Mental Health and Addiction

It’s not uncommon for individuals that struggle with a substance abuse problem to also have mental health issues. The National Survey on Drug Use and Health (NSDUH) reports that 45% of individuals with substance use disorder also have a co-occurring mental health problem.

How Addiction and Mental Health Are Connected

Dealing with alcohol or drug addiction on top of a mental health condition can be especially difficult. However, with the right treatment program, you can tackle both issues and go on to live a healthy, fulfilling life free from alcohol or drug use.

Addiction and mental health are linked in two primary ways:

  1. Mental health struggles can encourage substance abuse. Individuals with mental health issues may be more likely to abuse drugs or alcohol to alleviate particular symptoms of their mental health problems. For example, people with an anxiety disorder may experience debilitating panic attacks. Those intense panic attacks may draw them to misuse alcohol or other “downers” to decrease the intensity of panic attacks or chronic anxiety.
  2. Drug abuse can intensify certain mental health problems. Some drug use can increase the underlying risks for mental health issues. Drug use will interrupt normal brain function, which can in turn exacerbate symptoms of mental health disorders. For instance, regular drug or alcohol abuse can increase the frequency of psychosis for individuals with schizophrenia.

According to the National Institute on Drug Abuse (NIDA), the most common mental health issues that co-occur with substance use disorder include:

  • Anxiety disorders
  • Post-traumatic stress disorder (PTSD)
  • Panic disorder
  • Depression
  • Bipolar disorder
  • Attention-deficit hyperactivity disorder (ADHD)
  • Borderline personality disorder
  • Antisocial personality disorder
  • Schizophrenia

Substance abuse impacts the part of the brain that impacts a person’s decision-making, judgment, memory, behavioral control, and learning ability. When combined with a pre-existing mental health condition that already affects normal brain function, substance abuse can cause detrimental and even life-long effects.

Effective treatment of substance use disorder for individuals with a dual diagnosis of a mental health disorder may differ from standard addiction treatment. Your treatment plan will include both substance abuse treatment and mental health treatment protocols side by side.

What Is Addiction?

Addiction is a chronic disease characterized by repeated, compulsive behavior to continue a behavior despite the negative toll taken on a person’s life. In terms of drug and alcohol use, addiction is also known as substance use disorder.

Someone experiencing substance addiction will struggle to limit their alcohol or drug use. The addicted individual is also likely to experience intense anxiety if they cannot access their drug of choice.

Addiction is still a treatable disease despite the challenges it creates for people. Most treatment facilities offer varying levels of care to meet people’s needs.

Can Mental Illness Cause Addiction?

No, mental illness doesn’t cause addiction exactly—but people with mental health conditions may be more likely to self-medicate to alleviate symptoms of their mental illness, leading to addiction.

Adolescents with a mental health disorder are at an increased risk of developing substance use disorder, as most mental health issues begin to appear around a young age. Additionally, experimentation with drugs and alcohol may also begin in adolescence, increasing the chances for a young person to develop a problem with substance abuse.

Dangers of Self-Medicating

Self-medication happens when individuals consume drugs or alcohol to alleviate certain uncomfortable feelings. For those with mental or behavioral health issues, self-medicating is especially dangerous.

The effects of drugs or alcohol might temporarily alleviate some symptoms of mental disorders (e.g., consuming alcohol to ease social anxiety, taking stimulants to improve performance at work or school). However, over time the body will form a dependence upon these chemicals, which can quickly lead to developing an addiction.

Additional risk factors of self-medicating include:

  • Incorrectly self-diagnosing the issue
  • Delay in getting help from trusted health professionals
  • Potentially severe adverse effects
  • Dangerous interactions between drugs
  • Unsafe methods of administration
  • Wrong dosage
  • Masking a more severe disorder

Some individuals practicing self-medication may decide to quit without support but can face uncomfortable withdrawal symptoms if their body has become dependent on the substances they were using.

Some substances (such as alcohol and benzodiazepines) can cause life-threatening withdrawal symptoms. Others withdrawals (i.e., opioid painkillers) can cause complications that can increase depression, which is especially dangerous for someone already struggling with mental health issues.

