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Updated on September 26, 2022

Substance Abuse & Mental Health

Is Drug Addiction a Mental Illness?

According to the National Institute of Mental Health (NIMH), drug addiction is officially classified as a mental illness.4

Drug addiction is a severe type of substance use disorder (SUD). It’s considered a mental disorder that affects the brain and behavior. It leads to the inability to control substance use, like drugs or alcohol.4


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Connection Between Substance Use and Mental Health

About half of people with a substance use disorder (SUD) also cope with a co-occurring mental health or personality disorder. These disorders include:3, 4

  • Depression
  • Anxiety
  • Bipolar disorder
  • Post-traumatic stress disorder (PTSD)
  • Borderline personality disorder (BPD)
  • Antisocial personality disorder (ASPD)
  • Psychotic illness
  • Schizophrenia
  • Attention-deficit hyperactivity disorder (ADHD)

Also, about 1 in 4 people with a serious mental illness also have a substance use disorder (SUD). 

A serious mental illness refers to a diagnosable mental, behavior, or emotional disorder. The disorder must have led to impaired functioning that majorly impacted at least one significant life activity in the past year.3

More than 60 percent of adolescents in community-based treatment programs for SUD also struggle with other mental illnesses.3

What Comes First, Mental Illness or Substance Use?

Mental health disorders can lead to substance abuse, and substance use can lead to mental health disorders. Either can come first, and each can impact the other.

What is comorbidity?

When two or more disorders affect someone at the same time or one after the other, it’s called comorbidity, or co-occurring. When comorbidity occurs, the ways in which the illnesses interact can worsen.2

Why do people abuse drugs?

Someone struggling with a mental health disorder like depression may start to use drugs to feel a temporary, euphoric high. Many people use drugs or alcohol to escape or as a coping mechanism.4

Some drugs used to treat symptoms of mental health disorders can also become addictive or worsen symptoms over time.4 

Who is at risk of abusing drugs?

People with mental health and personality disorders have an increased risk of prescription opioid misuse.

Forty-three percent of people in addiction treatment for prescription painkillers are also diagnosed with or exhibit symptoms of mental health disorders like depression and anxiety.3

Someone battling a substance use disorder might also develop another mental health disorder like anxiety. This person might start to feel anxious if they haven’t had their fix. This means they have become reliant on drugs or alcohol to function.4

What risk factors do addiction and mental health disorders share?

Any brain functioning changes from substance use can take a mental toll.4

However, just because addiction and a mental health disorder are co-occurring, doesn’t mean that one caused the other. Addiction and mental health disorders share common risk factors, including family history, stress, and trauma.4​​

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How Drugs Change the Brain 

Addiction is considered a chronic, relapsing, complex brain disorder. It’s characterized by compulsive substance-seeking and continued use despite damaging consequences.5, 6

Drugs change the chemical makeup and functioning of the brain in significant ways. For example, they can change how a person behaves and weaken their ability to control impulses.2

This occurs because addictive drugs target the brain’s reward center, basal ganglia. The drugs flood the striatum with the feel-good endorphin, dopamine.5, 6

Dopamine regulates emotion, cognition, and motivation. It also reinforces rewarding behaviors, which drives people to use drugs more often.5

Signs of Co-Occurring Disorders

Major signs of substance use problems include: 

  • Taking the substance in larger amounts or over a longer than intended
  • Having a persistent desire for the substance
  • Struggling to cut back on, control the intake of, or quit using a substance
  • Spending a lot of time trying to obtain the substance, which takes a toll on other work and life responsibilities
  • Continuing to use the substance despite negative effects on physical or mental health and professional or personal relationships
  • Developing a higher tolerance for the substance over time, which results in needing a larger amount to achieve the desired effect
  • Experiencing withdrawal symptoms when trying to cut back on or quit using the substance
  • Using the substance to avoid or alleviate withdrawal symptoms

There are also some signs of mental health disorders to look out for. They vary depending on the mental illness. 

Some common signs of mental health issues, which can also be signs of a SUD, include:1

  • Mood swings
  • Irritability
  • Appetite changes
  • Changes in sleep patterns
  • Lacking motivation
  • Appearing fearful
  • Paranoia or anxiety
  • Engaging in secretive or suspicious activities
  • Frequently getting into trouble
  • Weight gain or weight loss

If you or someone you know is exhibiting any of the above signs, reach out for help.

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Treatment for a Dual Diagnosis 

Fortunately, if you or a loved one of yours is struggling with addiction, another mental health disorder, or a dual diagnosis, help is available.

Here are some common treatment options: 

  • Cognitive behavioral therapy (CBT) is a talk therapy that helps unpack the root cause(s) of mental health issues. Cognitive-behavioral therapists help people develop healthy coping mechanisms and fight addiction.4
  • Dialectical behavioral therapy (DBT) incorporates mindfulness and attentiveness to a person’s emotional state. Dialectical-behavioral therapists teach their patients the skills they need to control emotions and limit destructive behaviors.4
  • Assertive community treatment involves a community of people who share similar mental health struggles.4
  • Support groups like Alcoholics Anonymous (AA) help connect and empower people struggling with addiction. 
  • Inpatient and outpatient rehabilitation centers rely on medical and mental health professionals to assist and monitor people going through detox. 
  • Holistic therapies include meditation and yoga practices, nutritional guidelines, and body movement to release natural endorphins.
  • Certain medications are approved for treating addiction and may even reduce mental health disorder symptoms.4 For example, bupropion can treat depression (Wellbutrin) and nicotine addiction (Zyban).

If you’re worried about a co-occurring mental illness, consult your doctor about your symptoms. Your healthcare provider can help determine which treatment option(s) is best for you.

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  1. Mental Health and Substance Use Disorders.” Mental Health and Substance Use Disorders |
  2. National Institute on Drug Abuse. “Comorbidity: Substance Use Disorders and Other Mental Illnesses Drugfacts.” National Institute on Drug Abuse, 10 Jun. 2021.
  3. National Institute on Drug Abuse. “Part 1: The Connection between Substance Use Disorders and Mental Illness.” National Institute on Drug Abuse, 13 Apr. 2021.
  4. Substance Use and Co-Occurring Mental Disorders.” National Institute of Mental Health, U.S. Department of Health and Human Services.
  5. Substance Use Disorder Defined by NIDA and SAMHSA.” SAMHSA.
  6. Why Addiction Is a Disease, and Why It’s Important.” SAMHSA.

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