Which of these is true of mental illnesses and substance use disorders when taken together

Drug addiction may lead to mental illness or vice versa. Here are five important facts about substance abuse and mental health.

Substance use disorder and mental health conditions are often closely related—one may cause the other, or they may occur at the same time. In fact, there are special terms that distinguish the combination of a substance use disorder and a mental illness. When these conditions occur simultaneously, it's called dual diagnosis or co-occurring disorders. Read on for five interesting facts about the connection between substance abuse and mental health.

1. Substance use disorders (SUDs) and mental illness often occur simultaneously.  

“Mental health and substance use disorder co-occurrence is well studied and documented,” Dr. Julian Lagoy, MD, a psychiatrist with Community Psychiatry + MindPath Care Centers, tells WebMD Connect to Care.

“Patients with substance use disorder are at higher risk of experiencing depressive disorders, bipolar disorder, anxiety disorder, PTSD, eating disorder, schizophrenia, and ADHD,” Lagoy says.

The combination of substance abuse and mental illness is known as dual diagnosis or co-occurring disorders, according to the National Alliance on Mental Illness (NAMI). In 2019, nearly 9.5 million American adults suffered from both conditions, according to the National Survey on Drug Use and Health.

“There is a significant overlap between mental health and substance misuse, with over 80% of individuals having both,” Monty Ghosh, MD, Addiction Specialist at the University of Alberta Hospital in Edmonton, tells WebMD Connect to Care.

2. Substance use disorder is a mental health condition.

Substance use disorder (SUD) is a mental illness that affects your brain and behavior, states the National Institute on Mental Health (NIMH). Those with an SUD typically find it difficult to control their urges to use substances such as illicit drugs, alcohol, or medication—despite knowing that these substances cause harmful effects.

“Substance use disorders are highly prevalent, according to a survey in 2017. In the United States, about 7.2% of individuals 12 years and older had a substance use disorder within the past year,” Lagoy adds.

3. Mental disorders and SUDs can have common risk factors.

Since both SUDs and mental disorders can run in families, certain genes might be a risk factor for both conditions, states the NIMH. Genetic changes, which may happen due to certain environmental factors like stress and trauma, are passed down through generations and may lead to the development of SUDs or mental disorders.

“A family with a parent with substance use disorder is associated with higher rates of physical and sexual abuse, which increases the risk of substance use disorder in children,” Lagoy says.

4. Mental health conditions can lead to substance misuse.

Studies have shown that people with mental illnesses like depression, anxiety, or post-traumatic stress disorder (PTSD) may start using drugs or alcohol to self-medicate, states the NIMH. This may provide temporary relief from symptoms of mental illness.

 Although some drugs may provide you temporary relief, these drugs may worsen mental health symptoms over time. Additionally, the rewarding effect of such substances can make them difficult to quit.

5. Substance use during adolescence may increase vulnerability to the later development of an SUD.

Multiple national population surveys have found that around 50% of people who have an SUD will also experience mental illness during their lives, and vice versa.

Additionally, according to the National Institute on Drug Abuse, the brain circuits that control executive functions like decision-making and impulse control reach maturity at a relatively later developmental time, which increases vulnerability to drug use and the development of an SUD in adolescents. Early drug use is a strong risk factor for the later development of an SUD—and may also be a risk factor for the later emergence of additional mental illnesses. However, the link between SUDs and other mental illnesses is not necessarily causative, and may be related to the shared risk factors that the two conditions share, such as:

• Genetic predisposition
• Psychosocial experiences
• Environmental influences

Don’t Wait. Get Help Now.

If you or a loved one are struggling with addiction, WebMD Connect to Care Advisors are standing by to help.

URL of this page: https://medlineplus.gov/dualdiagnosis.html

The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Learn how to cite this page

The numbers do not lie. Mental illness and addiction often overlap. In fact, nearly 9 million people have a co-occurring disorder according to the Substance Abuse and Mental Health Services Administration. Yet, only 7 percent of these individuals get treatment for both conditions. And nearly 60 percent receive no treatment at all.

Comorbidity refers to the fact that two conditions, such as a specific mental health disorder and a substance use disorder, often co-exist together. What this means is that in many people with addictions, there is an underlying mental health issue as well. While neither condition actually causes the other, they do often exist together. What's more, one condition can exacerbate the symptoms of the other.

