Mental Health And Addiction: Connecting Mental Disorders And Substance Use Disorder

The connection between addiction and mental disorders is often bi-directional, and there are many factors that can contribute to their co-occurrence. With increased research on the topic, experts are beginning to understand more about the complexities of their relationship and develop more effective strategies for prevention and treatment. This article discusses the relationship between mental health and addiction, and how mental health professionals address this complex dynamic. 

What is a substance use disorder (SUD)?

Substance use disorder is a condition in which an individual becomes psychologically and sometimes physically dependent on a substance to the extent that they cannot control their urge to use it. With repeated use, the substances can cause changes in an individual’s brain structure and function in the areas responsible for learning, memory, decision-making, and behavioral control. People with SUDs might understand they have a problem, but are often unable to stop, even if they want to. 

How common is substance use disorder in the US?

Studies are ongoing, but key statistics from the Substance Abuse and Mental Health Services Administration (SAMHSA)'s 2023 National Survey on Drug Use and Health reveal that approximately 48.5 million Americans aged 12 or older (17.1%), have a substance use disorder. Substance use disorder can be broken down into different categories such as alcohol use, drug use, marijuana use disorders, or a combination. Prevalence numbers in the U.S. include:

• Alcohol use disorder (AUD): Roughly 28.9 million
• Substance use disorder (SUD): Approximately 27.2 million
• Both AUD and DUD: 7.5 million
• Marijuana use disorder: 19.2 million

The prevalence of SUDs varies across age demographics, as well. In 2023:

• 27.1% of young adults aged 18-24 had an SUD
• 16.6% of adults aged 26+ had an SUD
• 8.5% of adolescents aged 12-17 had an SUD 

Shared risk factors for substance use disorder and other mental health disorders

Substance use and other mental health disorders also often share common risk factors. These might include:

• Trauma
• Severe, chronic stress
• Adverse childhood experiences (ACEs)
• Genetics

Recent research highlights the role that genetics plays in predisposition for substance abuse and/or mental health issues in individuals. While genetics may provide a predisposition, environmental and experiential factors often serve as triggers. (The study of how environmental factors can alter gene expression without changing DNA is called epigenetics.) For example, adverse childhood experiences, such as abuse or neglect, can cause epigenetic changes that increase the risk for both mental illness and SUDs. These experiences can alter the brain's stress response system, affecting areas involved in motivation and emotional regulation.

Mental health and addiction: Young people

Substance use and addiction can happen at any age, but they typically begin in adolescence— as do the first signs of many mental conditions. As the brain continues to develop, mechanisms responsible for areas like impulse control and decision making mature in the later stages, potentially increasing an adolescent’s vulnerability to SUDs. Early substance use is a significant risk factor for SUDs later in life and may also increase the risk for mental conditions later in life. The inverse can be true as well. Developing a mental disorder in childhood or adolescence can increase the risk of SUDs later in life. 

Substance abuse and anxiety disorders

Like many other comorbidities, substance use and anxiety disorders share a bi-directional relationship. For example, people with anxiety disorders may use alcohol, drugs, or other substances to alleviate symptoms like fear and panic, and studies show that individuals with baseline anxiety disorders have a heightened risk of developing new-onset substance use disorders. 

For individuals without a pre-existing anxiety disorder, prolonged substance use can disrupt the nervous system, cause inflammation, and rewire the brain, which can lead to mental illnesses like anxiety. Additionally, physical symptoms during withdrawal from substances can include panic attacks, potentially contributing to the cycle of abuse. 

SUDs and mood disorders

The Substance Abuse and Mental Health Services Administration estimates that 19.4 million adults experience a co-occurring substance use disorder and mental illness in 2021. Bipolar disorder has one of the highest rates of co-occurring SUDs among all psychiatric disorders, according to a study from The National Institutes of Health. Like anxiety disorders, high comorbidity between SUDs and mood disorders may be driven by shared underlying factors such as genetics, trauma, and brain changes as well as a person's attempt to self-medicate mood symptoms with substances. 

SUD and psychotic disorders

Substance use disorders (SUDs) and psychotic disorders, particularly schizophrenia, frequently co-occur, with high rates of cannabis, tobacco, alcohol, cocaine, and amphetamine use. The disorders often share common risk factors, which can present diagnostic challenges and lead to poor health outcomes for those affected. Substances can both cause psychotic symptoms and mimic them, while existing psychotic disorders can be exacerbated by substance use. 

Other comorbid mental disorders

Numerous studies have established a significant connection between increased SUD risk and untreated ADHD in childhood and adolescence. The reasons are complex, but some use substances as a form of self-medication for ADHD symptoms. Additionally, the  ADHD brain is “wired” to respond to pleasure differently than neurotypical individuals, potentially enhancing the effects of drugs and alcohol. 

