Mental health and addiction issues often go hand in hand, and many people suffer from both. When you have a mental health disorder and substance use disorder at the same time, it is referred to as co-occurring disorders. Co-occurring conditions can be very difficult to manage, as each disorder often significantly impacts the other.
The Substance Abuse and Mental Health Service Administration estimates that about 9.2 million adults in the United States have a co-occurring disorder. Yet, only 7% of those individuals receive treatment for both issues. A whopping 60% of individuals with co-occurring disorders do not receive treatment for either issue. This is a growing concern when it comes to overall public health.
Co-occurring disorders, also known as dual diagnosis or comorbidity, refer to the simultaneous presence of a mental health disorder and a substance use disorder in an individual. This means that an individual may struggle with drug addiction and an underlying mental health condition such as bipolar disorder, depression, anxiety, PTSD, trauma, etc.
Research has shown that people with mental health disorders are more likely to develop a substance use disorder, and people with substance use disorders are more likely to develop a mental health disorder. In fact, roughly about 50% of people with severe mental illnesses are affected by substance abuse and vice versa. This is because individuals may turn to substances as a form of self-medication to cope with their mental health disorder symptoms. Substance use may also worsen existing mental health symptoms or lead to new mental health problems.
Self-medication is one of the main issues surrounding co-occurring disorders. People self-medicate to attempt to numb or cope with the symptoms of their mental health disorder, such as feelings of sadness or worthlessness. However, this is a risk factor for substance abuse and addiction.
Self-medication can also mask the underlying mental health issue, making it difficult for individuals to access the appropriate mental health services. This further perpetuates the cycle of substance abuse, making it even harder for individuals to break free from addiction.
The signs and symptoms of a co-occurring disorder vary depending on the abused substance and mental condition. For example, marijuana abuse and depression could look very different from the signs of alcohol abuse and schizophrenia.
That said, here are some questions you can ask yourself to help determine if you or a loved one may be struggling with comorbidity:
If you answered yes to any of these questions, you may have a dual diagnosis and should consider seeking professional help.
Co-occurring disorders can be challenging to diagnose and treat because the symptoms of the mental health disorder and the addiction tend to overlap. This makes it difficult to determine which condition is causing which symptoms. In some cases, the symptoms might vary in severity, making a patient receive treatment for one disorder while the other disorder remains untreated. People may also be less likely to seek help if they struggle simultaneously with both issues.
But the good thing is that many treatment facilities and professionals (like psychiatrists, psychologists, and therapists) specialize in treating comorbid conditions. These healthcare professionals are experienced in diagnosing and treating substance use and mental health disorders. They will perform a comprehensive assessment that includes physical exams, psychological evaluations, mental health screenings, and substance use assessments to determine the primary and contributing conditions.
Once a dual diagnosis is established, the healthcare provider will create a treatment plan that integrates both mental health and substance abuse treatment co-currently. Addressing these comorbid disorders at the same time ensures the best outcome.
With integrated treatment plans, the same practitioner offers both substance and mental health interventions in an integrated manner. The goal is to treat the person as a ‘whole,’ not just two separate issues. This treatment addresses the underlying causes of addiction, such as depression and anxiety, while providing strategies to help deal with cravings and overcome the physical aspects of addiction.
Integrated treatment often involves specialized therapies such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), motivational therapy, and trauma-informed psychotherapy. Each type of therapy helps address the underlying issues contributing to addiction while promoting healthy coping skills and emotional regulation. These therapies can be offered in individual or group settings.
According to SAMHSA, co-occurring disorders are treated in a stage-wise fashion with different services provided at different stages: engagement, persuasion, active treatment, and relapse prevention. At each stage, a team of professionals provides services that address mental health and substance use disorder.
After treatment, the patient is encouraged to attend support groups, such as Narcotics Anonymous (NA) and Alcoholics Anonymous (AA), to maintain sobriety. Additionally, they are encouraged to use the skills and techniques they learned in therapy, such as mindfulness and stress management, to help them cope with triggers and handle cravings.
Co-occurring disorders are complex conditions that require integrated and comprehensive health services. With the right combination of therapies, medications, and peer support, individuals can recover from mental health disorders and addiction.
There is a strong connection between mental health and substance use disorders. Results from the 2019 National Survey on Drug Use and Health revealed that 31.3% of adults with any mental illness were binge drinkers compared to 25.3% of adults with no mental illness. Also, 49.4% of adults with mental illness used illegal drugs, compared to only 15.7% who had no mental illness. When someone struggles with a mental illness, like depression and a substance abuse problem at the same time, they have a co-occurring disorder or dual-diagnosis.
