Substance Use and Mental Health Disorders: Understanding What’s Going On

On their own, substance use disorders and mental health disorders can be overwhelming and frustrating. The many, many people who are confronted with both at the same time face an added burden. Getting the right care is crucial, but there are plenty of reasons for these individuals to have hope. Understanding what’s going on is the first step.

Disentangling the symptoms, and getting the right diagnoses and treatment, of simultaneously occurring substance use and mental health disorders can be vexing for the person struggling with both issues, as well as their caregivers and loved ones. A disorder or disruption associated with these conditions can cause dysregulation of moods and create complex feelings and behavior patterns as the individual tries to seek relief.

Many of the symptoms of mental health disorders and the chronic use of drugs or alcohol overlap, making it difficult to attribute particular issues or behaviors to one disorder or the other. Equally challenging is that substance use disorders and mental health conditions may run in tandem, though that does not mean one has caused the other. A person suffering from both has “co-occurring disorders” or a “dual diagnosis.”

What Are the Symptoms, and Who’s at Risk?

Substance use disorder (SUD) is itself a mental health disorder that affects a person’s brain and behavior, leading to an inability to control the use of drugs, alcohol or prescription medications. There are often — very often — other issues involved: Researchers have found that about half of individuals who experience SUD also experience a co-occurring mental health disorder, and vice versa.

Why and how do addiction and mental health conditions co-occur? Research provides some clues.

• Genetic factors can play a role: Family histories and predispositions may contribute to the development of the disorders.
• Mental health disorders can trigger substance use and lead to SUD. Studies have shown that people with anxiety, depression and post-traumatic stress disorder may use drugs and alcohol as a form of self-medication. Substances offer temporary relief but can worsen the initial symptoms over time. Brain changes associated with mental health disorders may also enhance the rewarding effects of substances or promote their continued use, despite negative consequences.
• Substance use can contribute to the development of other mental health disorders simply because it can cause changes in the brain’s structure and functioning.

Mood disorders, including depression and bipolar disorders, are the most common co-occurring psychiatric conditions among people with substance use disorders. According to the National Alliance of Mental Illness, depressive symptoms vary from person to person but may include a sense of hopelessness, feelings of guilt, lack of interest in activities, changes in appetite or sleep, suicidal thoughts, physical aches and pains, agitation, and decreased physical activity. Persistence of these symptoms may be diagnosed as a depressive mood disorder.

Symptoms of substance use disorder also may vary, but they resemble mood disorder symptoms.

But for those with mood disorders, drugs and alcohol can feel like they’re helping. People who are depressed may drink or use drugs to lift their moods or escape feelings of despair or guilt. Among individuals with recurring major depression, roughly 16.5% have an alcohol use disorder and about 18% have a drug use disorder. A person struggling to thwart negative emotions associated with depression may increase their substance use; drug withdrawal can then intensify these emotions, causing the person to use to feel “normal.”

The National Survey on Drug Use and Health reports that 18% of people with an SUD also meet the criteria for having an anxiety disorder (panic disorder, generalized anxiety disorder, social disorder or specific phobias). As with mood disorders, anxiety disorders may develop from or be exacerbated by substance use disorders.

Getting Help and Getting Care

The co-occurrence of substance use disorders and mental health issues requires care that recognizes the importance of treating both conditions simultaneously, tailored to the needs of each individual. To get a proper mental health diagnosis, a person should maintain a period abstinence from drugs or alcohol, if possible, depending on the type of substance used and the severity of use. Health care professionals need to evaluate individuals for both disorders to understand any overlapping symptoms and determine accurate diagnoses.

Now for the good news: Treatment and recovery are possible. Treatment may include behavioral therapies and appropriate medications. Common therapies that serve to treat SUD and mental health issues include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), assertive community treatment (ACT) and contingency management (CM). Medications targeted to alleviate cravings and withdrawal from alcohol and drugs allow space for therapy to address psychological and emotional issues. Some prescribed medications serve a dual purpose by enhancing behavioral therapies and reducing the risk of relapse or return to use.

For more information on behavioral treatments and medications for SUDs, visit the National Institute on Drug Abuse facts and treatment pages, and for treatment of mental health disorders, check out the information provided by the National Institute of Mental Health.