The Intersection of Mental Illness, Medical illness, and Substance use Disorder

Inhalant use disorder, according to the DSM-V diagnostic criteria, is a problematic pattern of use of a hydrocarbon-based inhalant substance leading to clinically significant impairment or distress, manifested by at least 2 of 10 listed behaviors. The disorder is seen most often in adolescents; the prevalence in all Americans 18 years and older is 0.02% [1]. The disorder extending into adulthood is associated with substance use disorders, personality disorders, especially antisocial personality disorder, SI with attempts, higher rates of mood and anxiety disorders [2-4]. Similarly, albuterol inhaler overuse is associated with poorer outcomes, worse asthma control, dependence, lower mental and physical functioning. Patients who overuse are at an increased risk for clinical depression, and emotional dysregulation and overuse of short-acting inhaled medications often go hand in hand [5,6]. Complex medical histories including depression, asthma, and inhalant use disorder illustrate the interplay between mental illness, physical illness and substance use to create patient problems, and the difficulty in clarifying a diagnosis when many factors are at play influencing one another. Although broader consideration of the patient can complicate reaching a diagnosis, this is necessary for proper treatment and patient education. Utilizing a holistic approach to patient diagnosis and treatment ensures that vital care informing factors are not missed, and that essential patient motivators, triggers, and protectors are considered.

Keywords: Inhalant use disorder; Depression; Asthma; Inhaler overuse