Suppose you suspect you may need prescription drugs to assist you with your mental health condition. In that case, you can speak to your doctor or similar healthcare provider to get a safe, controlled alternative to self-medicating on your own.

Understanding Comorbidity

Comorbidity is also known as a dual diagnosis which can occur when someone with a mental health disorder also develops substance use disorder.

The National Institute of Mental Health (NIH) recommends treating both disorders simultaneously.

However, getting a dual diagnosis can often be challenging, as some mental health issues can overlap with complications that result from substance abuse.

Challenges of Dual Diagnosis

One of the primary challenges of dealing with a dual diagnosis for mental health disorders and substance abuse is getting the initial comorbidity diagnosis. Doctors and other healthcare providers may notice that symptoms of each disorder mirror one another, so it can be challenging to differentiate between the various symptoms.

Dual Diagnosis treatment is tailored according to several factors, including:

  • Current mental health condition
  • Age
  • Type of mental disorder
  • Type of substance abuse

Warning Signs of Co-Occurring Disorders

It might be hard to determine whether you have a co-occurring disorder. Still, some potential red flags might indicate you are struggling with substance use disorder and a mental health disorder.

Some warning signs of comorbidity include:

  • Depression or anxiety, even when you’re sober.
  • Reliance upon drugs or alcohol to numb uncomfortable feelings, give you courage, help you focus, or shift your mood.
  • Significant mood shifts when you take a particular drug or drink alcohol (e.g., Does alcohol make you more depressed?)

It’s also important to note any history of family members with substance abuse or mental health issues, as both of these traits can be hereditary.

If you’re concerned that you or a loved one may have co-occurring conditions, speak with your doctor or addiction counselor as soon as possible. It’s essential to get a thorough evaluation so that both conditions, if present, can be treated separately. Different treatments for each condition give you the best opportunity for success.

Common Types of Mental Health Disorders

Dual diagnosis impacts nearly half of all individuals that are struggling with addiction. The following mental health disorders are often diagnosed alongside substance use disorder.

In many instances, people dealing with one or more of these mental health conditions may seek out drugs or alcohol to cope with their symptoms. On the other hand, some substances can potentially trigger or significantly worsen preexisting mental health issues, creating an unhealthy and often dangerous cycle.

Anxiety

Individuals who struggle with anxiety disorders will often experience fear, restlessness, and excessive worry. These primary anxiety symptoms can also manifest into issues such as sleeplessness, increased heart rate, gastrointestinal problems, panic attacks, and sometimes phobia.

Because the symptoms of anxiety disorders are persistent and often constant, individuals with these issues may try to self-medicate through alcohol or other substances. A study published in the Psychiatric Journal shows a strong correlation between anxiety disorders co-occurring with substance use disorder.

Both substance use disorder and anxiety disorder are two of the most common psychiatric issues in the US.

Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder, or ADHD, is often diagnosed in children or adolescents, and it typically continues after they reach adulthood. People with ADHD are likely to struggle with impulsivity, focus, forgetfulness, and/or hyperactivity.

ADHD affects 6 to 9% of children and nearly 5% of adults across the world. Unfortunately, several studies have shown a significant overlap between people with ADHD and those who struggle with alcohol or drug abuse. This co-occurrence may be a result of ADHD’s characteristic impulsive behavior. Other research suggests a possible link between developing alcoholism and ADHD and might be hereditary in both cases.

ADHD medication, such as Adderall or Ritalin, can be addictive when abused. However, there is currently no strong evidence to suggest that these prescription drugs can lead to substance use disorder when used correctly.

Depression

Depression is more than just feeling sad or down. Instead, depression is classified as a low state of mind that interferes with normal day-to-day life. Individuals struggling with depression may feel worthless, hopeless, uninterested in things they used to enjoy, unusually tired, and potentially suicidal.

The Substance Abuse and Mental Health Services Administration reports that about 1 in 6 Americans experience depression at some point, with roughly 16 million Americans experiencing depression annually. Depression can be a clinical diagnosis on its own and a side effect of many other mental health conditions.

