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The Relationship Between Mental Health & Addiction

The Relationship Between Mental Health & Addiction

The human brain has been described as the most complex structure in the entire universe. Consider this: A synapse is a structure in the brain that allows the passing of an electrical or chemical signal from one neuron to another. According to Stephen Smith, Professor Emeritus of the Department of Molecular and Cellular Physiology at Stanford University, the cerebral cortex of the human brain contains in the neighborhood of 125 trillion synapses, which is roughly equal to the total number of stars in the Milky Way galaxies. And it’s estimated that each synapse may contain 1000 molecular-scale switches, meaning that a single human brain has more switches, “than all the computers and routers and Internet connections on Earth.”

So, how does all of this relate to mental health and addiction? The brain is at the center of all mental illness and substance use disorders. It should be no surprise then that understanding the causes, effects, and mechanizations of co-occurring disorders are themselves complex, and their treatments complicated and multifaceted.

This guide is designed to provide useful information and treatment advice on mental health and addiction for prospective patients, their families and friends. Recovery from co-occurring disorders is complex and difficult, but success is possible. Here’s what you need to know to get started.

The human brain has been described as the most complex structure in the entire universe. Consider this: A synapse is a structure in the brain that allows the passing of an electrical or chemical signal from one neuron to another. According to Stephen Smith, Professor Emeritus of the Department of Molecular and Cellular Physiology at Stanford University, the cerebral cortex of the human brain contains in the neighborhood of 125 trillion synapses, which is roughly equal to the total number of stars in the Milky Way galaxies. And it’s estimated that each synapse may contain 1000 molecular-scale switches, meaning that a single human brain has more switches, “than all the computers and routers and Internet connections on Earth.”

So, how does all of this relate to mental health and addiction? The brain is at the center of all mental illness and substance use disorders. It should be no surprise then that understanding the causes, effects, and mechanizations of co-occurring disorders are themselves complex, and their treatments complicated and multifaceted.

This guide is designed to provide useful information and treatment advice on mental health and addiction for prospective patients, their families and friends. Recovery from co-occurring disorders is complex and difficult, but success is possible. Here’s what you need to know to get started.

What Are Co-Occurring Disorders?

In most cases, the term “co-occurring disorder” refers to the concurrent existence of both substance use disorders and diagnosable mental illnesses in individuals. “Co-occurring disorder” is often used interchangeably with terms such as “dual disorder” and, more commonly, “dual diagnosis.” The disorders that make up a co-occurring disorder diagnosis may be biological, psychological and/or social in nature. Persons with co-occurring disorders may suffer from one or more of both mental illness and substance abuse problems.

Common Disorders Co-Occurring With Drug & Alcohol Abuse

According to the U.S. Department of Health & Human Services, more than one in four adults with serious mental problems additionally suffer from a problem with substance use, with substance use occurring more frequently along with the following mental health issues:

Common Addiction & Disorder Combinations

According to Psychology today, disorders that commonly coexist with alcohol and drug abuse:

  • Major depression with cocaine addiction
  • Alcohol addiction with panic disorder
  • Alcoholism and polydrug addiction with schizophrenia
  • Borderline personality disorder with episodic polydrug abuse

It’s important to note, however, that co-occurring disorders involve a wide range of disorder combinations, and are far from limited to the examples mentioned here.

Co-Occurring Disorders: Causes & Risk Factors

The causation of co-occurring substance abuse and mental illness is complex and unique to every individual. It is important to understand that while substance abuse often co-occurs with mental illness, one does not necessarily cause the other. In fact, it is often extremely difficult to determine which came first – the mental illness or the substance use disorder. Nevertheless, there are a number of common possible causal links between mental illness and substance abuse.

Self-Medication

Individuals suffering from a mental health condition often turn to drugs or alcohol as a form of “self-medication,” that is, substance use to relieve the symptoms of the mental illness. This is particularly true of persons suffering from depression, anxiety, or paranoia. While the user may experience an alleviation of his or her symptoms, the effect is temporary and, in most cases, leads to serious long-term negative consequences.

Chronic Drug Use

While any experimentation with drugs may be harmful, persons who abuse drugs over a long period of time are more likely to experience mental illness issues than casual users. Drugs can alter brain chemistry leading to the onset of depression or anxiety, for example, which in turn often results in the use of more or different drugs as a form of self-medication.

