support their recovery."

A post-secondary education, being married, and no lifetime history of major depressive disorder or generalized anxiety disorder were among the other factors associated with both remission from drug dependence and excellent mental health.

Although the Statistics Canada survey used for the study did not collect information on interventions that participants may have used to support their recovery, other research indicates that various psychosocial approaches (such as Motivational Interviewing, Cognitive Behavioral Therapy) and pharmacological approaches (such as Opioid Agonist Therapy) can help individuals reduce drug use and recover from dependence.

Drug dependence is a major public health crisis, with drug overdoses now representing one of the leading causes of death for adults under 50 in the United States. Although opioids tend to be the driving substance behind overdose deaths, there has been significant increases in cocaine-involved deaths and psychostimulant-involved deaths in recent years. In the United States, illicit drug use has an estimated cost of $193 billion per year due to healthcare expenditures, criminal justice costs, and loss productivity.

"Considering the tremendous loss of life due to drug dependence and its associated economic consequences, there needs to be a greater understanding of factors associated with both remission and with broader aspects of recovery, such as mental well-being," says MacNeil.