The relationship between mental health disorders and substance addiction is complex. Every individual is different, and both issues encompass so much variety as to render any generalization loose at best. After all, even if we were to brush over epigenetic, social, and psychological factors, there are myriad types of substance addictions, each with its own unique pathology and neurochemical effects.
Furthermore, while being distinct disorder categories, psychiatric conditions such as schizophrenia, bipolar disorder, major depressive disorder, and ADHD show clinical overlap. This can make it difficult to correctly identify disorder-specific treatments with recourse to old classification systems.
That being said, despite it being something of a ‘chicken and egg’ subject, the connection between mental health disorders and substance use has been widely studied, and comorbidity is shown to be extremely common.
According to reports published in the Journal of the American Medical Association, roughly 50 percent of individuals with severe mental health disorders are affected by substance abuse. Furthermore, 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental health illness.
What is comorbidity?
When two conditions, like a mental health disorder and a substance use disorder, co-exist, this is what’s known as comorbidity. While (from a technical standpoint) neither condition can be said to cause the other, they are usually interrelated: substance use can exacerbate a mental health disorder, and mental illness can contribute to addictions.
While a holistic framework is always the most effective approach to this kind of comorbidity, thinking about it in neurological terms helps garner a better understanding. For example, regular substance use can rewire the brain, causing it to function differently than before. This rewiring can lead to and exacerbate many mental health conditions.
Interestingly, the neurological alterations caused by many addictions take place in the frontal cortex: the same area of the brain impacted by anxiety, bipolar disorder, schizophrenia, and depression.
Certain mental health disorders, like schizophrenia, have been shown to increase the risk of drug use. Often, people who suffer from a mental illness will turn to addictive substances to self-medicate in order to cope with their symptoms (or to reduce the side effects of prescribed medication).
So, while the link is complex, the high rate of comorbidity between substance use and mental health disorders is unsurprising.
How substance use and mental health disorders are interrelated
There’s no question that substance abuse and mental health are inextricably linked and there now exists a considerable body of evidence that supports this connection. However, where one begins and the other ends is still a topic of ongoing debate.
From one standpoint, substance use disorders can contribute to the onset of mental illnesses by initiating vulnerability that can trigger disorder symptoms. Addictions can also influence the course and progression of a mental health disorder and/or complicate pre-existing mental health conditions.
Studies show that individuals with a history of drug or alcohol abuse often suffer from co-occuStudiesrring disorders, such as anxiety or depression. Even if these cases did not involve an existing mental health condition prior to substance use, opioids and other drugs can cause inflammation in the brain, leading to chemical changes and consequent psychological distress.
In extreme cases, substance use can increase suicidal ideation, suggesting that those who use specific substances are at higher risk for suicide than those who don’t. If left untreated, each component of this cycle — substance use, brain changes, worsening mental health — will accelerate over time, profoundly affecting an individual’s overall health and well-being.
On the other side of this apparent dichotomy, some mental health disorders can be risk factors for developing a substance use disorder. Despite how it may appear, this is not a fringe issue. People with severe, mild, or even subclinical mental health disorders often end up using substances as a way to cope with their symptoms.
While certain drugs may appear to offer relief temporarily, they can also exacerbate symptoms – both acutely and over the long term. For example, evidence suggests that periods of cocaine use may worsen the symptoms of bipolar disorder and contribute to the progression of this illness.
Certain mental health disorders can also change a person’s neurochemical relationship with the substance, enhancing the rewarding effects, decreasing awareness of the negative effects, or reducing unpleasant symptoms or side effects from the medication used to treat it.
Put simply, when a person develops a mental health illness, the resultant alterations to brain chemistry can make them more susceptible to addictions.
Reframing mental health disorders and substance abuse
The word ‘disorder’ presupposes a binary, as if humans, like machines, are either in good working order or malfunctioning. The prevalent stigmatization of addiction and mental illness isn’t served by the language it’s often couched in – the reality is much more nuanced than many articles or studies convey.
Humans are infinitely complex and defy such neat categorization. This is often what makes comorbidities of mental health disorders and substance use so difficult to accurately diagnose.
Indeed, in the last decade, the DSM-5 (The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders) has been criticized by some experts in the field. There are several studies outlining issues in the dominant methodology of psychiatric diagnosis. For example, this 2014 paper concluded that:
“The DSM shows both scientific and clinical limits, its wide use and the blind approval of its categories and criteria must be carefully reconsidered. When the DSM is used, it must be accompanied with alternative perspectives, emphasizing different aspects of human suffering including social, environmental, and political dimensions.”
While receiving a diagnosis can be immensely helpful for those suffering from a mental health disorder, it’s advised not to take such diagnoses as gospel – people are not defined by their mental illness.
There are emerging modalities that seek to make up for what the DSM may have left out. Developed in the UK by a group of senior psychologists, The Power Threat Meaning Framework is an alternative to more traditional models based on psychiatric diagnosis. Rather than being aimed at a subset of society, the PTMF has universal application, and the approach can be summarised by these four core questions:
- What has happened to you? (How is Power operating in your life?)
- How did it affect you? (What kind of Threats does this pose?)
- What sense did you make of it? (What is the Meaning of these situations and experiences for you?)
- What did you have to do to survive? (What kinds of Threat Response are you using?)
Using this framework, we can see how substance use could be a threat response for many people who suffered from early trauma. So, while mental health disorders can serve as a loose guide, an effective approach to treatment must be built upon an in-depth understanding of each person’s unique relationship with trauma and substance use.
Treatment for comorbidity of mental health disorders and substance use
Rather than seeing addictions as ‘diseases,’ or mental illnesses as ‘disorders,’ it is perhaps more helpful to view both sets of afflictions as overlapping responses to trauma. People who go through these ordeals aren’t just statistics in studies. They are, first and foremost, human beings; human beings who need love, acceptance, compassion, and support above all else.
Depending on the nature of the comorbidity, treatment can vary widely. The most important thing is that every individual is cared for according to their specific needs. Such treatment must incorporate all aspects of healing, not just medication and psychotherapy. Diet, exercise, mindfulness, being in nature, and a sense of love and belongingness – are all invaluable components of sustainable recovery.
How we can help
At the Centres for Health and Healing, we understand how addiction and mental health issues go hand in hand. Consequently, our team of experienced, caring professionals provides a range of treatments and therapies that encompass both, so they can be treated together in a coordinated way.
Our holistic approach is tailored to the individual’s needs and includes family support, group sessions, and aftercare, ensuring that every stage of your recovery is carefully tended to.
If you’d like to talk to us about a mental health condition and/or substance abuse, please contact us.
Additional Resources
- Why Mental Health Disorders Co-Exist With Substance Use VeryWell Mind, July 16, 2021.
- Why is there comorbidity between substance use disorders and mental illnesses? National Institute on Drug Abuse, April 13, 2021.
