Substance Use and Mental Health

When you have both a substance use problem and a mental health issue such as depression, bipolar disorder, or anxiety, it is called a co-occurring disorder or dual diagnosis. Dealing with substance use, alcoholism, or drug addiction is never easy, and it’s even more difficult when you’re also struggling with mental health problems.

In co-occurring disorders, both the mental health issue and the drug or alcohol addiction have their own unique symptoms that may get in the way of your ability to function at work or school, maintain a stable home life, handle life’s difficulties, and relate to others. To make the situation more complicated, the co-occurring disorders also affect each other. When a mental health problem goes untreated, the substance use problem usually gets worse. And when alcohol or drug use increases, mental health problems usually increase too.

Co-occurring substance use disorders and mental health issues are more common than many people realize. According to reports published in the Journal of the American Medical Association:

Roughly 50 percent of individuals with severe mental disorders are affected by substance use.
37 percent of people with an alcohol use disorders and 53 percent of people with a substance use disorder also have at least one serious mental illness.
Of all people with a mental health diagnosis, 29 percent misuse alcohol or drugs.

While substance use problems and mental health issues don’t get better when they’re ignored—in fact, they are likely to get much worse—it’s important to know that you don’t have to feel this way. With the right support, self-help, and treatment, you can overcome a co-occurring disorder, reclaim your sense of self, and get your life back on track.

What Comes First: Substance Use or the Mental Health Problem?

Substance use disorders and mental health disorders such as depression and anxiety are closely linked, although one doesn’t necessarily directly cause the other. Use of substances such as marijuana or methamphetamine can cause prolonged psychotic reactions, while alcohol can make depression and anxiety symptoms worse.

Determining Whether You Have a Dual Diagnosis:

Do you use alcohol or drugs to cope with unpleasant memories or feelings, to control pain or the intensity of your moods, to face situations that frighten you, or to stay focused on tasks?
Have you noticed a relationship between your substance use and your mental health? For example, do you get depressed when you drink? Or drink when you’re feeling anxious or plagued by unpleasant memories?
Has someone in your family grappled with either a mental health disorder or an alcohol or drug use?
Do you feel depressed, anxious, or otherwise out of balance even when you’re sober?
Have you previously been treated for either your addiction or your mental health problem? Did the substance use treatment fail because of complications from your mental health issue or vice versa?

Treatment for your mental health problem may include medication, individual or group counseling, self-help measures, lifestyle changes, and peer support.

Treatment for your substance use disorder may include detoxification, assessment, managing of withdrawal symptoms, substance use counseling, and support groups to help maintain your sobriety.

Depending on your specific issues, the best treatment for co-occurring disorders is an integrated approach, where both the substance use disorder and the mental health disorder are treated simultaneously. Whether your mental health or substance use problem came first, long-term recovery depends on getting treatment for both disorders by the same treatment provider or team.