The relationship between depression and addiction is often cyclical. Some substances can trigger or increase feelings of depression. Alternatively, many individuals struggling with depression may turn to substances as a form of self-medication.

Obsessive-Compulsive Disorder (OCD)

People with obsessive-compulsive disorder (OCD) typically experience uncontrollable compulsions, intrusive thoughts, and unwanted obsessions. OCD often manifests in a cycle and is usually very disruptive to a person’s daily life.

Living with OCD can be extremely draining, and it can lead some individuals to seek relief through drinking or abusing drugs. The US National Library of Medicine notes that addiction impacts almost 30% of individuals being treated for OCD.

Post-Traumatic Stress Disorder (PTSD)

PTSD, or Post-traumatic stress disorder, can happen due to going through a significant traumatic event. PTSD is commonly associated with war veterans, but it can affect people of all ages and walks of life.

Individuals with PTSD are likely to experience prolonged side effects, including disturbing recollections of the event, dissociation, nightmares, and flashbacks, among other troubles.

According to a publication from the National Institute on Drug Abuse, about 50% of people seeking treatment for substance use disorder also meet the criteria for having PTSD. The report also acknowledges a need for more research into the appearance of this comorbidity to better understand these disorders and how they interact.

The current theory is that PTSD and SUD can develop from the same traumatic event. As trauma can cause PTSD, traumatic experiences may also lead a person to self-medicate or try to cope by overdrinking or abusing drugs.

Bipolar Disorder

Bipolar disorder is a condition that causes the individual to experience intense mood swings, shifting between mania and depression. These mood swings can occur a few times a year and can last days or weeks; these are not phases that occur rapidly (e.g. multiple times in a day).

Phases of mania can cause euphoria, abundant energy, and/or feelings of irritability. Manic episodes can include reckless and risky behavior, from overspending to experimenting with substances.

On the flip side, the depressive phases of bipolar disorder can cause the individual to lose interest in things they used to enjoy. Some people try to cope with depression through alcohol or drug use.

Schizophrenia

Impacting about 1% of the US population, schizophrenia is considered a more severe mental health disorder. Common symptoms include delusions, hallucinations, and mental confusion.

Approximately 16% of the general population will experience substance use disorder at some point. Comparatively, 47% of individuals with schizophrenia will develop substance use disorder. The most common drugs used by individuals diagnosed with schizophrenia are alcohol, tobacco, marijuana, and cocaine.

One of the theories about the high prevalence of substance abuse among patients with schizophrenia is that they are trying to lessen the symptoms of their disorder. Another theory suggests the brain’s reward center may have a specific dysfunction that is tied to schizophrenia that may also make someone more prone to developing an addiction.

Borderline Personality Disorder (BPD)

People with Borderline Personality Disorder (BPD) struggle to regulate their emotions. Symptoms of BPD can manifest as impulsivity, mood swings, and extreme thinking. People with BPD may have difficulty maintaining relationships and have a distorted, often negative, sense of self-worth.

About 25% of people who have a substance use disorder also meet the criteria for a BPD diagnosis, and this might be because of the impulsivity common to both disorders. Ongoing research indicates other potential reasons for this dual diagnosis, including emotional dysregulation, impulsivity, and potentially a biological predisposition.

Unfortunately, substance abuse is very likely to increase some of the more dangerous symptoms of BPD, including depression and recklessness.

Eating Disorders

About 5% of the general population will deal with an eating disorder in their lives. Eating disorders are classified as severe ongoing issues with healthy eating patterns. The most common age group to experience an eating disorder is women between 12 and 35.

There are multiple types of eating disorders, including anorexia, bulimia, and binge eating disorder.

The connection between substance use disorder and eating disorders is complex. In some cases, individuals with an eating disorder may also experience depression, social isolation, and other symptoms that can compel them to self-medicate with substance use. Alternatively, some individuals with eating disorders may abuse specific drugs to lose weight (such as Adderall).

Self-Harm

Self-harm is injuring oneself as a negative way of coping with overwhelming emotions. It’s important to note that self-harm itself is not a mental illness but can often appear alongside a mental illness as a person’s way of dealing with their pain. Self-injury can take a few different forms, including cutting, punching, and/or burning oneself.

