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Charlie Sheen Substance Abuse: FAQ

Experts Weigh in on Common Questions About Addiction and Outrageous Behavior

By Stephanie Watson
WebMD Health News

Reviewed by Laura J. Martin, MD

March 1, 2011 -- After actor Charlie Sheen trashed his suite at New York's Plaza Hotel, called Chuck Lorre, the creator of the TV show "Two and a Half Men," a "turd," and rambled incoherently in a television interview about being a "high priest Vatican assassin warlock," people started to wonder whether the TV star had come completely unhinged.

Sheen has admitted to a history of drug use, but is his erratic behavior a sign that he's still addicted and in denial, or that he's also dealing with a mental illness? Sheen certainly isn't the first celebrity to deal with drug addiction. If it turns out, as some experts have speculated, that he's also got a mental illness, he similarly wouldn't be alone in having both conditions.

WebMD asked addiction experts about the connection between mental illness and substance abuse. What's the link? What can happen when someone who is addicted refuses to get treatment? And what are the best ways to overcome an addiction?

What's the Connection Between Addictions and Psychiatric Disorders?

Addiction and mental illness often go hand in hand. Up to half of people with depression, bipolar disorder, or another mental illness also have a substance abuse problem.

Experts say having one of these conditions increases your vulnerability for the other. "If you have a lifetime addiction and have taken drugs over a long period of time it can affect your psychiatric functioning," says Bruce Goldman, LCSW, CASAC, program director of the Project Outreach Clinic in West Hempstead, N.Y.

Conversely, people with mental illness often use drugs and alcohol as a way to cope. "People will self-medicate, and that may be a risk factor for starting an addiction," says Elizabeth Howell, MD, a board-certified addiction psychiatrist at the University of Utah Neuropsychiatric Institute.

The addictive substance itself can cause symptoms that mimic mental illness. Being high or going through withdrawal from drugs can make you feel anxious, angry, or restless, which are also common signs of psychiatric conditions, Goldman says.

Why Are Addictions So Hard to Overcome?

The reason why drugs like cocaine and heroin are so quick to lead to addiction is the effect they have on the brain. When you smoke cocaine, for example, you get increased levels of dopamine and serotonin-- brain chemicals that give you feelings of pleasure.

Then suddenly, that good feeling is gone.

"You're on this roller coaster where you feel this extreme dopamine spike and then you have a crash and you want more," Howell says.

Having an untreated mental illness can make an addiction even harder to shake. So can having a lifestyle that makes drugs easily accessible, which is why so many celebrities, like Sheen, are always making headlines.

What Happens if You Don't Get Treated for Addiction?

When actor Martin Sheen was interviewed about his son's drug problem, he called it "a form of cancer." Is addiction really like a disease? Howell thinks it is. "Addiction is a disease process, and we know that the diseased organ is the brain," she says.

Just like cancer or any other serious disease, addiction can become life-threatening if it's not treated. "It is a potentially fatal disease, and I've seen people die from overdose, from complications, from poor judgment -- accidents," Howell says.

Which Treatment Works Best for Addiction?

That depends on the addiction. Cocaine withdrawal is typically treated supportively and does not always require medication or hospitalization. Medications can help withdrawal symptoms for some addictions.

Cognitive behavioral therapy helps people recognize the situations where they're most likely to use. Motivational incentives provide good reasons to stay off drugs.

This broad range of therapies allows for a very individualized treatment approach. "I truly believe that there's no best treatment for everyone, and different treatments work better for different problems and different individuals," Goldman says.

What's most important is that you recover in a supportive setting where other people are also trying to get clean, Howell says.

Depending on the addiction, treatment may start with a medically supervised withdrawal, commonly called "detox," to get you off the addictive drug. Then you need to completely abstain from not only your drug of choice, but other drugs too.

Whatever you do, don't try to treat yourself for an addiction.

Though Sheen claims to have cured himself with "the power of my mind," Howell says trying to self-treat for an addiction is a dangerous prospect.

"It doesn't work," she says. "As a psychiatrist, I've been trained in how to do psychotherapy, but I never do psychotherapy on myself. If you're a surgeon you don't take out your own appendix. You have to have an outside person or support system helping you who has a perspective that you can never have for yourself."

How Are People With Both Addiction and Mental Illness Treated?

Treating addiction without addressing the underlying mental illness isn't enough.

"Many years ago when we were treating addiction, we had the false belief that if you treated the addiction and waited, some of the psychiatric problems would resolve themselves. We no longer believe that," Goldman says. "You really need to treat both of them simultaneously to be effective."

Considering that so many people who show up for addiction treatment also have a mental illness, centers today are well equipped to deal with both conditions.

What Should You Do if a Family Member or Friend is Addicted?

If you suspect that a family member or friend is addicted to drugs or alcohol, try to get them help. "I think if you're concerned about someone's health and safety, you're compelled to step in and intervene to see that the person gets help," Goldman says.

There is a chance the person will try to avoid facing the problem, especially if he or she also has a mental illness. It's common for both drug users and people with conditions such as bipolar disorder to deny there's anything wrong with them.

If your friend or family member refuses treatment, it's hard for you to do much more, unless the situation is spiraling out of control.

"Some states do have laws that allow you to commit someone who is addicted and out of control and potentially harmful to themselves because of their addiction," Howell says.

How Can People Stay Clean After An Addiction?

Once you've gone through treatment, you need begin the process of learning how to live without drugs or alcohol. That can be hard, especially if you've relied on the substance -- or substances -- for years.

Sheen says he just "blinked and I cured my brain." But getting clean is never that easy.

"There's no magic to it. It's a long, arduous road," Howell says. "It's a chronic problem that's going to be with people throughout their lives."

Part of overcoming addiction involves changing your perspective, and starting to see your addiction not as something you're going to be "cured" from, but as something you'll have to work on throughout your life.

"Addictive disorders are chronic diseases. In other chronic diseases, such as diabetes, we don't measure success in absolute terms over the course of a lifetime. It's similar with addictions," Goldman says.

The longer you stay in treatment, the better your odds for success.

"People have to be convinced personally," Goldman says. "They have to be very motivated and committed to living a drug- and alcohol-free lifestyle."

SOURCES: ABC News: "Charlie Sheen Confronts His Critics."E! Online: "Two and a Half Men Crew Rips Charlie Sheen."National Alliance on Mental Illness: "Dual Diagnosis: Substance Abuse and Mental Illness."Bruce Goldman, LCSW, CASAC, program director, Project Outreach Clinic, West Hempstead, N.Y.Elizabeth Howell, MD, addiction psychiatrist, University of Utah Neuropsychiatric Institute.MSNBC: "Martin Sheen calls Charlie's Addiction 'Cancer.'" National Institute on Drug Abuse: "Treatment Approaches for Drug Addiction."Good Morning America: "Charlie Sheen Says He's 'Not Bipolar but 'Bi-Winning.'"Pittsburgh Post-Gazette: "Charlie Sheen: 'Spiraling out of control.'"

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