To better understand how comorbidity is possible, it helps to recognize that both are chronic brain disorders. In other words, when someone struggles with an addiction, their brain has been permanently rewired by the substance they abused. This, in turn, causes the brain to function differently than before. Just like diabetes or heart disease, a person with an addiction must manage their condition for the rest of their life. It is not as simple as stopping the drug use or alcohol condition. Many times, this is simply not possible.

Likewise, the changes that take place in the brain due to substance abuse occur in the same brain areas that are impacted by depression, anxiety, schizophrenia, and bipolar disorder. Consequently, it should not be surprising that there is a high rate of comorbidity between addiction and other mental illnesses. While the link is complex, some mental health issues increase the risk factors for substance abuse. What this means is that some people with mental illnesses will turn to alcohol or drugs to cope with the pain of their mental health issues.

Even though there is a high rate of comorbidity between addiction and mental illness, it does not mean that one necessarily caused the other—even if one condition appeared first. Instead, there are still a number of factors that need to be considered, according to the National Institute on Drug Abuse. For instance:

• Drug abuse can cause people to experience one or more symptoms of another mental illness. For example, there is an increased risk of psychosis in some marijuana users.
• Mental disorders can lead to drug or alcohol abuse because some people use substances to self-medicate. For instance, the nicotine in tobacco products sometimes lessen certain symptoms of schizophrenia and may improve cognition.

There also is some evidence that indicates that addictions and mental illnesses are caused by underlying brain deficits, genetic influences, and/or exposure to trauma early in life.​ For instance, it is estimated that 40 to 60 percent of a person's vulnerability to addiction can be attributed to genetics. There also are several regions of the human genome that have been linked to an increased risk both for substance abuse and mental illness.

Another common factor between mental health issues and addiction is the age at which the symptoms appear. During the teen years, people are still developing, maturing, and growing. As a result, significant changes in the brain occur during adolescence. For instance, teenagers are more prone to take risks and act impulsively. These behaviors, while common among teens, can influence the risk of addiction and other mental disorders.

Finally, people who are physically or emotionally traumatized are at a much higher risk of substance use disorders. This connection is particularly concerning for veterans returning to the country. In fact, one in five military servicemen and women coming back from Iraq and Afghanistan have reported symptoms of post-traumatic stress disorder (PTSD) or major depression.

Some studies suggest that half of all veterans diagnosed with PTSD also have a co-occurring substance abuse problem.

Co-occurring disorders are sometimes difficult to diagnose. One reason is that the symptoms are often complex and can vary in severity. As a result, it is not uncommon for people to receive treatment for one disorder while the other disorder remains untreated. Sometimes this happens because the symptoms are so similar or overlap. In other words, both mental health issues and addiction can have similar biological, psychological, and social components.

Another reason for not diagnosing both conditions might include inadequate training or screening. In any case, the consequences of undiagnosed, untreated, or undertreated co-occurring disorders can lead to a higher likelihood of experiencing homelessness, jail time, medical illnesses, and even suicide.

What's more, people with mental health issues who also abuse substances like drugs or alcohol are at an increased risk for impulsive or violent acts, potentially landing them in legal trouble. Achieving lasting sobriety is increasingly difficult for them.

Research suggests that co-occurring conditions need to be treated at the same time. In fact, for the best outcome, it helps when people with both an addiction and a mental health issue receive integrated treatment. With integrated treatment, doctors and counselors can address and treat both disorders at the same time. This, in turn, often lowers treatment costs and creates better outcomes for patients.

What's more, early detection and treatment of both conditions can greatly improve the person's recovery and quality of life. However, it is important to note that people who have both an addiction and another mental illness often have symptoms that are more persistent, severe and resistant to treatment compared with patients who have either disorder alone. For this reason, maintaining sobriety may be very difficult for them.

Making a correct diagnosis of both an addiction and a mental health issue is vitally important to a patient's success. When this occurs, their chance of recovery increases. ​But there needs to be increased awareness of comorbidity for this to occur. Too many times, one of the conditions goes undiagnosed and untreated. As the recognition and treatment for co-existing conditions improves, this will help reduce the social stigma that makes people so reluctant to pursue the treatment that they need.