Roughly 9.5 million American adults reported having a dual diagnosis in the 2019 NSDUH survey on Drug Use and Health. The reason is that people with mental health issues like depression turn to alcohol or drugs as they try to cope with sad feelings. On the flip side, depressant drugs and alcohol can increase feelings of fatigue and sadness, and people can experience depression as the effects of drugs wear off or as they face the impact of addiction.
Whenever addiction and depression are discussed together, the question becomes, which one comes first. The basic addiction disease model dictates that substance misuse changes the brain so that it can’t self-regulate. For many, depression serves as a gateway to addiction. For others, substance abuse can lead to depression. Either way, these two disorders always seem to co-occur.
Everyone has bad days, whether it’s because of loss, relationships, family, or workplace issues. Most people shake the feelings off and get on with their lives. But for people with depression, the periods of unhappiness don’t go away. They feel sad, helpless, and worthless for days to weeks. Depression is a severe mental health problem that affects about 10% of adults in the US. Data from the Centers for Disease Control indicate the following as risk factors for depression.
People with depression tend to turn to drugs to try to relieve these depressive symptoms. As estimated, one-third of people with major depressive disorder engage in substance abuse as a way to self-medicate to relieve feelings of despair, low self-esteem, and hopelessness. Unfortunately, abusing alcohol and drugs doesn’t resolve these feelings. It only makes them worse. In fact, it can lead to depression symptoms like sadness, hopelessness, lethargy and in some cases, they can turn to acts of self-harm.
There are many different types of depression. Here are some common examples:
Major depression is a common type of depression that affects about 7% of people in the US. If untreated, the major depressive disorder can recur throughout the person’s life.
Persistent depressive disorder is a chronic form of depression that lasts for a year or more. Since it's milder, it’s usually easier to cover with drugs or alcohol. However, the condition may eventually lead to major depressive disorder.
As the name implies, seasonal affective disorder is seasonal, mostly happening in winter months. The disorder is diagnosed when someone exhibits the symptoms of depression over three consecutive winters.
Depression serves as an entry point into alcohol and drug use. As mentioned earlier, those struggling with depressive disorders turn to substances to escape the symptoms of depression. But drugs don’t do much to help them feel better. If anything, one feels worse once the effects of drugs start to wear off. Yet, the person keeps using it to try to forget their problems. It is like a catch 22. Eventually, their bodies become tolerant and need larger doses to attain the same effects.
At this point, they can’t stop using or reduce intake because of withdrawal symptoms like trembling, nervousness, agitation, cold, sweats, or nausea set in. So they may start feeling sad and guilty because they are abusing drugs. Some try to quit cold turkey. But with the withdrawal symptoms and mental disorder, it’s almost impossible.
Besides, quitting leads to an even stickier situation for those with severe depression. People who’ve been abusing substances for years may have a more pronounced depression when they stop using. It is, therefore, a good idea to seek dual diagnosis treatment that addresses both issues in one go.
Depression itself isn’t a cause of substance abuse – but it makes one more susceptible to addiction. The inability to cope with hard feelings and life stressors is one of the causes of depression and addiction. Here are some ways depression may lead to addiction.
People struggling with depression are afraid to ask for help. They fear that people will judge them for their condition, so they choose to keep it to themselves. Again, unlike other medical conditions, it is hard to identify the symptoms of depression. So, even if the person gathers the courage to seek help, they may find it hard to explain what they’re going through. So, most people may turn to substances as a way to cope.
One of the hidden risks of drug use is that mental health issues happen gradually. So, a person might not even realize they have depression. So, they’ll take stimulants to keep up with work or a bottle of wine to try to cheer up. When someone doesn’t know they’re dealing with a mental disorder, they’ll keep up with the unhealthy coping mechanism.
Many people are afraid of taking psychiatric medication, not just because of how others will view them but also because of the “damaging effects.” They are scared that the drugs will change their personality or ability to function and that they might not handle the side effects. So they turn to drugs assuming that they are a safer option. Alcohol and drugs offer instant fixes without the hassle of getting a prescription.
Luckily, dual disorders are treatable. If you or someone close to you is struggling with addiction and depression, it’s a good idea to enroll in a rehab that offers holistic treatment. This way, you won’t have to treat depression or addiction separately.
It is easy to wonder why or how someone in their right minds would self-harm. But as it turns out, "normal" people intentionally hurt themselves every day. Some do it to cope with stress and discomfort or to feel real and alive. Others do it to punish their bodies or to feel empowered. Sometimes, people don't even know why they cause self-harm, but they still do it anyway.
