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Updated on October 12, 2021

Connection Between Substance Use Disorders (SUD) and Mental Health

Substance Abuse and Mental Health Issues

Substance abuse and mental health issues go hand-in-hand. There is a proven connection between substance use disorders (SUD) and mental health disorders. Many people struggle with both issues, and for most, one drives the other in some manner.

How does someone know if they have a substance use disorder (SUD) and a mental health issue?

  • Use a substance, either drugs or alcohol, to cope with intense moods, frightening situations, difficult memories, or unpleasant feelings
  • Notice a link between the use of a substance and mental health, such as getting depressed when drinking alcohol or feeling depressed and turning to alcohol
  • Have relatives with mental health issues or engage in drug or alcohol abuse
  • Experience feelings of anxiety or depression when sober
  • Have an unresolved history of abuse or trauma
  • Might have previously undergone treatment for mental health issues or substance abuse

What are Co-occurring Disorders?

A substance use disorder (SUD) accompanied by a mental health disorder is called a co-occurring disorder. This means that two or more health issues are happening concurrently and likely contribute to one another. It also means when one problem goes untreated, the other worsens.

Mental health disorders and substance abuse disorders frequently occur in tandem. According to the National Alliance on Mental Illness, about half of all people with severe mental illnesses abuse drugs. More than one-third of all people with alcohol use disorder and more than one-half of all drug abusers are also battling mental illness. And of everyone diagnosed with a mental health disorder, nearly a third abuse drugs or alcohol.

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Why Is It Challenging to Diagnose Both Conditions?

Co-occurring disorders can be challenging to diagnose. One reason is that the symptoms may vary in severity and be complex. It is not unusual for people to receive treatment for one condition while the other remains untreated.

Sometimes this occurs because the symptoms are so similar or overlap. Both mental health conditions and addiction can introduce similar biological, psychological, and social components.

Another reason why it may be difficult to diagnose both conditions is due to inadequate training or screening. The consequences of undiagnosed, undertreated, or untreated co-occurring conditions can lead to higher chances of experiencing homelessness, prison, medical illnesses, and suicide.

People with mental health problems who also abuse drugs or alcohol are at an increased risk for impulsive or violent behavior and acts, potentially introducing them to legal trouble. Achieving and maintaining sobriety may be particularly challenging.

Does Substance Abuse or a Mental Health Problem Come First?

There is no rule as to whether a substance use disorder or mental health disorder comes first. The situation is different for everyone. One does not cause the other, though the two share a link.

Some people with mental illness use drugs or alcohol to self-medicate and manage the symptoms of their mental illness, especially when undiagnosed. Substances make it easier for some people to deal with difficult emotions or alter their moods. Unfortunately, substance use disorders tend to have a negative long-term effect on your mental health. A person might feel better initially, but over time both problems will worsen.

Abuse of alcohol and drugs also increases the underlying risks of mental health disorders. Mental health issues are linked to a person’s genetics, environment, and a variety of other external factors. Alcohol or drug use could serve as a “tipping point” for anyone at risk for mental illness.

The use of alcohol and drugs makes symptoms of mental illness worse. The use of substances can also cause mental health medication less effective.

Symptoms of Substance Abuse

Recognizing the symptoms of substance use disorders is an important factor in getting appropriate healthcare support. A person who has any of the following symptoms might have a substance use disorder:

  • Desire to cut back on substance use but not being able to do so
  • Dishonesty about drug or alcohol use
  • Overusing pharmaceuticals and needing more before a prescription runs out
  • Friends and family express concern or discontentment with drug or alcohol use
  • Feelings of guilt or shame related to drug or alcohol use
  • Blacking out from drinking or drug use
  • Relationship problems linked to drinking or drug use
  • Problems at work, at school, or with the law due to drinking or drug use

Symptoms of Common Mental Health Disorders

There are many different mental health disorders, but some are more commonly linked to alcohol and drug abuse. These include depression, anxiety, mood or personality disorders, and PTSD.

