Understanding the connections between substance use disorder + mental health co-occurrences

Both mental health conditions and substance use disorders (SUDs) are on the rise in the United States, with nearly 60 million people experiencing mental illness and almost 50 million meeting the criteria for a SUD in 2021.

These problems don’t always appear independently; mental health conditions and substance use frequently present simultaneously in an individual. When someone experiences and is diagnosed with SUD and a mental health condition, they are described as having co-occurring disorders. While co-occurrences can make successful treatment more complicated, there are approaches that evaluate and address both conditions to help the patient attain the best possible outcomes.

According to recent research, approximately 25% of people with a diagnosed mental health condition (such as major depression, schizophrenia, or bipolar disorder) also experience issues with substance use, and 43% of people in treatment for a substance use disorder have a co-occurring mental health condition. Because these two serious issues are often linked, understanding how they interact can be vital to the treatment process.

How are mental health and substance use disorders linked?

It’s no surprise that mental health and substance use disorders are closely linked. Although addiction isn’t always diagnosed or treated as a mental health condition, it does result from a permanent rewiring of the brain caused by substance use. This means addiction and mental health conditions—like depression, anxiety, ADHD, PTSD, and many more—are operating via similar and related mechanisms in the brain. Additionally, many of the social determinants of health, including potential trauma history, can also point to a person’s likelihood of developing a substance use disorder.

The prevalence of these co-occurring disorders has led some to speculate that mental health conditions cause addiction or that addiction leads to the development of mental health conditions in otherwise healthy people. There is no evidence to suggest that one causes the other, but it is clear the conditions can influence each other—especially when social factors, like a history of trauma or lack of resources, are also present.

The most likely scenario is that co-occurring disorders come from a combination of genetic, environmental, and developmental factors. According to some research, between 40 and 60% of an individual’s vulnerability to addiction can be hereditary. Substance use could also have an epigenetic impact, activating dormant genes that influence mental health and addiction.

Both mental health conditions and substance use have been linked to trauma, especially early in childhood, meaning that those who’ve experienced abuse, significant adversity, or other trauma are more likely to develop conditions related to  mental health and substance use later in life.

How co-occurring disorders exacerbate one another

The links between mental health and substance use disorders are complex and poorly understood, but they are readily apparent. Both can cause a permanent alteration of the brain, and addiction acts in the same parts of the brain impacted by most serious mental health conditions. When the brain changes from one condition, it may become more vulnerable to other problems in the same region. 

Another concern is that substance use often develops organically when a person tries to self-medicate for an undiagnosed or untreated mental health condition. Severe mental health conditions may cause difficult or extreme emotions, problems with mood regulation, and disturbing thoughts. In some cases, alcohol, marijuana, opioids, and other common drugs may temporarily ease these symptoms. When a person experiences relief due to substance use, they become more likely to develop dependence. Unfortunately, this type of self-medication is not an effective long-term treatment for mental health conditions and may lead to continued or harmful use long after any therapeutic effects have worn off.

Additionally, having a substance use disorder doesn’t just make a person more likely to have or develop a mental health condition, or vice versa. Many symptoms are shared between co-occurring conditions, and the symptoms of one may exacerbate the symptoms of the other. For example, alcohol is well known to worsen the symptoms of depression and anxiety, and marijuana use can prolong the episodes of psychosis that a person already experiences. 

What are common risk factors for substance use disorders and mental health conditions?

Because co-occurrences of addiction and mental health conditions are so high, mental health should always be considered a risk factor for SUD. Other risk factors include:

• Family history of addiction: Predisposition to addiction can occur genetically, and those who have parents, siblings, or other close relatives with SUD issues should consider themselves at risk, too. A family history of addiction also falls into the category of adverse childhood experiences (ACEs).
• Financial insecurity: Another strong predictor of substance use disorder is financial and housing insecurity, which causes high stress and anxiety levels. Substance use under these conditions can create a dangerous feedback loop whereby substance use contributes to further financial insecurity.
• Use of highly addictive substances: Some drugs alter a person’s brain chemistry faster and more dramatically than others, causing addiction to take hold unexpectedly. Drugs like opioids and cocaine are among those that lead to addiction more quickly than others.
• Adverse childhood experiences (ACEs): This refers to potentially traumatic events that occur between infancy and the end of a person’s teen years and affect their ability to cope in adulthood. ACEs typically include violence or neglect in the home, violence or instability in the community, and disrupted bonds between a child and their caregiver (often due to premature death, incarceration, or a family history of addiction or mental health conditions). 

What treatments are available for co-occurring disorders?

When experiencing co-occurring disorders, seeking treatment can be challenging but also imperative. Individuals should seek help from professionals qualified to treat both mental health conditions and substance use disorders  simultaneously. It’s difficult or even impossible to separate the symptoms from each condition, and treating co-occurring disorders is far more effective than treating them as separate and unrelated illnesses. For the best success rates, these treatments need to be comprehensive, involving several stages and concrete goals, and take place over extended periods. 

Medication-based treatments

Treatments for both mental health conditions and substance use disorders generally fall into pharmacological and behavioral categories. Pharmacological treatments for SUD use medication to help manage cravings during periods of detoxification and withdrawal and may also be used to treat pain.

Managing addiction cravings through medication can help alleviate mental health symptoms, allowing doctors to tease apart each condition’s impact. This can lead to more effective treatment of illnesses like depression and anxiety while controlling addiction cravings. These treatments are often used in conjunction with behavioral therapies for the best results. When it comes to treating addiction specifically, a medication-first approach is considered the gold standard and should not be contingent on the patient seeking behavioral treatment. 

Behavioral treatments

Behavioral treatments can include various types of evidence-based counseling such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), assertive community treatment (ACT), and—in the case of childhood and young adult addiction—multidimensional family therapy (MDFT). Each of these treatment methods functions differently, but they all aim to address substance use issues and develop healthy ways of dealing with them:

• CBT addresses coping mechanisms for difficult situations and explores how to change the behaviors exhibited in these situations.
• DBT, on the other hand, employs mindfulness practices to help control extreme emotions, come to terms with the realities of addiction, and improve the patient’s interpersonal relationships.
• ACT is a community-based strategy that emphasizes connection to one’s community.
• MDFT examines how a family’s dynamics and behaviors can impact many areas of a child’s behavior, including substance use, social skills, and school performance. 

Medication-based treatment for long-term success

Medication for addiction treatment is a proven approach to breaking free from opioid use disorder, so it’s easier to regain control over your life. Detangling the complex interactions between mental health and addiction is difficult, but there’s no need to go through it alone. Ophelia’s clinical care teams make it a point to get to know each patient’s unique needs and the challenges they might face during treatment. In addition to Suboxone® or another form of buprenorphine-naloxone, our patients have access to care that helps them understand their behavioral and social needs, as well as emergency support.