There are a few connections between self-harm and substance abuse. First of all, both self-harm and substance abuse can often result from emotional dysregulation and an attempt to cope through external means. Second, self-harm may also manifest as dangerous or reckless alcohol and drug abuse. And finally, the abuse of some drugs (such as methamphetamine) can result in self-harming behavior, such as excessive scratching and picking of the skin.

Treatment for Mental Health and Addiction

Overall, individuals struggling with a mental disorder are at a higher risk for developing substance use disorder. That’s because individuals with mental illness may seek outside ways of coping with the symptoms of their mental health conditions, sometimes turning to drug or alcohol abuse.

In treating substance use disorder for someone with a mental health issue, treatment may differ slightly from just treatment of substance use disorder. Patients with this comorbidity may not be eligible for particular Medication-Assisted Treatment (MAT), and they may also require more intensive therapy sessions to deal with both of their diagnoses.

The good news is that people with mental illness and substance use disorder still have a good chance of recovering from addiction. The key is to find a treatment program that addresses both conditions individually.

Resources for Mental Health and Addiction Support

Individuals with mental illness can benefit in multiple ways from the variety of programs available in the treatment of addiction.

Support groups such as Alcoholics Anonymous (AA) can provide important socialization and support that can assist with maintaining your sobriety and reduce loneliness and isolation. Some support groups also engage in healthy group outings unrelated to official recovery meetings, allowing for more opportunities to form healthy relationships with people you can rely on (and vice versa).

The types of therapy used to treat addiction are also beneficial for treating various kinds of mental illness. Cognitive-Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) are two of the most common forms of psychotherapy found in recovery treatment programs and treatment for mental health issues.

You Can Get the Support You Need

If you or your loved one is looking for help with a substance use disorder, you can call the Substance Abuse and Mental Health Services Administration (SAMHSA) Helpline at 1-800-662-4357.

Alternatively, the SAMHSA program locator can provide a referral for the types of treatment programs available in your area.

Reviewed by:Chris Carberg

Addiction Guide Founder & Mental Health Advocate

  • Fact-Checked
  • Editor

Chris Carberg is a visionary digital entrepreneur, the Founder of Addiction Guide, and a long-time recovering addict from prescription opioids, sedatives, and alcohol.  Over the past 15 years, Chris has worked as a tireless advocate for addicts and their loved ones, while becoming a sought-after digital entrepreneur. Chris is a storyteller and aims to share his story with others in the hopes of helping them achieve their own recovery.

Written by:

Content Manager

Jessica Miller is a USF graduate with a Bachelor’s Degree in English. She has written professionally for over a decade, from HR scripts and employee training to business marketing and company branding. In addition to writing, Jessica spent time in the healthcare sector (HR) and as a high school teacher. She has personally experienced the pitfalls of addiction and is delighted to bring her knowledge and writing skills together to support our mission. Jessica lives in St. Petersburg, FL with her husband and two dogs.