Genetics

Genetics have been found to play a significant role in susceptibility to mental illness. NIH researchers, for example, have determined that five major mental disorders – major depression, schizophrenia, attention deficit hyperactivity disorder (ADHD), autism, and bipolar disorder – all share the same genetic risk factors. Genetic research also indicates that addiction has an inherited component. Overlapping genetic vulnerabilities for mental illness and addiction may, therefore, increase a person’s susceptibility to the development of a co-occurring disorder.

Environment

Environment refers to the circumstances, conditions and surroundings in which a person exists. Research has shown that there are countless environmental risk factors – family, friends, school, work, community, etc. – that increase the likelihood of substance abuse. For example, if an individual’s home environment is accepting of drug use, that individual is more likely to use drugs him or herself. This is particularly true for persons with an exposure to substance use early in life.

Trauma

Likewise, the occurrence of major trauma – whether recurring or as a singular event – can create a vulnerability to both mental illness and substance abuse. And, as with environment, early childhood trauma can be especially damaging. Common forms of trauma include physical abuse and sexual abuse.

Is Alcohol & Drug Addiction a Mental Illness?

The answer to this question depends on how the terms “drug addiction” and “mental illness” are defined. The National Institute on Drug Abuse (NIDA), part of the U.S. government’s National Institutes of Health, argues that drug addiction is a mental illness, stating:

Yes, because addiction changes the brain in fundamental ways, disturbing a person’s normal hierarchy of needs and desires and substituting new priorities connected with procuring and using the drug. The resulting compulsive behaviors that override the ability to control impulses despite the consequences are similar to hallmarks of other mental illnesses.

In addition, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes specific criteria for Substance Use Disorder, indicating that substance abuse is itself a mental health disorder.

Signs and Symptoms of Mental Illness and Substance Abuse

The importance of early identification and treatment of substance use and mental illness disorders cannot be overstated. Recognizing the presence of a problem is the first step. Here are some of the most common signs and symptoms to look for:

Signs of Alcohol and Drug Abuse

Specific symptoms vary depending on the particular substance being abused. Nevertheless, a person abusing drugs or alcohol may exhibit one or more of the following:

  • Cravings and Dependence:

    The feeling that one must use the substance regularly, possibly daily or multiple times a day. Over time, those feelings typically evolve into an ever-increasing and intensifying urge to use.

  • Tolerance:

    The need to consume more of the substance over time in order to experience the desired effect.

  • Failing to meet work, family and social obligations:

    Coming into work late or being absent from work entirely, missing a child’s birthday party or sporting event, cutting back recreational and social activities, etc.

  • Financial problems:

    Breaking budgets, draining bank accounts, missing mortgage or rent payments, or other bills, etc. Paying for drugs is often at the core of these problems.

  • Poor judgment and risky behaviors:

    Making bad choices and participating in dangerous activities, usually in pursuit of obtaining the abused substance. Common behaviors include selling drugs or committing other crimes, and risky sexual activities.

  • Isolation or replacing old friends with new, unhealthy relationships:

    Spending more and more time alone or with others who share in the substance abuse to the exclusion of family and long-time friends.

  • Physical signs:

    Including inability to sleep, loss of appetite, shaking and sweating, slowed walk or staggering, runny nose or nose rubbing, excessive coughing, teeth grinding or jaw clenching, needle marks, bloodshot or glazed eyes, dilated pupils, excessive bruising or skin infections, abrupt changes in weight.

Signs of Mental Illness

As with substance abuse, signs and symptoms vary depending on the particular mental health disorder, but often include:

  • Feelings of sadness or “feeling down”
  • Confusion or an inability to focus or concentrate
  • Lack of interest in life activities or interacting with others
  • Excessive anxiety, worrying, fear and/or nervousness
  • Suicidal thoughts
  • Unusual behavior or sudden changes in mood
  • Changes in sleeping habits or appetite
  • Hallucinations, delusional thinking or paranoia
  • Feelings of guilt or worthlessness
  • Alcohol or drug abuse

It’s important to note that mental illness and substance abuse share many signs and symptoms. And, in fact, substance abuse itself may be a sign of a mental health problem.

Fast Facts: Substance Abuse and Mental Health

There are many ingredients that go into issues of mental illness and substance use disorders, with many of those ingredients shared by both. Here are a few eye-opening facts and figures that illustrate the connection between mental illness and drug addiction:

People addicted to drugs are around twice as likely to suffer from mood and anxiety disorders, and people with mood and anxiety disorders are around twice as likely to be addicted to drugs, when compared to the population in general. [NIH National Institute on Drug Abuse: Comorbidity: Addiction and Other Mental Disorders]

Co-occurring disorders, particularly post-traumatic stress disorder (PTSD), are prevalent in the military population. One study found that 74% of Vietnam Veterans with PTSD also suffered from a comorbid substance use disorder.[Substance Abuse and Mental Health Services Administration (SAMSHA) 2015 National Survey on Drug Use and Health, pg. 2555.]

