Today, an estimated 40.3 million Americans over the age of 12 struggle with a substance use disorder, commonly known as addiction. That epidemic of substance abuse maps closely to the 52.9 million Americans over the age of 18, or 21% of the adult population, who have a mental illness. Most importantly, with 17 million Americans having both a substance use disorder and a mental illness, the rate of addiction goes up from 14.5% of the general population to 32.6% of the population with mental health problems.

The connection between mental illness and substance use is clearly visible. But, what is it? Unfortunately for anyone looking for help, the answers aren’t always as clear cut as we might like. Mental health problems are a risk factor to substance abuse, substance abuse is a risk factor to mental health problems, and there are dozens of other ways the two connect.

Substance Use Disorder is a Mental Health Disorder

Substance use disorder or SUD is a behavioral disorder, or a mental health disorder. While it’s a very specific form of mental health disorder, in which behavioral problems including substance seeking, risk-taking, and self-medication are prominent, it overlaps significantly with other mental health disorders.

For example, the drops in neurotransmitters like serotonin and dopamine seen in addicts almost perfectly maps to that seen in people struggling with chronic depression. Both mental illnesses and substance use disorders also increase the risk factors for the other. Both also result in changes to serotonin, dopamine, and GABA production and uptake in the brain and central nervous system. In addition, both addiction and mental health disorders result in behavioral patterns that decrease quality of life and quality of mental health. E.g., negative coping habits, negative emotions, emotional ups and downs, unsustainable habits, lethargy or tiredness, stress, etc.

In addition, both are caused by many of the same issues:

  • Epigenetics
  • Social and economic risk factors
  • Exposure to trauma
  • Physical illness
  • Adverse Childhood experiences

In addition, even having an ongoing physical illness increases your likelihood of getting both a mental health disorder and a substance use disorder. Eventually, no case should ever be diagnosed without a full assessment and understanding of the individual. Mental and behavioral health are complex and interconnected.

Does One Disorder Lead to Another?

Often, people will start out with either a substance use disorder or a mental health disorder and their behavioral or mental health will deteriorate until they have a dual diagnosis. This is common for several reasons, including self-medication, losing self-care habits, and decreasing quality of life.

Self-Medication – If someone is having physical or mental health problems, it’s very easy to try to treat that with something that makes you feel better. If you drink, you relax and feel less stressed. It may temporarily relieve symptoms of anxiety and depression or pain. If you have a prescription, taking a few more pills might help with relaxation or dealing with a bad night. This type of treatment is insidious because it often escalates over time, without the user noticing. You start out taking a bit more and then a bit more, and then you develop tolerance and have to increase that. This pattern of escalation and tolerance is extremely easy to build into an addiction, especially when you have other very real mental or physical health problems to distract from the growing problem.

Exacerbating Existing Problems – If you’re drinking or using, you’re exacerbating existing problems, even if those problems aren’t at the forefront. E.g., if you drink, you might relax for the moment, but you wake up with a hangover, fatigue, lack of concentration, and likely dehydration. Even prescription medication can result in significant side-effects and feeling bad the day after. This creates a self-reinforcing pattern, where you use to stop feeling bad but then you feel bad because you used. Over time, substance abuse impacts your ability to produce serotonin and dopamine in the brain in a  phenomenon known as emotional blunting. You might feel numb, depressed, or lethargic when not using. And, that contributes significantly to developing depression, to worsening anxiety, and to triggering other forms of mental illness.

Prescriptions Result in Substance Use Disorders

Often, people with mental health disorders are given prescriptions to help with short-term treatment. Today, those prescriptions are often very short. E.g., new patients on Xanax are often recommended to a 5-week course. That hasn’t always been the case and some people have been on prescription sleeping aids or benzodiazepines for over a decade. The longer someone is on a benzodiazepine or sleeping aid, the more likely they are to come to rely on that prescription to function. For example, you start out taking Xanax to stop a panic attack. Then, you start to have panic attacks because you haven’t taken your Xanax and you could have a panic attack. You take one pre-emptively, your usage goes up, and you increase the risk of addiction.

This kind of behavioral reliance is one of the primary factors in prescriptions turning into substance use disorders. It’s also why most new prescriptions include significant Risk Evaluation and Management strategies to prevent exactly that. But, if you have a prescription and aren’t going in for regular checkups and don’t have strict management of your intake, you could also be at risk.

Substance Abuse Feeds into Mental Illness

With over 17 million Americans struggling with both a substance use disorder and a mental health disorder, it’s clear there is a link between the two. That’s especially clear when you look at persons with PTSD, where over 60% struggle with substance abuse. That relates to the fact that substance abuse feeds mental illness and the other way around.

Here, it’s also often because people go in for a diagnosis, are given a single diagnosis, and that’s treated. E.g., if you develop depression and start drinking to cope with that and then go in for treatment and only the substance use disorder is treated, you’ll leave rehab with the same problems you had before. That means the treatment is significantly less likely to be effective and you’re more likely to relapse.

Going to treatment and getting a dual diagnosis also requires a significantly different approach to treatment. Here, the approach is normally to treat critical issues that impact your health first – e.g., get you through detox, and then to treat the issues that might interfere with treatment. That might mean offering motivational therapy, treating depression or anxiety, or getting you onto medication to treat bipolar disorder or panic attacks. You have to be in a mentally sound state in order to benefit from treatment.

Taking that dual diagnosis approach does mean spending more time on therapy, getting a personalized plan that’s updated throughout treatment, and usually going to inpatient care. However, it does mean treating the full problem, including underlying disorders, for a holistic approach that considers mental health as the primary driver of behavioral health.

If you or you loved one need help with mental health treatment, drug rehab, or alcohol rehab Compassion Recovery Center is here to help. Contact us to ask about our mental health programs and how we can support your specific requirements as you move into treatment.