24 references
  1. Substance Abuse and Mental Health Services Administration. (2016). Obsessive-Compulsive Disorder and Substance Use Disorders. Advisory, Volume 15, Issue 3.
  2. Berenz, E. C., & Coffey, S. F. (2012, October). Treatment of co-occurring posttraumatic stress disorder and substance use disorders. Current psychiatry reports. Retrieved April 22, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3466083/
  3. BJ; C. F. A. E. P. C. (n.d.). Substance abuse in bipolar disorder. Bipolar disorders. Retrieved April 22, 2022, from https://pubmed.ncbi.nlm.nih.gov/11552957/
  4. Centers for Disease Control and Prevention. (2021, September 23). What is ADHD? Centers for Disease Control and Prevention. Retrieved April 22, 2022, from https://www.cdc.gov/ncbddd/adhd/facts.html
  5. Gupta, R., Narnoli, S., Das, N., Sarkar, S., & Balhara, Y. P. S. (2019). Patterns and predictors of self-harm in patients with substance-use disorder. Indian journal of psychiatry. Retrieved April 22, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767833/
  6. Khokhar, J. Y., Dwiel, L. L., Henricks, A. M., Doucette, W. T., & Green, A. I. (2018, April). The link between schizophrenia and substance use disorder: A unifying hypothesis. Schizophrenia research. Retrieved April 22, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6094954/
  7. Mancebo, M. C., Grant, J. E., Pinto, A., Eisen, J. L., & Rasmussen, S. A. (2009, May). Substance use disorders in an obsessive-compulsive disorder clinical sample. Journal of anxiety disorders. Retrieved April 22, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2705178/
  8. Mayo Foundation for Medical Education and Research. (2018, May 4). Anxiety disorders. Mayo Clinic. Retrieved April 22, 2022, from https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
  9. Mayo Foundation for Medical Education and Research. (2021, February 16). Bipolar disorder. Mayo Clinic. Retrieved April 22, 2022, from https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955
  10. Mental health and substance use co-occurring disorders. Mental Health and Substance Use Co-Occurring Disorders | MentalHealth.gov. (n.d.). Retrieved April 22, 2022, from https://www.mentalhealth.gov/what-to-look-for/mental-health-substance-use-disorders
  11. Mental health and substance use disorders. SAMHSA. (n.d.). Retrieved April 22, 2022, from https://www.samhsa.gov/find-help/disorders
  12. MP;, H. C. C. B.-G. J. W. (n.d.). Co-morbidity of eating disorders and substance abuse review of the literature. The International journal of eating disorders. Retrieved April 22, 2022, from https://pubmed.ncbi.nlm.nih.gov/7920577/
  13. Smith, J. P., & Book, S. W. (2008, October). Anxiety and substance use disorders: A Review. The Psychiatric Times. Retrieved April 22, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904966/
  14. Torres, F. (n.d.). What is depression? Psychiatry.org - What Is Depression? Retrieved April 22, 2022, from https://psychiatry.org/patients-families/depression/what-is-depression
  15. Trull, T. J., Freeman, L. K., Vebares, T. J., Choate, A. M., Helle, A. C., & Wycoff, A. M. (2018, September 19). Borderline personality disorder and substance use disorders: An updated review. Borderline personality disorder and emotion dysregulation. Retrieved April 22, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145127/
  16. U.S. Department of Health and Human Services. (2021, April 13). Part 1: The connection between Substance Use Disorders and mental illness. National Institutes of Health. Retrieved April 22, 2022, from https://nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness
  17. U.S. Department of Health and Human Services. (n.d.). Borderline personality disorder. National Institute of Mental Health. Retrieved April 22, 2022, from https://www.nimh.nih.gov/health/topics/borderline-personality-disorder
  18. U.S. Department of Health and Human Services. (n.d.). Substance use and co-occurring mental disorders. National Institute of Mental Health. Retrieved April 22, 2022, from https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health
  19. U.S. National Library of Medicine. (2021, August 10). Self-harm. MedlinePlus. Retrieved April 22, 2022, from https://medlineplus.gov/selfharm.html
  20. Watson, S. (n.d.). ADHD and substance abuse: Alcohol and drugs connected to ADHD. WebMD. Retrieved April 22, 2022, from https://www.webmd.com/add-adhd/adhd-and-substance-abuse-is-there-a-link
  21. What are eating disorders? Psychiatry.org - What are Eating Disorders? (n.d.). Retrieved April 22, 2022, from https://psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders
  22. What is OCD? International OCD Foundation. (n.d.). Retrieved April 22, 2022, from https://iocdf.org/about-ocd/
  23. What is posttraumatic stress disorder (PTSD)? Psychiatry.org - What is Posttraumatic Stress Disorder (PTSD)? (n.d.). Retrieved April 22, 2022, from https://psychiatry.org/patients-families/ptsd/what-is-ptsd
  24. What is schizophrenia? Psychiatry.org - What is Schizophrenia? (n.d.). Retrieved April 22, 2022, from https://psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia

Contact Us

If you or someone you love is struggling with addiction, there is help available. Get in touch today and let us guide you to the recovery option that’s right for you.

  • Receive customized guidance
  • Get up-to-date information
  • Find the treatment that’s right for you

Talk to an advocate now

Hidden
This field is for validation purposes and should be left unchanged.