Currently, 9.4 percent of Americans have diabetes, while another 84.1 million individuals have prediabetes, a condition that frequently leads to diabetes if not properly treated. A large number of these individuals struggle with a substance use disorder.
Diabetes and substance use disorders are both within the top five health conditions affecting commercially insured Americans. Substance use disorders and complications from diabetes are two of the top conditions which lead to hospital admissions.
Seeking and obtaining addiction treatment which offers comprehensive care for both these conditions grants a person the greatest opportunity for better health and stable recovery.
Substance Use In The Diabetic Population
A Duke University study found that 82 percent of individuals studied with high-risk diabetes had a mental health or substance use disorder recorded in their electronic health record. Researchers found that nearly half (48 percent) had some form of a substance use disorder recorded, while 75 percent had a mental health disorder notated.
It’s been estimated that 50 to 60 percent of individuals with diabetes use alcohol. The Substance Abuse and Mental Health Services Administration cited research which found that “more than one-third of people with diabetes ages 18 to 25 engage in past-month binge drinking.”
Young people use drugs and alcohol at high rates, a trend which is echoed in the diabetic population. A 2014 study prepared by the Health Care Cost Institute found that “Young adults with diabetes had 4 times more mental health and substance use admissions and nearly 3.5 times more ER visits than young adults without diabetes.”
The Risks And Dangers Of Substance Use For Diabetics
Individuals with diabetes who use drugs or alcohol have higher rates of adverse health effects. This includes both type 1 and types 2 diabetes. These individuals are also less likely to manage existing medical conditions, leading to a worsening of symptoms and the emergence of new complications.
Specifically, these individuals:
- encounter critical health complications on a more frequent basis
- have an increased risk of hospitalization
- have longer hospital stays
- seek routine care for diabetes less frequently
- are less apt to maintain their diabetes treatment regimen
- often exercise less frequently, which can worsen the disease
Substance use frequently impairs a person’s ability to maintain healthy habits of self-care. For a diabetic, this could be particularly dangerous.
Many diabetics require daily doses of insulin or medications to manage their symptoms. In addition to this, a diabetic must carefully monitor their food and beverage intake. Routine blood sugar (glucose) testing is also a vital part of many diabetic’s daily schedules.
Substance use may cause a person to forget these critical tasks or to disregard their importance. For an insulin-dependent diabetic, skipping insulin injections or forgetting to set their pump can have disastrous, and even deadly, consequences.
Eating poorly and consuming sugar- and carb-laden foods and drinks accompany many forms of substance use, eating habits which can be problematic for a diabetic. While under the influence, some individuals may forget to eat. Others, such as those abusing cocaine, ADHD medications or other stimulant drugs, may have little to no appetite.
Not eating enough can send a diabetic into a hypoglycemic state, which could require emergency medical care. On the other hand, a person may consume an excess of food while intoxicated, leading to high blood sugar (hyperglycemia), an equally dangerous state.
The Dangers Of Drinking While Diabetic
Binge or heavy drinkers face higher risks of developing diabetes. Additionally, combined alcohol and cigarette use have been shown to increase the risk for type 2 diabetes. Consuming alcohol in these ways or smoking cigarettes can also worsen existing diabetes.
Drinking large amounts of alcohol, as is characteristic of alcoholism, can cause chronic inflammation of the pancreas (pancreatitis). Pancreatitis can make it very difficult for this vital organ to produce necessary amounts of insulin, a condition which could develop into, or worsen, diabetes.
Diabetes is linked to numerous long-term health and medical complications. Alcohol consumption has been shown to worsen several of these, including:
- the burning, numbness, and pain caused by diabetic neuropathy, or nerve damage caused by diabetes
- eye damage caused by diabetic retinopathy
- high triglycerides
- ketoacidosis, a potentially deadly condition
- uncontrolled blood pressure, which increases the risk of kidney disease and stroke
Diabetics are at risk of developing fatty liver disease, a condition which may also be caused by alcohol. Fatty liver disease increases the odds of liver inflammation or scarring (cirrhosis), liver cancer, heart disease and kidney disease, all conditions which are tied to alcoholism.
Drinking alcohol impairs the liver’s ability to produce glucose. This can cause a significant drop in blood sugar or hypoglycemia. A person can experience alcohol-induced hypoglycemia for up to 24 hours after drinking. The risk for hypoglycemia increases when a person binges on alcohol, or any other drug, while failing to eat.
Hypoglycemia can resemble certain symptoms of alcohol intoxication, including confusion, dizziness, lightheadedness, and sleepiness. Some individuals or their peers may mistake these signs for drunkenness, instead of seeking medical help. Without prompt treatment, uncontrolled diabetic hypoglycemia can become very dangerous, leading to a loss of consciousness and seizures.