Borderline personality disorder (BPD) and antisocial personality disorder (ASPD) can be particularly prevalent in individuals with SUDs—studies suggest up to 50% of individuals with BPD and APD also have a substance use disorder. Studies also show that 30-60% of individuals with post-traumatic stress disorder (PTSD) have a comorbid SUD. 

Dual diagnosis for substance use disorder with comorbid conditions

To diagnose comorbidity of SUD and mental illness, experts may use screening tools and interviews to assess an individual’s symptoms, history, current lifestyle, exposure to environmental factors, and more. Though they may vary widely, symptoms of SUD and mental conditions often overlap. Overlapping symptoms might include:

• Trouble focusing
• Social withdrawal and isolation
• Mood swings
• Sudden behavior changes
• Engaging in risky behaviors
• Changes in sleeping and eating patterns
• Challenges with functioning in daily life

Treatment for substance abuse, mental health and addiction issues

Timely screening and early intervention for mental health problems can help prevent the development of substance use disorders and vice versa. Addressing both conditions simultaneously may be key, as treating one without the other might not be effective. Research shows that integrated treatment, which addresses both conditions simultaneously, is  the most effective approach for individuals with co-occurring disorders. 

Psychotherapy

Therapy methods for co-occurring SUDs and mental disorders are often tailored to the individual’s unique needs and circumstances. Common treatments include:

• Cognitive behavioral therapy (CBT): CBT helps individuals identify and change negative thought patterns and behaviors associated with their mental health and substance use. It is one of the most effective types of therapy for comorbid SUDs and mental disorders.
• Dialectical behavior therapy (DBT): DBT teaches skills for managing emotions and reducing self-harming behaviors, which can include substance use. 
• Motivational interviewing: Motivational interviewing is a client-centered approach that helps people explore their motivations and resolve ambivalence about addressing their substance use. 
• Mindfulness-based relapse prevention (MBRP): MBRP combines mindfulness meditation with strategies to help individuals recognize and respond skillfully to risk exposure and cravings and potentially prevent relapse. 

Medications

Medications to treat SUDs and co-occurring mental health conditions may be used to address the addiction (particularly if it’s a severe condition like opioid use disorder), the mental illness, or both. For example, alcohol or substance misuse may be treated with naltrexone to block the rewarding effects of the substance. Mood stabilizers or antidepressants might be used to treat depression, bipolar, or anxiety. 

Medication assisted treatment is most effective when combined with therapy such as CBT. Treatment plans can be tailored to the individual and might involve different combinations of medication and therapeutic techniques. 

Group therapy

Group therapy can help individuals with co-occurring substance use and mental health disorders. Group settings can provide a support network, connecting individuals with peers who share similar challenges, which may help combat the isolation and stigma often associated with both mental health conditions and substance use disorders. Group therapy might offer practical benefits, as well, including: 

• Skill development: Group therapy offers a structured environment for learning and practicing new coping mechanisms and communication skills essential for recovery and relapse prevention. 
• Peer feedback and modeling: Participants can gain valuable insights and strategies by observing and learning from the experiences and behaviors of other group members under a therapist's guidance. 
• Increased motivation: Group settings can boost motivation for treatment and engagement, as individuals see others making progress and find encouragement in their shared journey. 

Online treatment for substance abuse and mental disorders

Research indicates that teletherapy can be as effective as in-person therapy for treating SUDs and co-occurring conditions. For example, one 2022 study published in JMIR (The Journal of Medical Internet Research) measured outcomes of 12 randomized controlled trials with a total of 931 participants. Psychological conditions studied ranged from SUDs and eating disorders to ADHD. No significant difference was found  between therapy delivered via phone or video and in-person therapy immediately after treatment or at three, six, and 12-month follow-ups. Other benefits of attending therapy from home might include:

• Removes geographical and logistical barriers 
• Offers a more discrete option, potentially reducing stigma and discomfort
• Allows for more flexible scheduling options
• Provides users with the opportunity to attend sessions from comfort of home, which can create a more open and relaxed atmosphere
• Delivers integrated care addressing both mental health and addiction issues
• BetterHelp is often more affordable than traditional therapy without insurance

Takeaway

Science repeatedly shows a relationship between substance use disorder and other mental conditions like depression, anxiety, and bipolar disorder. Such co-occurrences can present added complications and barriers to recovery—but they are highly treatable with time and active participation in a therapeutic program. If you or someone you know is experiencing a co-occurring SUD and mental health condition, reach out to a mental health professional at BetterHelp and get started on the path to healing.