In 2015, over eight million adults (18 years of age or older) in the U.S. suffered from a co-occurring substance use disorder and mental illness. [U.S. Department of Veteran Affairs: Treatment of Co-Occurring PTSD and Substance Use Disorder in VA]

Approximately 44 percent of all cocaine, 40 percent of all cigarettes, and 38 percent of all alcohol are consumed by persons with an existing mental illness. Additionally, approximately 84 percent of all cocaine, 69 percent of all alcohol, and 68 percent of all cigarettes have been consumed by individuals who have experienced a mental illness at some point in their lives. [National Bureau of Economic Research: Mental Illness and Substance Abuse]

Co-occurring disorders often go undiagnosed, untreated, or undertreated. The consequences can be serious, resulting in “homelessness, incarceration, medical illnesses, suicide, or even early death.” [SAMSHA: Co-occurring Disorders]

How Rehabs Treat Addiction With Co-Occurring Disorders

Every person with a co-occurring disorder asks the same question: “Which came first, my substance abuse problem or my mental illness?” An answer to that question likely exists, but when it comes to treatment, the answer doesn’t really matter. What does matter is that both issues be treated simultaneously. This is known as “integrated treatment.”

Technically speaking, integrated treatment refers to treating two or more coinciding conditions through a combination of psychotherapy and medication. Treatment facilities often employ a range of medical, pharmacological, therapeutic, and holistic approaches and resources in their programs for patients with co-occurring disorders. Every patient is different and requires his or her own individual treatment plan. Nevertheless, the process of treatment typically includes a number of common steps:

Beyond Addiction: Other Factors Associated With Co-Occurring Disorders

Homelessness

Individuals with mental illness issues make up approximately one-third of the homeless population. A relatively equal percentage of homeless persons abuse drugs and alcohol. It is no surprise then that co-occurring disorders are common among those experiencing homelessness. The problem is that few homeless persons have access to integrated treatment, and therefore their mental health and addiction issues often go undiagnosed and untreated. More information on homelessness and housing for persons with co-occurring disorders can be found here.

Incarceration and the Criminal Justice System

Nearly half of all prisoners and jail inmates in the U.S. meet the criteria for both mental health and substance use disorders, according to the federal government’s  Substance Abuse and Mental Health Services Administration (SAMSHA). As with homelessness, access to diagnosis and treatment of co-occurring disorders remains limited for persons within the criminal justice system or following release from incarceration.

Military Service

Mental health disorders (particularly PTSD) and co-occurring substance use disorders are common among veterans and those currently serving in the military. Many veterans and military members regularly fail to receive proper treatment due to military culture and the stigma of weakness it attaches to those suffering from mental health and addiction problems.

An Interview with Addictions Expert Geoff Kane, M.D.

About Geoffrey P. Kane, MD, MPH
About Geoffrey P. Kane, MD, MPH

Geoffrey P. Kane, MD, MPH, is Chief of Addiction Services at the Brattleboro Retreat in Brattleboro, Vermont. Dr. Kane is a graduate of Boston College and the Yale School of Medicine, and received training at the Montefiore Medical Center. Since 1988, Dr. Kane has served as medical director of addiction services in a number of psychiatric and general hospitals throughout the Northeast. He is Editor and Principal Contributor to Addiction Medicine Updates on the National Council on Alcoholism and Drug Dependence website and additionally maintains his own website at www.geoffkane.com.

  • Don’t all persons with a substance abuse issue have an underlying mental health problem

    My first answer would be “yes” because part of the human condition is to have issues with shame and self-esteem, and a proneness to self-defeating behavior. When it comes to substance use disorders or addiction, many people also have a diagnosable mental illness in terms of the criteria that mental health professionals use to diagnose mental illness. People have troubled emotions and moods which sometimes lead to a diagnosis of a formal mental illness, and sometimes [those emotions and moods] just come with the package of addiction.

  • When treating both addiction and mental illness, I get the feeling that a lot of times the treatment itself is much the same for both problems. Is that correct?

    When it comes to treating co-occurring disorders, it’s not specific to PTSD or depression or alcohol dependence or opioid dependence. It has to do with human connection and positive interpersonal relationships – helping individuals reduce their shame by owning their mistakes and telling their stories, and growing in resilience because the clinician believes in them as human beings and is reinforcing their honesty, self-disclosure and sharing. So, you’re totally right about that.

