It is not unusual for individuals with a mental health diagnosis or condition to also have an addiction or substance use disorder—or those who with a substance use disorder to also have mental health issues.

According to the 2021 National Survey on Drug Use and Health: 

• Of 44 million adults in the U.S. with substance use disorder, 19.4 million also have a mental illness.
  
• Of the 14.1 million adults with a serious mental illness (such as psychotic, personality and anxiety disorders and treatment-resistant depression), 6.4 million also have substance use disorder.
  
  

Self-Medicating to Cope

Sometimes, those with mental illness use substances to self-medicate or cope with their mental health condition, says psychiatrist Ram Mahato, M.D., medical director at the Center for Behavioral Health at JFK University Medical Center. Conversely, individuals who use illicit drugs, alcohol, prescription medications or other substances to cope may find themselves, for example, depressed, because their substance abuse has led to a loss of important things in their lives like relationships, a job, a house, a car.

In many cases, individuals may initially seek care for the one condition that is causing the most pain, challenges or disruption to their lives. That could be either the substance use, or a mental health issue like depression.

Once they talk to someone and seek care, it is very common for people to realize that self-medicating through substance use is only temporarily masking mental health or other emotional issues, and the journey to treat both issues together can begin.

“There are associations with substance use and ongoing mental illnesses, but one doesn’t necessarily cause the other,” Dr. Mahato says. “In fact, both addiction and mental illness have biological predispositions, and are also greatly influenced by life circumstances, trauma, and other factors that influence how people process and manage their feelings.” 

Common Risk Factors for Substance Use Disorder and Mental Illness

While the relationship between substance use disorder and mental illness is not fully understood, the two conditions are quite common and typically referred to as “co-occurring”. One condition may also predispose someone to the other. That crossroads exists because substance use disorder and mental illness share common risk factors, Dr. Mahato says. 

Common risk factors include:

• Adverse childhood experiences(ACE), such as abuse (physical, verbal or emotional), neglect or lack of supportive and loving relationships
• Biological vulnerabilities, such as a family history of substance use disorder and/or mental illness
• Trauma or PTSD, such as exposure to war, violence, tragic events, injury, abuse or loss
• Psychosocial stressors, such as going through a divorce or being laid off from a job
• Depression during or after pregnancy

This list is not exhaustive – mental illness and substance use disorders can develop at any time and do not have to result from specific trauma.

It’s important to prioritize self care and regularly take inventory of your mental health and well-being. If you notice changes in your mood like persistent sadness or a loss of interest in normal activity, don’t hesitate to seek care. Sometimes we don’t notice these changes in ourselves, so pay attention to trusted family and friends who are expressing concern. They typically have your best interests at heart.

Treatment for Substance Use Disorder and Mental Illness

Ideally, treatment for both substance use disorder and mental illness can happen at the same time. “If you are just treating opioid use disorder or alcohol use, and you're not addressing the person’s anxiety and depression, the likelihood of them abstaining from use is much less likely,” Dr. Mahato says. “We can address both at the same time leading to long term success and happiness.”

To effectively treat people with substance use disorder and mental illness, care professionals must first determine if the substance use stems from a primary mental illness (for example, if a person is using alcohol to cope with bipolar disorder symptoms) or if a substance is causing mental illness symptoms (for example, someone experiencing delusions caused by taking opioids).

With an understanding of what is going on with a particular individual, a plan for inpatient and outpatient care is developed that typically incorporates medications(MAT or Medication-Assisted Treatment) for the specific substances used and for the mental illness with a variety of therapies, including support groups, motivational interviewing, cognitive behavioral therapy, coping skills education, and drug and psychological counseling.

Dr. Mahato says appropriate treatment works to improve the health and wellbeing of people with co-occurring chemical dependencies and mental illness. “We work with patients at their level of readiness,” he says. “There is absolutely hope for these patients.”

Next Steps & Resources:

• Meet our source: Ram Mahato, M.D.
• To make an appointment with a behavioral health specialist near you, call 800-822-8905 or visit our website.

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.