People often turn to substances as a form of self-medication to numb the pain of other issues So, is substance abuse a mental health disorder?
A substance use disorder is a mental health disorder. There is more to a substance use disorder than addictive drugs – while the substance itself is crucial to the disorder, there are other external as well as internal (genetic) factors that make addiction much more likely, in the same way, they affect the onset of conditions like depression and anxiety.
Furthermore, both substance use disorder and other mental health disorders are deeply entwined, often co-occurring, and complicating treatment. In fact, more than half of every person affected by drug addiction will be diagnosed or is already diagnosed with another mental health problem.
Understanding the way substance use disorder works, how it affects the brain and mind, and how it interacts with other mental health issues can help provide greater context for how addiction develops, and how it can be treated effectively.
What Is a Substance Use Disorder?
A substance use disorder is a mental health condition characterized by a person’s inability to control or stop the recreational use of drugs. It is also characterized by mental (and often physical) dependence, including potential withdrawal symptoms, powerful cravings after quitting, and a high risk of relapse or overdose.
Substance use disorder symptoms occur on a spectrum and may include people who aren’t necessarily “addicted” in a conventional sense but are in the early stages of pre-addiction, including binge drinking or drinking problems, or recreational/unprescribed use of prescription medication.
On the severe end of the scale, substance use disorder carries a higher risk of death by overdose or drug/alcohol poisoning, and significant physical and mental impairment.
Brain Disease or Mental Health Disorder?
Substance use disorder is sometimes called a brain disease, because of the way it can affect and change how the brain processes pleasurable and enjoyable experiences. The changes made in the brain by drug use aren’t always permanent – those that are long-lasting are related to the damage drugs can wreak on the cognitive centers of the brain, such as our ability to problem solve, or retain information and store memories.
But being a brain disease does not exclude substance use disorder from being a mental health condition, as well. These terms are synonymous, describing the way excessive drug use can affect and change the brain, and affect both thinking and behavior.
On a neurological level, many of the changes made in the brain by the repeated use of addictive drugs target the limbic system. This is a series of physical structures in the brain related to motivation and intrinsic reward. Different drugs lead to different side effects and types of “highs”, or different symptoms of intoxication.
For example, cocaine leads to the release of dopamine in the same way as alcohol or nicotine, but it has an additional effect as a central nervous system stimulant and can significantly increase a person’s heart rate. Alcohol, on the other hand, is a nervous system depressant, slowing down breathing and slurring speech. Opioids are powerful painkillers that interact with receptors in our nerve cells to eliminate pain signals and release endorphins, but excessive amounts can slow the heart and respiratory systems down to a standstill, causing death.
Substance Use Disorder and Other Mental Health Disorders
People with a substance use disorder are at a much higher risk of developing or experiencing other mental health issues, and vice versa.
The two feed into each other very often, partially due to the effects drugs can have on a person’s mind, and due to the social effects of drug use and addiction, including stigmatization and isolation. Also known as a dual diagnosis or a co-occurring disorder, substance use disorder coupled with a mental health disorder often requires specialized treatment, tackling both problems at once.
What Are the Causes of Substance Use Disorder?
People use drugs for a variety of different reasons. Some of them are more environmentally directed than others. A long family history of drinking and drug use makes it harder to stop or quit drugs, especially if a person starts using drugs as a teen. Some people use drugs the first time to feel good, after feeling bad for a long time.
Others use drugs to feel better – to combat stress, to celebrate. Sometimes, it’s part of the culture – whether it’s work-related drinking and partying or peer pressure. In some cases, people start using drugs for reasons other than feeling good – stimulants like cocaine and methamphetamine have been used as extreme weight loss tools, and prescription stimulants are sometimes sold as “smart pills” despite having no effect on cognition or memory.
Rather than identify explicit causes, it is more productive to think of the development of a person’s drug habit as a result of multiple conflating factors. These risk factors can compound, creating additional risk the more they overlap over time.
For example, someone with a long-standing family history of drug use, easy access to drugs, lack of access to drug education or drug addiction treatment, and several other risk factors, such as physical chronic illness, a diagnosis of depression, and low income, is much more likely to struggle with drug addiction for a long time.
Identifying the valid risk factors in any given case of substance use disorder can be helpful because it can provide further context for how the treatment process should help address the causes of addiction in a client’s life.
How is Substance Use Disorder Treated?
Most substance use disorders are treated either through intensive outpatient treatment or residential treatment.
Outpatient treatment programs are strictly scheduled appointments that a client must attend over the course of their recovery, including one-on-one visits to therapists, group therapy or support group sessions, and experiential treatments, such as art therapy. In an outpatient treatment program, the patient continues to live at home but regularly travels to and from a clinic or treatment center to receive assistance and support.
Inpatient treatment programs for addiction usually involve a residential compound that has been converted into a professional clinic, providing a comfortable and community-based treatment plan for clients who require professional supervision. In these cases, treatment usually begins with careful detoxification. Residential treatment centers often staff physicians and nurses to ensure the health and safety of their tenants.
In addition to providing therapy and cotreatment for other disorders, residential treatment facilities also help clients transition back into living alone or living with family, and continuing recovery through local support groups and referred mental health professionals.