  • How important to treatment is a patient’s willingness to ask for help and be open to sharing their feelings?

    It’s crucial, it’s very important, it’s essential. And people have an extraordinarily difficult time asking for help. With issues of shame and low-self esteem, one of the most common things that goes on is all-or-nothing thinking. The all-or-nothing thinking says, “If I ask for help, then I’m admitting I’m incomplete, I’m imperfect – which means I’m worthless.” That’s a distortion, but the conviction is there. And people do get stuck, and they do die because they don’t ask for help. So, it’s crucial to legitimize asking for help, and to help people understand that the way we all get better is by talking about what’s going on.

  • Can you tell us a bit about the use of medication in the treatment process?

    Medication has a place. The medications relevant to mental illness are generally different than the medications related to addiction treatment. Yet in both instances, they help people have better traction to do what they need to do in relationships, with honesty, with avoiding situations that put them too close to a substance, and with toxic and abusive relationships. One of the misconceptions people have, though, is that medication is the answer. Medications can provide traction, but they’re not a moving sidewalk. People have to make some effort. There’s a responsibility on the patient to sort out their feelings, and to get to meetings or treatment, or whatever it is.

  • Is there a specific message you’d like to pass on in regard to treatment?

    With mental illness and with addiction, it’s important to have hope. These conditions are treatable. I am an eyewitness to decades of individuals who get better. They get better, though, when they own their piece of the problem, when they take on the responsibility for keeping their distance from what’s toxic, be it a bar or a shaming parent, when they ask for help from appropriate people, and when they get their stories and their feelings out. It’s treatable, but you have to do your part. What is the Woody Allen quote, that 80% of life is just showing up? You just have to be damn careful where you show up. So, there’s plenty of room for hope.

Don’t all persons with a substance abuse issue have an underlying mental health problem

My first answer would be “yes” because part of the human condition is to have issues with shame and self-esteem, and a proneness to self-defeating behavior. When it comes to substance use disorders or addiction, many people also have a diagnosable mental illness in terms of the criteria that mental health professionals use to diagnose mental illness.[...]

People have troubled emotions and moods which sometimes lead to a diagnosis of a formal mental illness, and sometimes [those emotions and moods] just come with the package of addiction.

Find More

When treating both addiction and mental illness, I get the feeling that a lot of times the treatment itself is much the same for both problems. Is that correct?

When it comes to treating co-occurring disorders, it’s not specific to PTSD or depression or alcohol dependence or opioid dependence. [...]

It has to do with human connection and positive interpersonal relationships – helping individuals reduce their shame by owning their mistakes and telling their stories, and growing in resilience because the clinician believes in them as human beings and is reinforcing their honesty, self-disclosure and sharing. So, you’re totally right about that.

Find More

How important to treatment is a patient’s willingness to ask for help and be open to sharing their feelings?

It’s crucial, it’s very important, it’s essential. And people have an extraordinarily difficult time asking for help. With issues of shame and low-self esteem, one of the most common things that goes on is all-or-nothing thinking. [...]

The all-or-nothing thinking says, “If I ask for help, then I’m admitting I’m incomplete, I’m imperfect – which means I’m worthless.” That’s a distortion, but the conviction is there. And people do get stuck, and they do die because they don’t ask for help. So, it’s crucial to legitimize asking for help, and to help people understand that the way we all get better is by talking about what’s going on.

Find More

Can you tell us a bit about the use of medication in the treatment process?

Medication has a place. The medications relevant to mental illness are generally different than the medications related to addiction treatment. Yet in both instances, they help people have better traction to do what they need to do in relationships, with honesty, with avoiding situations that put them too close to a substance, and with toxic and abusive relationships.[...]

One of the misconceptions people have, though, is that medication is the answer. Medications can provide traction, but they’re not a moving sidewalk. People have to make some effort. There’s a responsibility on the patient to sort out their feelings, and to get to meetings or treatment, or whatever it is.

Find More

Is there a specific message you’d like to pass on in regard to treatment?

With mental illness and with addiction, it’s important to have hope. These conditions are treatable. I am an eyewitness to decades of individuals who get better.[...]

They get better, though, when they own their piece of the problem, when they take on the responsibility for keeping their distance from what’s toxic, be it a bar or a shaming parent, when they ask for help from appropriate people, and when they get their stories and their feelings out. It’s treatable, but you have to do your part. What is the Woody Allen quote, that 80% of life is just showing up? You just have to be damn careful where you show up. So, there’s plenty of room for hope.

Find More