Excessive drug use and alcohol use commonly coincide with other mental health issues, such as some of the most common co-occurring disorders. Whether one came before the other is a case-by-case matter – sometimes, the onset for a mental health problem is after the addiction began; in other cases, the problem is what led to the drugs.
The link between drug use and poor mental health is biopsychosocial. Addictive drugs can affect the brain, and exacerbate or even cause depressive and intrusive thoughts, anxious behavior, and psychotic episodes. The psychology behind addiction can leave a person feeling overly guilty and self-deprecating, to the point of self-loathing, or self-hatred. And finally, the social effects of addiction often lead to poverty and isolation.
There are systemic issues that feed both addiction and mental health problems. Societal stigmas, lack of access to care for either, and the cost of care in many cases can magnify these problems and make it much easier for an alcoholic to become depressed, or for a depressive person to start drinking too much.
If you want to help a loved one overcome their addiction and mental health problem – also known as their co-occurring disorder – then knowing how co-occurring disorders work is important.
What Are the Most Common Co-Occurring Disorders?
A co-occurring disorder, comorbid disorder, or dual diagnosis is a term used to differentiate between people with substance use disorder, people with another mental health disorder, and people with both.
Why the special treatment? Because drug addiction and prolonged drug use can change the treatment plan for a person with anxiety issues or a depressive disorder. It’s not enough to treat each condition – they must be treated together.
Anxiety Disorders and Drug Use
Anxiety disorders include the most commonly diagnosed mental disorders, such as generalized anxiety disorder and social anxiety disorder. Anxiety is characterized as an overwhelming and irrational feeling of worry and fear, followed by physical symptoms such as elevated heart rate and excessive sweating, being out of breath, restlessness, feelings of fatigue, and inability to focus.
Anxiety disorders often co-occur with alcoholism and prescription drug abuse. Depressants like alcohol and benzodiazepine (Xanax) help reduce anxiety symptoms in the short term, and when used recreationally (in the case of Xanax) can cause feelings of euphoria. However, these short-term effects don’t last. Alcohol use can actually increase anxiety, not to mention the damage long-term use can have on the brain and liver.
Depression and Drug Use
Mood disorders like major depressive disorder affect millions of Americans, with MDD itself affecting more than 7 percent of all adults in the US. Most mood disorders have symptoms of depression, which are characterized by long-lasting and often unprovoked low mood, and loss of joy (anhedonia).
People affected by depression will have a hard time feeling excited about things they used to enjoy, and often experience physical symptoms such as fatigue and unexplained aches. Depression-related loss of motivation can make personal hygiene and basic tasks like cooking and grocery shopping feel nigh-insurmountable during intense episodes, often affecting their health and nutrition.
Drugs can help make those feelings go away for a little while, but they come back stronger. This turns into a self-fulfilling cycle where depressive episodes are fueled by the regret of drug use, leading to a relapse. On the other hand, long-term drug use such as alcoholism has led to the onset of mood disorders in many cases.
Bipolar Disorder and Drug Use
Bipolar disorder is another common mood disorder, one characterized by episodes of both depression and mania. These episodes usually last multiple months, with peaks and valleys of intensity, and moments of neutral mood in between called euthymia.
During periods of mania, some people may be at risk of taking drugs due to a lack of risk assessment abilities, as mania often coincides with restlessness, feelings of grandeur, extreme excitability, and hostility.
Personality Disorders and Drug Use
There are ten different recognizable personality disorders, split between three distinct clusters. These personality disorders encompass a number of symptoms affecting a person’s thinking, feeling, and behavior.
Personality disorders are characterized as modes of thinking, feeling, and behavior that cause distress and interfere with normal everyday functioning. This feeling of being shut out or different can lead to frustration and substance use, especially in patients who are obsessive-compulsive (which can cause panic and anxiety), paranoid, or have dependent personalities.
The Link Between Mental Health and Substance Use
Current research suggests at least three possible reasons that substance use and other mental health issues are so often paired together.
The first is that common risk factors tie the two together. Both excessive drug use and mental health problems can be related to excess amounts of stress, a traumatic experience, chronic trauma, and even genetic predisposition. Just as anxiety can run in the family, so can alcoholism.
The second is a strong causal effect between mental health issues and substance use disorder. Studies show that a common motivator for an excess or non-medical use of prescription drugs and alcohol is for self-medication. Depressants like alcohol can help lower inhibition and “take the edge off”. Drugs like marijuana can help serve as an escape. Drugs like cocaine can spark pure euphoria, if only for a short while.
The third is that prolonged drug use has a significant negative impact on the brain. This means that substance use triggers changes that make the onset of mental health problems more likely – while exacerbating existing mental health symptoms.
Co-occurring disorders are treatable. First-line treatments often include medication, whether to reduce the effects of a substance use disorder (such as naltrexone and suboxone), or to reduce the symptoms of a mental health disorder (such as antipsychotics and antidepressants), as well as talk therapy. Cognitive behavioral therapy and dialectical behavior therapy are two common modalities employed for dual diagnosis cases, as well as group therapy sessions.
In addition to medication and therapy, many cases of a dual diagnosis are treated through inpatient or outpatient treatment clinics. These are facilities where patients can either visit for regular sessions or enroll into a residential treatment program. These programs help patients detox and begin their recovery while seeking treatment.
The road to recovery with a co-occurring disorder is long, but support systems can help make it easier. Alongside professional treatment, patients will need guided help from their friends and family to keep them on track and help them reach out to mental health resources whenever necessary. If you or a loved one are struggling with a co-occurring disorder, consider talking to a professional together.