Dual Diagnosis: Substance Abuse and Mental Health

Dealing with co-occurring disorders? Learn how to tackle addiction when you’re also dealing with depression, anxiety, or another mental health problem.

 

The link between substance abuse and mental health

When you have both a substance abuse 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 abuse, 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 abuse problem usually gets worse. And when alcohol or drug abuse increases, mental health problems usually increase too.

Co-occurring substance abuse problems 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 abuse.
• 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.
• Of all people diagnosed as mentally ill, 29 percent abuse alcohol or drugs.

While substance abuse 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. There are things you can do to conquer your demons, repair your relationships, and get on the road to recovery. 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 abuse or the mental health problem?

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

Alcohol and drugs are often used to self-medicate the symptoms of mental health problems. People often abuse alcohol or drugs to ease the symptoms of an undiagnosed mental disorder, to cope with difficult emotions, or to temporarily change their mood. Unfortunately, self-medicating with drugs or alcohol causes side effects and in the long run often worsens the symptoms they initially helped to relieve.

Alcohol and drug abuse can increase the underlying risk for mental disorders. Since mental health problems are caused by a complex interplay of genetics, the environment, and other factors, it’s difficult to say if abusing substances ever directly causes them. However, if you are at risk for a mental health issue, abusing alcohol or drugs may push you over the edge. For example, there is some evidence that those who abuse opioid painkillers are at greater risk for depression and heavy cannabis use has been linked to an increased risk for schizophrenia.

Alcohol and drug abuse can make symptoms of a mental health problem worse. Substance abuse may sharply increase symptoms of mental illness or even trigger new symptoms. Abuse of alcohol or drugs can also interact with medications such as antidepressants, anxiety medications, and mood stabilizers, making them less effective at managing symptoms and delaying your recovery.

 

Recognizing a dual diagnosis

It can be difficult to identify a dual diagnosis. It takes time to tease out what might be a mental health disorder and what might be a drug or alcohol problem. The signs and symptoms also vary depending upon both the mental health problem and the type of substance being abused, whether it’s alcohol, recreational drugs, or prescription medications. For example, the signs of depression and marijuana abuse could look very different from the signs of schizophrenia and alcohol abuse. However, there are some general warning signs that you may have a co-occurring disorder:

• 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 disorder or alcohol or drug abuse?
• 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 abuse treatment fail because of complications from your mental health issue or vice versa?

 
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