Symptoms of Depression

  • Hopeless or helpless feelings
  • Loss of interest in once-beloved activities and everyday life
  • Inability to feel pleasure
  • Changes in weight and/or appetite
  • Loss of energy
  • Sleeping a lot more or less
  • Problems concentrating
  • Intense feelings of guilt or worthlessness
  • Anger
  • Physical pain
  • Reckless behaviors (tends to occur more in males)

Symptoms of Anxiety

  • Chronic worry or tension
  • Feelings of restlessness
  • Feeling irritable or “on edge”
  • Nausea, dizziness, or trembling
  • Shortness of breath or rapid heartbeat
  • Headaches
  • Muscle tension
  • Problems concentrating
  • Insomnia

Symptoms of Mood or Personality Disorders

  • Intense and unpredictable mood swings
  • Black and white thinking
  • Fear of abandonment that leads to poor boundaries in relationships
  • Patterns of unhealthy or unstable relationships
  • Distorted self-image or sense of self
  • Impulsiveness or recklessness
  • Self-harming behavior
  • Suicidal thoughts, threats, or behavior
  • Feeling of emptiness
  • Anger management issues
  • Trust issues

Symptoms of PTSD

Post-traumatic stress disorder (PTSD) can occur anywhere from a month to years after the traumatic event. Symptoms can interfere with work, relationships, and overall quality of life. Health experts group PTSD symptoms into four categories including:

  • Intrusive memories, which include recurrent memories of the event, nightmares, and physical reactions triggered by memories of the event
  • Avoidance of conversations about the event or things that remind a person of the event
  • Negative changes in thinking and mood that might also include numbness, lack of interest, memory problems, and feelings of detachment from family and friends
  • Changes in physical and emotional reactions, which can include insomnia, easily startled, constantly feeling “on guard,” and self-destructive behavior

This is not a comprehensive list. Symptoms tend to vary over time or from person to person.

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Helping a Loved One with a Dual Diagnosis

Helping a loved one with a substance and mental health problem can be challenging. Resistance to treatment is common, and reaching recovery can be long.

The best way to help a loved one is to accept what you can and cannot do. You cannot force someone to become or remain sober, nor can you make someone take their medicine or attend appointments.

What helps is making positive choices for yourself, encouraging loved ones to seek help, and offering your help and support while ensuring you do not lose yourself in the process.

Treatment for Co-occurring Disorders

Treatment is available for co-occurring mental health disorders and substance use disorders. Treating only one or the other is rarely effective. Integrated treatment approaches addressing both issues simultaneously work best.

Treatment for mental health disorders might include:

  • Individual or group counseling
  • Medication
  • Peer support
  • Lifestyle changes

Treatment for substance use disorder might include:

It also helps to:

  • Consider the role of alcohol and/or drugs in your life
  • Find rewarding employment and/or hobbies
  • Educate yourself about drugs and alcohol and how substances affect mental health
  • Design recovery goals that are unique to you
  • Learn to manage overwhelming emotions
  • Build a connection with people
  • Make healthy lifestyle changes that incorporate exercise, healthy eating, and a proper amount of sleep
  • Avoid situations that trigger the urge to use drugs or alcohol

Finding the Right Treatment Program

When choosing a treatment program for co-occurring disorders, ensure that it is appropriately licensed and accredited with therapies backed by research. You should also ensure it has an aftercare program to prevent relapse.

As well as this, you should ensure that the program has experience with your particular mental health problem. Some programs may not experience treating certain mental health issues, like schizophrenia or bipolar disorder.

There are several approaches that treatment programs may take, but here are the basics you should seek:

  • Addresses both the substance abuse issue and your mental health condition
  • You are involved in the decision-making process and in setting goals, and creating strategies for change
  • Treatment involves basic education about your disorder and related issues
  • You learn healthy coping strategies to reduce substance abuse, strengthen your relationships, and deal with life’s stressors

Recovery can be more challenging for those with co-occurring conditions, but it is still possible with proper support.

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“NIMH » Borderline Personality Disorder.” Nih.Gov, 4 Dec. 2018

“Post-Traumatic Stress Disorder (PTSD) - Symptoms and Causes.” Mayo Clinic, 2018

Behavioral Health, United States, 2012. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013. 4, MENTAL HEALTH AND SUBSTANCE USE DISORDERS: TREATMENT LANDSCAPE.

Hartwell, Karen J et al. “Biologic Commonalities between Mental Illness and Addiction.” Primary psychiatry vol. 16,8 (2009): 33-39.

Mental Health, MedlinePlus, April 2015

Hartwell, Karen J et al. “Biologic CommonMcLellan, A Thomas. “Substance Misuse and Substance use Disorders: Why do they Matter in Healthcare?.” Transactions of the American Clinical and Climatological Association vol. 128 (2017): 112-130.

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