Somatic Symptom Disorder and Substance Abuse

Somatic symptom disorder and other related disorders are psychiatric conditions in which people have maladaptive psychological reactions to physical symptoms. Some of the disorders are defined as psychosomatic, while others have both medical and psychological components.

Many somatic disorders involve pain, fatigue and anxiety—all of which can drive people to seek relief through substance use. For this reason, people with these conditions often develop co-occurring substance use disorders and require coordinated treatment to recover from both.

Effects of Substance Abuse on Somatic Symptom Disorder Symptoms

People who develop somatic symptom disorder or other somatic disorders often experience pain differently from other people. They may be more physiologically sensitive to pain, or they may have developed intensified reactions to pain as a learned behavior in childhood.

People with somatic disorders commonly either had a serious childhood illness or had parents who were acutely or chronically ill. They learned to either fear medical symptoms or embrace them as a way to receive attention and care.

Regardless of the cause, their heightened sensitivity and reactivity to pain often drives people with somatic conditions to seek relief through substance use. Many substances alleviate both physical and psychological pain, especially alcohol, benzodiazepines, opiates and marijuana. This respite from pain can lead to substance dependence and associated complications as well as cause somatic symptoms to worsen.

Substances that provide relief from pain often increase sensitivity to pain over time, especially opiates. This phenomenon is called hyperalgesia and affects the perception of pain whether it is physiological or psychosomatic in nature. Increased subjective pain can intensify both somatic and psychological symptoms of somatic disorders.

Drug Abuse as a Cause of Somatic Symptom Disorder

Hyperalgesia not only worsens existing somatic symptoms but can also cause them. People who abuse substances may develop pain or physical symptoms for the first time in response to substance-induced changes to brain chemistry and nervous system functions.

These new uncomfortable sensations may be enough to trigger the development of a somatic disorder on their own. However, additional effects of substance use disorders go even further to contribute to the onset of one of these conditions. Drug abuse can cause depression and anxiety, especially in periods between use and as substance use progresses to dependence. These symptoms can develop into mental health disorders in some individuals.

Three of the five specific somatic conditions listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) involve both somatic and anxiety symptoms: illness anxiety disorder, somatic symptom disorder and psychological factors affecting other medical conditions. The combination of intensified anxiety and heightened sensitivity to physical comfort can provoke anxious rumination focused on fear of illness or unusual sensations, which can then develop into one of these disorders.

Statistics on Somatic Symptom Disorder and Drug Abuse

About 5 to 7 percent of people in the general population have somatic symptom disorder.

Approximately 20 to 25 percent of patients with serious somatic symptoms later develop a chronic somatic disorder.

People with alcohol use disorders are two times as likely to develop a somatic disorder.

One study found that men with somatic symptom disorder are more than two times as likely to have an opioid use disorder than men who do not have a somatic disorder. Rates are probably similar for women, if not higher.

Somatic Symptom Disorder and Alcohol

Research shows a strong link between somatic disorders and alcohol abuse. The accessibility of alcohol as well as some of its specific properties contributes to its frequent use for relief from psychological and somatic distress. The mild euphoria and numbing qualities of alcohol can temporarily reduce or mask pain. In addition, its disinhibiting qualities can lower anxiety.

Unfortunately, anxiety and unpleasant sensations typically intensify as the effects of alcohol wear off. Alcohol use may also introduce new medical issues that add to somatic complaints and related anxiety symptoms. Alcohol dependence causes many medical complications, such as high blood pressure, heart disease, liver disease and chronic inflammation. These are serious concerns on their own, and some somatic disorders can interfere with the treatment of them.

Somatic Symptom Disorder and Marijuana

People with somatic disorders frequently use marijuana, which is receiving increasing attention for its ability to alleviate the symptoms of chronic pain. However, like alcohol, marijuana leads to many negative effects when used regularly to manage psychological and physical discomfort.

Like any other mind-altering chemical, marijuana is associated with increased anxiety during periods between use, especially for people who are diagnosed with cannabis dependence and experience cannabis withdrawal effects.

