The link between a co-occurring mental illness and substance abuse is incredibly strong. Surveys show that about half of all people with a severe mental health disorder are also struggling with a substance use disorder. Furthermore, well over a third of people addicted to alcohol and well over half of people addicted to drugs have at least one other diagnosis of a mental disorder.
However, the factors that feed this relationship are complex. There is more than one simple identifiable reason why drugs and mental health issues go hand in hand. Understanding this can help families and individuals seeking treatment, especially because a co-occurring disorder will often require a long-term approach to both mental health and drug recovery.
What is a Co-Occurring Disorder?
At its heart, a co-occurring disorder is any instance of a substance use disorder diagnosed alongside another mental health disorder. Common mental disorders that intersect with substance use include anxiety disorders, depression, bipolar disorder, schizophrenia, obsessive-compulsive disorder, personality disorders, and post-traumatic stress disorder. A co-occurring disorder is also known as a dual diagnosis.
The prevalence of co-occurring disorders is clinically relevant because they are often harder to treat than individual cases of just substance use disorder or a mental disorder.
Furthermore, it may be harder to convince someone with a co-occurring disorder to seek treatment. One of the most common characteristics of a co-occurring disorder is that the drug use began as a form of self-medication, to moderate mental health symptoms, from panic attacks to suicidal thinking.
The difference between feeling down and binge drinking after the death of a loved one, and a co-occurring disorder, is a consistent pattern of disordered behavior. While it’s unhealthy, some people cope with loss by having a few more drinks than usual. They may recover emotionally without becoming an alcoholic, and their grief is not a sign of depression.
On the other hand, a person with major depressive disorder is diagnosed with a condition that robs them of the ability to feel joy. Their emotional baseline is well below normal, and their symptoms of low mood and sadness remain constant and occur without outside input or are made worse by it (such as bullying or grief).
If this person begins drinking more frequently because the euphoric effects of alcohol help them feel a bit better for a short while, they develop a drinking problem. And when they reach a point where they cannot voluntarily stop drinking, they have developed an alcohol use disorder with concurrent depression.
The Link Between Co-Occurring Mental Illness and Substance Abuse
There are multiple theories on why drug use and mental health problems are thoroughly linked. These can be summarized in a biopsychosocial model.
The biological reasons may be a combination of related genetic and environmental factors. People who are more likely to become dependent on an addictive substance may also be statistically more likely to have a family history of depression or anxiety. There may be neurological connections between a person’s likelihood of addiction and the development of these disorders.
Furthermore, the effects of long-term drug use on both physical and mental health can be demoralizing and psychologically debilitating. They can lead to depression where there previously was none. Drug use is also generally linked with increased levels of anxiety, increasing the likelihood of panic attacks or anxious thinking.
The psychological reasons include self-medication, as well as depressive or anxious thoughts caused by difficulties during recovery and rehab. Addiction can also destroy relationships, rob people of career opportunities, and claim entire years of a person’s life. This has a tremendous effect on a person’s self-esteem and psyche, and it’s one of the reasons why building someone back up – helping them rediscover and recontextualize their identity in a positive light – is crucial during treatment.
The social aspect of co-occurring disorders cannot be understated. Access to treatment for both mental health issues and addiction is poor. Few people get the help they need, even after decades of mental health awareness. It can be expensive to seek treatment.
A history of drug use and drug treatment can affect or end career opportunities. A history of mental illness can undermine custody battles and reliability. There is a definite stigma against people with mental health problems and people with a history of drug addiction, even after years of treatment.
Biological, psychological, and social factors can enforce the connection between drug use and mental health problems and make it even harder to get meaningful help. Professional treatment is crucial and something many people are afraid to consider as an option.
Seeking Treatment for a Dual Diagnosis
A co-occurring mental health issue is more than just an addiction running concurrent to a mental disorder. The interconnectivity between the two means that treating one is impossible without treating the other.
Helping someone who began drinking to overcome their anxieties simply stop drinking does not address the underlying issue, nor does it address the ways long-term alcohol consumption can amplify and worsen anxiety disorders. Similarly, treating their anxieties may not be enough to help them avoid their drug of choice. Addiction, at a certain point, is more than just psychological and requires both mental and physical treatment.
A treatment plan developed for a patient with a co-occurring disorder will usually involve either inpatient or outpatient treatment at the onset of recovery and continue with long-term recovery options in the form of treatment education, group therapy, and developing support systems through family therapy.
Incorporating Family into the Treatment Process
Family therapy can be an effective treatment tool, especially for patients who live with their loved ones. Family dynamics often play the role of either a protective factor or risk factor for mental health problems and addiction, so improving the relationships between family members and their understanding of a loved one’s condition is important for long-term recovery.
The long-term treatment path is a lifelong commitment. Addiction is something that can happen to anyone, and if you have a history of substance use problems, the only way to truly “overcome” that history is through continued sobriety and healthy coping skills. But that doesn’t mean a treatment program, whether inpatient or outpatient, must be a one-and-done deal. It is also important to learn when to recognize a challenge as something you can deal with alone or may require help for, whether professional help or the support of your loved ones.