A substance use disorder (SUD) is a treatable mental health disorder that impacts an individual’s brain and behavior, leading to an inability to control the use of substances like legal or illegal drug use, alcohol, or medications. Symptoms can range from moderate to severe, with addiction being the most severe form of SUD. Substance abuse and drug abuse problems can have devastating effects on an individual’s life, impacting their relationships, employment, physical and mental health, and overall well-being.
Individuals with SUD may also have another mental health disorder or mental illness, and individuals with mental disorders may struggle with substance use. These other mental health problems can include anxiety disorders, depression, attention-deficit hyperactivity disorder (ADHD), bipolar disorder, personality disorders, and schizophrenia, among others. The presence of multiple mental health conditions, including a SUD, is known as co-occurring disorders or dual diagnoses.
The Relationship Between Mental Health Problems and Substance Misuse
Mental health and substance use disorders are closely related. While individuals may have a substance use disorder and a mental disorder, it does not necessarily mean that one caused the other. However, a dual diagnosis can treat both. Research suggests three possibilities that could explain why substance use disorders and other mental disorders may occur together:Common Risk Factors For a Dual Diagnosis
Common risk factors can contribute to the development of both substance use disorders and mental health disorders, such as bipolar disorder. These risk factors may include genetics, stress, trauma, and environmental influences.Mental Disorders Contributing to Substance Use
A mental illness or several mental disorders can contribute to substance use and the development of substance use disorders. Individuals with mental health problems may turn to drug use or alcohol as a form of self-medication to cope with their symptoms.Substance Use Contributing to Mental Disorders
Substance use and substance use disorders can contribute to the development of other mental disorders. A chronic drug, such as ADHD medications or alcohol problems, can alter brain chemistry and lead to the onset of mental health issues. These possibilities are not mutually exclusive, and in some cases, all three may play a role in the co-occurrence of substance use disorders and mental health disorders.s and Substance Abuse According to the National Survey on Drug Use and Health (NSDUH), approximately 9.2 million adults in the United States had both a mental illness and a substance use disorder in 2018. This represents 3.7% of all adults in the country. The survey on drug use also found that individuals with a mental disorder or a mental health problem are at a greater risk of developing substance use disorders compared to those without mental illnesses.Diagnosis and Treatment
When an individual has a tendency to abuse alcohol or any substance use disorder and another mental health problem, it is generally better to treat them simultaneously rather than separately. Treatment should be tailored to an individual’s specific combination of co-occurring disorders and symptoms, considering factors such as age, the misused substance, and the specific mental disorder(s). Effective treatment may include behavioral therapies and medications, and it is essential to give the treatment time to work. The goal of treatment is to address both the substance use disorder and co-occurring mental health problems simultaneously, as they often exacerbate each other and can lead to a vicious cycle if left untreated.Behavioral Therapies for Substance Use Disorder
In addition to support groups for drug use, several effective behavioral therapies have shown promise for treating individuals with co-occurring substance use disorder and mental illness. For adults, cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), assertive community treatment (ACT), therapeutic communities (TC), and contingency management (CM) are commonly used approaches. For children and adolescents, effective behavioral treatments include brief strategic family therapy (BSFT), multidimensional family therapy (MDFT), and multisystemic therapy (MST).Medications for Substance Use Disorder
In addition to behavioral therapies, there are effective medications that treat opioid, alcohol, nicotine, and other drug addiction and withdrawal symptoms, as well as alleviate symptoms of other mental illnesses. Some medications may be useful in treating co-occurring disorders. Medications used to treat opioid use disorder include buprenorphine, methadone, and naltrexone. For alcohol use disorder, medications such as naltrexone, acamprosate, and disulfiram can help reduce cravings, prevent relapse, and discourage drinking. For other mental illnesses or mental disorders, like schizophrenia, bipolar disorder, and major depressive disorder, antipsychotics, mood stabilizers, and antidepressants may be prescribed.
When to Walk Away from Someone with Mental Illness
Deciding to walk away from someone with mental disorders is a personal choice that depends on individual circumstances. However, there are some situations where it may be necessary to distance yourself for your well-being:Abusive or Dangerous Behavior
If the person with mental illness is engaging in abusive, violent, or dangerous behavior towards you or others, especially if drug use is present, it is essential to prioritize your safety and well-being. Seek help from health care providers and support services if needed.Refusal to Seek Help
Often, family members are concerned about an increased risk of self-harm when a person suffering from one or multiple disorders doesn’t seek help. If the individual with mental illness consistently refuses to seek help from a treatment provider or adhere to treatment plans, despite your encouragement and support through one-on-one counseling or support groups, it may be necessary to set boundaries to protect your mental health.Negative Impact on Your Mental Health
If your relationship with a person with a severe mental illness is causing significant stress and anxiety or negatively impacting your mental health, it may be necessary to take a step back and focus on self-care. It is important to remember that walking away does not mean abandoning the person with mental illness. You can still offer support and encourage them to seek professional help while maintaining healthy boundaries for yourself.The Relationship Between Mental Health Disorders and Substance Abuse
Depression and substance use disorders often co-occur, and the relationship between the two can be complex. In some cases, individuals with depression may turn to recreational drugs or alcohol as a means of self-medication, attempting to alleviate their symptoms. Conversely, substance abuse can also lead to the development of depression, as chronic drug use can alter brain chemistry and contribute to feelings of sadness, hopelessness, and despair. Research suggests that depression and substance abuse share common risk factors, such as genetics, stress, and trauma. Additionally, the presence of one condition can exacerbate the symptoms of the other, creating a vicious cycle that can be difficult to break without professional intervention. When treating co-occurring depression and substance abuse, it is crucial to address both conditions simultaneously. This integrated approach, known as dual diagnosis treatment, combines mental health services and substance abuse treatment to provide comprehensive care. By addressing the underlying causes and symptoms of both serious mental illnesses and substance abuse problems, individuals can work towards lasting recovery and less mental health.