While it can make people feel relaxed, marijuana sometimes causes episodes of severe anxiety and paranoia. People who frequently use it report strange bodily sensations that can cause anxiety. Cannabis-induced perceptual changes can worsen or even cause somatic symptoms and disorders.

Somatic Symptom Disorder and Opioids

Co-occurring somatic and opioid use disorders are common. Since opioid drugs are primarily used to manage pain, they have immediate appeal for anyone experiencing severe physical discomfort, including people with somatic disorders. Because somatic disorders are chronic conditions, opioid use frequently progresses to dependence for people with these disorders.

Opioid dependence typically leads to hyperalgesia or heightened sensitivity to pain. This effect is due to the way long-term opioid use trains the brain to produce fewer endogenous opioids. Over time, the brain and nervous system come to depend on chemicals introduced into the body from external sources.

This dynamic can complicate and worsen any chronic pain condition and have particularly serious effects on people with somatic pain disorders. Because these disorders are rooted in subjective pain perception, this alteration of the body’s pain management processes is likely to increase somatic anxiety as well.

Somatic Symptom Disorder and Stimulants

Stimulant use activates the sympathetic nervous system in ways that complicate somatic disorders. It is natural to become nervous in response to environmental stressors which is what the sympathetic nervous system is normally activated by. However, when the fight-or-flight instinct is provoked in the absence of external stimuli, it can take a long time before the brain and body become calm again.

High doses of stimulant drugs like methamphetamines can directly induce extreme anxiety, up to the point of panic and paranoia. The combination of physical and mental symptoms can heighten fears about the sudden onset of illness in people with somatic disorders.

The six most commonly abused types of stimulants are:

All of these drugs cause symptoms like increased heart rate, rapid breathing and tremors. These physical effects trigger anxiety that can be especially severe for people with somatic conditions.

Drug Abuse as a Hindrance to Somatic Symptom Disorder Treatment

There are many different ways that substances can hinder the medications that are used to treat somatic disorders and comorbid mental health conditions like depression and anxiety. These hindering effects include the following:

  • Marijuana, opioids and alcohol can increase the sedative effects of other medications, causing an increased risk of excessive intoxication and inadvertent harm
  • Marijuana, alcohol and opioids can interfere with the metabolization of antidepressants and other psychiatric medications, reducing or negating their therapeutic effects
  • Stimulants can exacerbate the effects of antidepressant medications including selective serotonin reuptake inhibitors (SSRIs), leading in some rare cases to a dangerous effect called “serotonin syndrome”

In addition, substance use can interfere with psychotherapy. Cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) are both used to target the irrational thoughts and anxious rumination that can cause distress for people with somatic disorders. Progress in CBT and ACT is interrupted by the use of substances that alter thought processes.

Mindfulness-based interventions and other therapeutic modalities used to reduce stress and improve body awareness can also be negatively impacted by substance use. Most drugs have the potential to distort somatic perception. Substances that induce relaxation only work temporarily and can make it hard to learn and integrate emotional and stress regulation techniques.

Treatment for Somatic Symptom Disorder with Co-Occurring Substance Use Disorders

The primary therapeutic interventions used to treat somatic symptom disorder and other somatic disorders can also be effective in the treatment of co-occurring behavioral health conditions including depression, anxiety and substance use disorders. Co-occurring disorders respond best to an integrated treatment approach in which services are offered through the same provider or are closely coordinated between providers.

The best approach for treating co-occurring somatic and substance use disorders is a coordinated group and individual therapy using techniques from CBT and mindfulness-based interventions. It is also important for clinicians providing mental health services to people with somatic disorders to coordinate closely with their patients’ physicians.

People with somatic disorders and comorbid mental health conditions who have a good relationship with their doctors usually have better treatment outcomes. Integrated treatment can ensure that doctors are not working with people in a way that interferes with their progress in a group or individual treatment for somatic and co-occurring substance use disorders.

The Recovery Village operates treatment centers throughout the United States that provide integrated services for people with co-occurring conditions. If you or someone you know is affected by somatic symptom disorder and addiction, contact a Recovery Village representative today to learn more about treatment options that can meet your needs.

Somatic Symptom Disorder and Substance Abuse
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