Self-harm and cutting are a form of addiction as many young adults crave the relief that these behaviors elicit. Like substance abuse, users continually cut, punch, bang, and burn themselves to self-medicate but end up having trouble stopping. Most of them describe a specific type of high, connectedness, release, or a sense of calm after the self-injury.
Individuals who inflict self-injury are trying to release pent-up emotions. They see their actions as positive as it allows them to express feelings and remain in control. So they keep hurting themselves to try to release or control feeling of sadness, fear, frustration, anger, overwhelm, or even happiness.
But sadly, hurting yourself never truly resolves the feeling. It only leaves behind a sense of guilt or shame. Eventually, the person may have to perform more intense or prolonged self-injury to achieve the same release. This may go on and on that the individual feels unable to stop. Addiction to self-harm mimics addiction to drugs and alcohol in many ways. For instance, people who cause themselves harm aren't in full control of their actions just like those with SUD. Besides, most underlying pieces (conditions, triggers, causes, etc.), are the same in both cases.
Self-harm is more common than many people realize. About two million cases of self-harm cases are reported in the United States every year. The condition – clinically referred to as non-suicidal self-injury (NSSI) – is characterized by an intentional self-induced injury that's not meant to be fatal. Estimates show that 1 in 5 females and 1 in 7 males engage in self-harm behaviors. 90% of those who self-harm start during their pre-adolescent years, and that 50% of them have been sexually abused. Reports also show that 70% of young adults who engage in self-harm have made at least one suicide attempt. But note that NSSI and a suicide attempt are two different things.
Intentionally hurting yourself isn't a mental disorder in or of itself. But it is a behavior that's often associated with anxiety, stress, depression, borderline personality disorder, PTSD, and substance abuse disorder. The cutting and banging and burning tend to worsen over time, especially when the co-occurring problem remains unaddressed.
Since self-harm is a coping mechanism, the frequency of harm increases as the person's mental health degrades. This escalates the overall risk and danger. Besides, when substances are involved, there's an increase in harming behavior with more chance of severe injury. Most ER visits from self-harm happen when the individual has been abusing drugs or alcohol and harms themselves more severely than intended.
If a loved one has co-occurring disorders, he or she should seek professional help. According to National Institute on Drug Abuse, anyone seeking help for comorbid conditions should be evaluated for both disorders and treated accordingly. That’s why you have to find a reputable addiction treatment center that offers effective behavioral therapies like:
As mentioned above, self-harm can happen when an individual has an addiction problem. However, the opposite is also true. And individual can turn to drugs and alcohol in an attempt to numb their feelings or alleviate stress. But since drugs and alcohol impair motor skills, slow reaction times, and interfere with nerve ending connections, they may make it hard for an individual to control their self-harm behaviors.
In addition to substance use disorders and mental health issues, other self-harm risk factors include:
Many people who engage in these acts don't want others to find out. So they do so in secrecy and cut places that are hard to spot, like on the stomach, higher up on the thighs, or arms. Most of them seem normal or even happier on the outside, with no sign tell-tale sign of the habit. This makes it hard to know if your loved one is self-harming or cutting. However, some signs of self-harm include:
Strange scars: if a loved one is cutting or scratching, chances are they will have strange scars on their body. Look out for scar tissue or multiple cuts in one location. Cutting addiction may also include thin lines like those from a sharp object.
Unexplained abrasions or cuts: Your loved one could be cutting if they always blame accidents or clumsiness for their injuries or bandages.
Bloodstains on clothes: Nothing is alarming about spotting blood on your loved one's belongings. However, if you notice blood on the sink, toilet paper, hand towels, or clothes, it could be a sign they are self-harming.
Covering the skin: Your loved one may insist on wearing pants and long-sleeved clothes even when it’s hot outside. That's because they don't want you to see the scars.
Isolation: People who cut tend to isolate themselves because of depression or the need to hide their behavior. They may also feel irritable or uncomfortable in public.
Keep in mind that these warning signs vary among individuals. So, it is worth looking into any strange behaviors your loved one is showing. They could be crying out for help, but you don't even notice. And even if self-harm is not the issue, your loved one could be struggling with another serious issue, like substance abuse or depression.
Self-harm like burning or cutting may offer temporary relief to physical and emotional pain. However, in the end, it may cause feelings of shame and guilt along with physical side effects like anemia and infections. A cutting addiction is hazardous because one may cut a vein and bleed to death or cause long-term nerve or tendon damage.
Growing evidence suggests that behavioral addictions like cutting and self-harm mimic substance addictions in many ways. They have similar phenomenology, natural history, overlapping genetic contribution, comorbidity, tolerance, neurobiological mechanism, and response to treatment. So, self-harm patients may benefit from various therapies that we mentioned above and treatments offered in addiction centers.
