Mental Health and Addiction: A Look into Co-Occurring Conditions and Dual-Diagnosis Treatment

Published: 03/17/2016 | Author: Mark Harrigan

Mental health and addiction use can go hand-in-hand. If you have a mental health condition and a substance use disorder (SUD), this is known as a dual diagnosis, or co-occurring conditions. About half of people who have a SUD will also experience a mental health disorder.¹

In this article:

• How are Mental Health and Addiction Related?
• Can a Mental Health Condition Make an Addiction Worse?
• Treatment for Co-Occurring Mental Health and Substance Use Disorders

How are Mental Health and Addiction Related?

Mental health conditions and addiction can influence one another or co-occur due to shared risk factors.¹ Research shows that mental health and addiction have overlapping risk factors that can increase the likelihood of someone developing both an addiction and a mental health condition, such as depression or anxiety. Environmental stress or trauma, for example, can cause someone to cope using drugs or alcohol or cause them to develop posttraumatic stress disorder (PTSD) or panic disorder.

Genetic predisposition to substance addiction and certain mental health disorders can also increase the risk of developing these conditions. Some heritable genes can influence the way you respond to stress or other environmental factors. For example, if you are genetically predisposed to struggle with substance misuse, you may be more likely to start using drugs compared to someone in the same situation who has a different genetic makeup.⁵

Mental Health Conditions That Commonly Co-Occurs with Addiction

Certain mental health conditions commonly co-occur in people with SUD, including:^1,2

• Anxiety, such as generalized anxiety and panic disorder
• Posttraumatic stress disorder
• Depression
• Bipolar disorder
• Attention-deficit/hyperactivity disorder (ADHD)
• Personality disorders, such as borderline personality disorder and antisocial personality disorder
• Schizophrenia

The more severe your mental illness is, the more likely you are to experience co-occurring substance misuse.² Research from 2019 shows that about 3.8% of American adults struggle with a mental illness and substance misuse.³

Can a Mental Health Condition Make an Addiction Worse?

The connection between mental health conditions and addiction is complex and dynamic. Some people may be able to determine whether their mental health symptoms or their substance use came first. For example, someone with PTSD may clearly remember using drugs to cope. For others, it can be difficult to determine which disorder came first.

Though a mental health condition can increase the risk of someone having a SUD, the reverse is also true. People with mental health disorders like anxiety, depression, or PTSD may turn to substances to cope with their symptoms. For example, you might use specific substances, like nicotine or sedatives, to manage your anxiety symptoms.⁴

Alternatively, if you have a mood disorder like depression or bipolar disorder, you may use substances like cocaine to temporarily boost your mood or energy levels. Though this type of self-medicating can provide temporary relief, studies show it can worsen mental health symptoms over time.⁵ As mental health symptoms increase in severity, individuals may escalate drug or alcohol use to cope, creating a compulsive cycle of substance use. If untreated, a mental health condition can contribute to the development of an addiction or cause an addiction to progress.

Substances can also create changes in the brain when used that can result in mental health symptoms. These substance-induced mental health symptoms can occur during active use or withdrawal. Achieving stable recovery from a substance addiction thus often requires seeking treatment for mental health conditions, as well. ^1,5

Treatment for Co-Occurring Mental Health and Substance Use Disorders

Treatment for co-occurring mental health and substance use disorders is commonly referred to as dual diagnosis treatment. Dual diagnosis treatment is necessary in order to fully address both conditions and how they affect each other.

There are different types of dual diagnosis therapies and treatment options available. ¹ A dual diagnosis treatment center or qualified mental health professional can assess you to determine what symptoms result from substance misuse or a mental health condition. For example, if you are dealing with hallucinations, a treatment provider can determine if this is a result of substances or a psychotic disorder like schizophrenia.

Once a provider has a clear idea of what is going on, they can work with you to establish treatment goals. From here, treatment can help you improve and manage co-occurring conditions to help you achieve long-term recovery. Your treatment plan could include:¹

• Cognitive Behavioral Therapy (CBT): A type of therapy that aims to alleviate harmful behaviors like substance use. CBT therapists believe that behaviors directly result from the way you think and feel. CBT can help you change the way you think to change the way you act, and it can also help you develop coping skills to deal with difficult feelings or upsetting thoughts.
• Dialectical Behavior Therapy (DBT): A therapy approach that helps you develop better coping skills. DBT focuses on mindfulness, interpersonal relationship skills, distress tolerance skills, and emotion regulation. DBT can be helpful in dual diagnosis treatment as you learn how to manage mental health symptoms and tolerate urges to use substances.
• Contingency Management: A strategy that rewards positive, healthy behaviors. An example of what this could look like in dual diagnosis treatment is providing more privileges for you when you have made progress toward your treatment goals.
• Family therapy: A form of therapy that includes at least one other cohabitant, significant other, or family member to help address behaviors and issues that may worsen mental health conditions. This can be especially helpful for adolescents in dual diagnosis treatment for mental health and addiction.
• Medication: A treatment that may be used for withdrawal or maintaining recovery from opioid, nicotine, or alcohol use disorder. Medication can also be used to treat mental health conditions like anxiety or depression.
• Holistic or experiential treatments: Other therapeutic techniques that can be added to treatment, such as meditation or yoga, to provide you with new ways to manage your emotions. Experiential therapies like equine-assisted psychotherapy or art therapy might also be helpful.

An inpatient or residential program is the best form of treatment for someone with a dual diagnosis, as it provides comprehensive, integrated care in an environment away from triggers. These facilities are 24/7, highly structured programs that allow patients to focus fully on recovery and mental health. Some programs only last a few weeks, while others may take several months to complete.

Treatment should be individualized for you to have the best results for long-standing recovery.¹ Talking with a treatment provider about your symptoms, behaviors, and unique needs can help optimize your experience, as treatment may also depend on the type of mental health symptoms you are experiencing or the substance you are using.¹

If you could benefit from mental health and substance misuse treatment, please call 888-647-0051 (Who Answers?) to speak with a treatment specialist about the options available to you.

Resources

1. National Institute of Mental Health. Substance Use and Co-Occurring Mental Disorders.
2. National Institute on Drug Abuse. Part 1: The Connection Between Substance Use Disorders and Mental Illness
3. Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health
4. Brady, K., Haynes, L., Hartwell, K., & Killeen, T. (2013). Substance use disorders and anxiety: A treatment challenge for social workers. Social Work in Public Health, 28(3-4), 407-423.
5. Substance Abuse and Mental Health Services Administration. Why is there comorbidity between substance use disorders and mental illnesses?