Alcohol interacts with certain medications used to treat diabetes. This may reduce the efficacy of these medications or increase the odds of liver damage.
Binge Drinking Linked To An Increased Risk For Type Two Diabetes
The journal Substance Use and Rehabilitation reported that “binge drinking of alcohol…was associated with a 43% increase in the risk of developing diabetes.” According to the National Institute on Alcohol Abuse and Alcoholism, binge drinking typically occurs when a woman consumes four drinks in two hours or less and a man, five.
Research presented by the journal Science Translational Medicine found that a history of binge drinking results in insulin resistance, while also increasing a person’s risk of developing metabolic syndrome, a risk factor for type 2 diabetes. Metabolic factor raises the risk of a person developing type 2 diabetes.
Illicit Drug Use And Diabetes
Various forms of illicit drug use have been shown to worsen diabetes or to increase the risk of a person developing it.
According to SAMHSA:
- Amphetamine causes an advanced glycation end-product reaction which contributes to the development of diabetes.
- Cocaine, ketamine and MDMA (ecstasy) can quickly cause acute symptoms of diabetes in individuals with the disease.
- Heroin and methadone use have been linked to an increased risk of diabetes.
- Higher amounts of insulin resistance have been tied to heroin use in men aged 49 and older.
In regard to young, diabetic drug users, research out of the United Kingdom found that cocaine, ecstasy and opiates (mainly heroin) were associated with the greatest effects on glycemic management, emergency hospital admissions and long-term complications.
Treating Dual Diagnosis Concerns In Diabetics
Diabetic substance users face a wide array of behavioral health concerns. Diabetes has been shown to cause an elevated risk and/or higher rates of the following mental health disorders:
- anxiety
- depression
- eating disorders
- schizophrenia
These and other mental health disorders are frequently tied to addiction. Individuals who have a co-occurring disorder, or both a mental health and substance use disorder, require more intensive care. Untreated mental health disorders act as triggers for relapse, complicating treatment and jeopardizing a person’s sobriety.
Diabetic individuals in need of substance use treatment should be thoroughly screened for a dual diagnosis. Should one exist, an individualized treatment plan should be designed which takes into account all aspects of physical and mental health. Treatment typically blends a combination of therapy, counseling, and medications, as needed.
Stress, if not properly controlled, can cause a person to mismanage their self-care and diabetes treatment. Uncontrolled stress is also one of the biggest triggers of relapse. Stress-reduction and coping techniques should also be taught within rehabilitation to reduce these risks.
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Treating Diabetes And Substance Use Disorders
Individuals facing chronic diseases like diabetes require focused medical care and support as part of their drug rehabilitation treatment.
Not every person with prediabetes or diabetes is aware of their condition. In fact, according to the CDC, one in four individuals with diabetes is unaware they have the disease. Because of this, treatment providers should administer a physical evaluation as part of the clinical assessment for drug rehabilitation.
Withdrawal can be painful and uncomfortable, to the extent that it is very difficult for a diabetic to properly administer insulin and medications. Due to this, and the unpredictability and complications of withdrawal, individuals with diabetes are advised to seek a medically-supervised detoxification program prior to rehabilitation.
Because of the complexity of these treatments and the ones which follow in rehabilitation, inpatient residential programs are strongly recommended. Here, treatment providers should be educated on diabetes, so they can assist individuals in managing their disease while faced with the challenges of recovery.
While highly-trained medical support should be offered within a drug rehabilitation program, diabetes patients often require specialized medical treatments. The treatment of diabetes requires a collaborative approach, often including appointments with various doctors, such as a nephrologist, ophthalmologist or podiatrist. These needs should be discussed prior to an individual enrolling in treatment.
Medical providers may have to adjust the treatment of a person’s diabetes, as to not trigger a drug relapse. Using needles to administer insulin can be a risk factor for individuals recovering from an addiction to injection drugs, such as heroin. These individuals may need to be converted to an insulin pump and be educated on this new means of diabetes management.
Personal self-care and diabetes management should be included in the treatment plan for rehabilitation from a drug or alcohol addiction. Motivational interviewing and cognitive–behavioral therapy, two psychotherapies which are also used to treat addiction, have been shown to help diabetic patients manage their condition more effectively.
Patients may require education and supportive services to ensure they adhere to their treatment plan, both during and after treatment. Mutual-help groups can be vastly beneficial during this time, providing diabetic clients with encouragement and life skills throughout their treatment. Nutritional guidance and instruction are also critical for diabetics in recovery, in addition to meals which are prepared to meet their specific dietary needs.
Relapse prevention techniques are a vital part of treatment. As part of this, individuals should be educated on the risks of relapse as it pertains to their illness. Since both diabetes and addiction are chronic diseases, individuals should be connected to aftercare resources and support.
Contact Vertava Health to learn more about addiction treatment options for diabetics.
