For most people seeking help for addiction, substance use is only part of the problem. Often, substance use is only one result of an underlying mental health issue. According to the National Institute on Drug Abuse, at least half of people with substance use disorders also have a co-occurring mental health challenge.
The relationship between substance use and mental health is complex. Typically, the mental health issue comes first and people use drugs and alcohol as a way to cope.
Sometimes they share a common cause or the causes are not easy to distinguish. In most cases, substance use moderates mental health symptoms in the short term but makes them worse in the long run, which then leads to more substance use.
In order for recovery to last, you need to treat any co-occurring conditions simultaneously with the addiction and in an integrated way. The following are some of the most common mental health issues linked to substance use disorders.
Anxiety disorders are the most common mental health issue in the US. Anxiety disorders are a class of mental health issues that includes generalized anxiety disorder, panic disorder, social anxiety disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and phobias.
The National Epidemiological Survey on Alcohol and Related Conditions surveyed more than 43,000 American adults and found a high correlation between substance use disorders and anxiety disorders, especially generalized anxiety disorder and panic disorder. Nearly 18 percent of respondents with a substance use disorder also had an anxiety disorder. It’s important to note that this survey did not include PTSD.
While PTSD is technically an anxiety disorder, it carries such a high risk of substance use that it deserves special mention. Studies have found that among people seeking help for a substance use disorder, between 20 and 50 percent also have symptoms of PTSD.
Episodes of re-experiencing the trauma, as in flashbacks or nightmares, are particularly associated with substance use and relapse. In fact, people with PTSD have a higher risk of relapse in general.
Studies also show that about 35 percent of people diagnosed with PTSD also have an alcohol use disorder–more than five times the rate of alcoholism in American adults.
Major depression represents another huge chunk of co-occurring mental health issues with depression and anxiety frequently occurring together. Depression affects about seven percent of American adults in any given year, and according to the World Health Organization, it’s the leading cause of disability worldwide.
It’s also a major risk for addiction. One study found that among people with major depression, 16.5 percent had an alcohol use disorder and 18 percent had a drug use disorder–more than three times the rate of substance use issues in the general population.
Bipolar is a mood disorder like major depression but it deserves special attention because its effect on addiction risk is so huge. The study cited above that found that people with major depression have an 18 percent risk of developing a drug use disorder also found that people with bipolar disorder have a 56 percent chance of developing a substance use disorder at some point in their lives.
Bipolar is challenging to treat and it can also present challenges to addiction treatment, especially if someone has a manic episode during treatment.
Borderline personality disorder, or BPD, affects about 2.7 percent of adults, but a staggering 78 percent of people with BPD develop a substance use disorder at some point in their lives. People with BPD have an especially tough time recovering from substance use disorders because their volatile emotions make them more impulsive, more prone to suicidal behavior, more prone to drop out of treatment, and more prone to shorter periods of sobriety.
Attention-deficit/hyperactivity disorder, or ADHD, is characterized by excessive energy and difficulty focusing. It is the most common childhood mental health issue, affecting between five and 10 percent of children.
Symptoms persist into adulthood about 60 percent of the time, and therefore PTSD can be a particular problem for adults who were never properly diagnosed or treated. The National Comorbidity Survey Replication found that more than 15 percent of adults with ADHD also met the criteria for a substance use disorder.
The prevalence of schizophrenia worldwide is fairly low, only about 0.5 percent. However, about half of people with schizophrenia will develop substance use issues at some point in their lives. As with BPD, people with schizophrenia are less likely to adhere to treatment.
What’s more, the links between schizophrenia and substance use are more complicated than other mental health issues. For example, people with schizophrenia tend to have more severe psychotic symptoms when they use drugs and alcohol.
Also, substance use may precipitate symptoms in teens with a genetic predisposition to schizophrenia. And people who use cocaine and amphetamines are far more likely to suffer from stimulant psychosis if they have a family member with schizophrenia.
Long-term success in addiction recovery requires identifying and treating any co-occurring mental health issues. Otherwise, it’s like trying to fill a bucket with a hole in it. Some mental health issues, like borderline personality disorder, bipolar disorder, schizophrenia, and some forms of depression can be especially tough to treat.
At The Kimberly Center, we use a range of evidence-based methods, including cognitive behavioral therapy, or CBT, and dialectical behavioral therapy, or DBT, a form of therapy specifically developed to treat borderline personality disorder and is also used to treat other tough conditions like eating disorders, suicidal depression, and self-harm. To learn more about our programs and treatment, call us today at 855-452-3683.