Mental Health and Substance Abuse

Last updated: April 2020

The National Institute on Drug Abuse reports that many people who struggle with substance use disorders also struggle with mental illnesses and vice versa. This phenomenon is known as “comorbidity,” and it is essential to understand the risk factors and treatment options available to those who may be struggling.

Statistics of Mental Illness and Substance Use Disorders

The Substance Abuse and Mental Health Services Administration reports that 43.6 million Americans (18.1%) of the adult population have experienced some form of mental illness, such as depression or anxiety, within their lifetimes. Over 20 million adults have a substance use disorder. Within these two figures, however, 7.9 million have experienced both a mental illness and substance use disorder simultaneously.

  • The Anxiety and Depression Association of American reports that 20% of Americans with an anxiety or mood disorder have a substance use disorder.
  • The U.S Department of Veterans Affairs reveals that more than two out of 10 veterans with PTSD have a substance use disorder, and almost one in three veterans seeking treatment for a substance use disorder has PTSD.
  • The National Eating Disorder Association reports that up to 35% of individuals with a substance use disorder also have an eating disorder.
  • Research from the Schizophrenia Bulletin indicates that nearly 50% of people struggling with schizophrenia also present with a lifetime history of substance use disorders.

Mental illnesses and substance use disorders can both impact and exacerbate one another.

Someone struggling with a substance use disorder may experience mental health symptoms as a result of repeated use. This can include bouts of depression, irritability, anxiety, sleep problems and paranoia.

On the other hand, some people use drugs or alcohol to self-medicate the uncomfortable symptoms (depression, low self-esteem, ruminating thoughts, paranoia) often associated with mental illness. The mood-altering substances can provide a temporary escape and numbing sensation to avoid coping with the intolerable distress.

Both mental illness and substance use disorders are associated with numerous devastating consequences that can severely impact an individual’s mental, physical, financial health. In fact, if left untreated, severe comorbid conditions can be fatal. In 2016, there were over 64,000 drug-related overdose deaths. Each year, nearly 45,000 Americans die by suicide (123 average deaths per day). While it is impossible to pinpoint exact reasons for these deaths, comorbid conditions remain a pressing source of concern for all Americans.

Biopsychosocial Factors and Their Influence

Rather than focusing on a singular origin, most professionals endorse that a range of biopsychosocial factors can influence one’s likelihood of developing a mental illness or substance use disorder.

Biological and genetic factors can certainly play a role. Children who have at least one parent with a substance use disorder are 8x more likely to develop an addiction when compared to children whose parents do not have an addiction.

Research from the National Institute of Health reports that recent studies found genetic risk factors in five mental disorders: bipolar disorder, major depression, attention deficit hyperactivity disorder (ADHD), schizophrenia, and autism.

Environmental factors also to play a role in mental illness and substance use development. For example, the National Child Traumatic Stress Network reported that more than 70% of adolescents receiving substance abuse treatment indicated a history of trauma exposure. Trauma exposure varies, but it can include neglect, family conflict, difficulties in school or friendships, bullying, poverty or medical illness. While substance use can temporarily conceal the uncomfortable feelings in the wake of trauma, they can also exacerbate more trauma, as addiction is often associated with dangerous, risky behavior and environmental circumstances.

A Need for Specialized Treatments for Comorbidity

For individuals struggling with both mental illness and substance use disorders, specialized treatment can provide the needed stabilization and support for recovery. The National Alliance on Mental Illness (NAMI) suggests that the best treatment entails an integrative and comprehensive approach, meaning that individuals with comorbid conditions receive proper care for both disorders.

Some individuals will begin their treatment processes in a detoxification center, where trained medical staff can provide safe monitoring during acute withdrawal stages. Professional supervision becomes especially important when the individual presents with a severe mental illness symptoms, such as suicidal thoughts or psychotic behavior. Successfully detoxing from drugs or alcohol alone, however, is not a sufficient form of treatment. Simply “getting sober” does not adequately prepare individuals with the distress tolerance skills and coping strategies needed for sustained recovery.

For this reason, many individuals benefit from structured inpatient or outpatient care via psychotherapy, psychiatric medication and ongoing support. The level of care will depend on both the severity of the comorbid condition and the individual’s treatment history.

For most people struggling with comorbid conditions, recovery represents a two-fold process. The mental illness symptom management ideally reduces the cravings to use drugs or alcohol or “numb” problems when they arise. Similarly, committing to sobriety can make it easier for people to focus on implementing the self-care skills needed to maintain sustainable mental and physical health.

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Information on is not intended to be a substitute for professional medical advice. Always consult your physician or other qualified professionals with any questions you may have regarding mental health and substance use.