Mental Health and Drug Abuse
In 2016, only an estimated 6.9% of adults with mental illness and substance abuse disorder received the mental health and substance abuse care they needed.
Mental illness is common among people who struggle with substance abuse and addiction.1 In 2016, 8.2 million adults had a co-occurring mental illness and substance use disorder in the past year. Of those 8.2 million, only 48.1% received treatment for either their mental health disorder or their addiction. This means that roughly half of the adults with co-occurring disorders did not receive either type of treatment. Only an estimated 6.9% of adults with mental illness and substance abuse disorder received the mental health and substance abuse care they needed that year.1
Studies have found that among individuals with non-alcohol substance use disorders, 28% had co-occurring anxiety disorders, 26% had mood disorders, 18% had antisocial personality disorder, and 7% suffered from schizophrenia. Unfortunately, while the prevalence of co-occurring disorders among those seeking substance abuse treatment is high, the number of programs equipped to treat co-occurring conditions may not match the need for this kind of treatment. While many substance abuse treatment programs are able to additionally address some relatively mild forms of mood, anxiety, and personality disorders, there is evidence to suggest that these same programs may be reluctant or ill-equipped to manage individuals with severe mental illness. Correspondingly, the mental health system, while adept at treating cases of severe and chronic mental illness, may not be equipped to address the treatment of concurrent substance use disorders. This is extremely unfortunate, as an individual with co-occurring disorders is generally seen as "continuously at risk for relapse."2 Comprehensive treatment and adequate aftercare may help to reduce some of this risk. One study found that, among patients with moderate-to-high severity dual diagnosis disorders, treatment outcomes were improved when their drug abuse treatment was supplemented with targeted mental health care.2
If you need treatment for both a mental health disorder and a substance abuse disorder—or you suspect that you might—it is very important that you find a facility that is equipped with the staff necessary to handle your treatment. Dual diagnosis programs can provide care for both addiction and mental health issues.2 If you suffer from a mental health disorder, make sure to communicate that to the treatment center before you enter.2
Is Drug Addiction a Mental Illness?
The answer to whether drug addiction qualifies as a mental illness is yes. Here’s why: addiction results in distinct brain changes and can disrupt a person's "hierarchy of needs and desires," leading them to prioritize drug use above all else. A person's ability to control their compulsion to use substances becomes significantly diminished as these brain changes occur, which can promote continued drug or alcohol use despite knowledge of the harm it is causing. The compulsive behaviors associated with substance use disorders (addictions) bear similarities to other mental illnesses.3
Healthcare professionals in the United States refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM) when making diagnoses of mental disorders. The DSM states that "an important characteristic of substance use disorders is an underlying change in brain circuits that may persist beyond detoxification." Like other illnesses, addiction may require long-term treatment approaches. This goes against the ideas that addiction is a simple issue of willpower or is a condition with the potential to be remediated by "just saying no;" instead, it is now seen as a "chronic and relapsing brain disease" that requires specialized treatment.3 In fact, genetics is shown to play a major role in a person's risk of developing a substance use disorder—it is estimated that 40 to 60% of a person’s vulnerability to substance abuse is genetic.4
Substance abuse often occurs with other mental illnesses. Many people who regularly abuse drugs or alcohol are diagnosed with other mental health issues at some point. Studies show that people who are diagnosed with mood or anxiety disorders are nearly twice as likely to have a substance use disorder compared to the general public.3
The same goes for antisocial personality or conduct disorder. People diagnosed with these types of disorders are more likely to abuse substances. In addition, gender plays a factor in the prevalence of co-occurring disorders. For example, males are more likely to be diagnosed with antisocial personality disorder, while women are more likely to suffer from mood or anxiety disorders.3
In some cases, it is difficult to know what came first—the substance abuse or the mental health disorder. It can also be difficult or impossible to determine causality; even if the symptoms of one condition appeared first, it may not have caused the other. What is known is that it is relatively common for people to self-medicate mental health symptoms with substances. Also, substance abuse may worsen or bring about symptoms of mental illness. For example, marijuana has been shown to increase the risk of psychosis for some users.3
In addition, substance use disorders and mental illness have overlapping risk factors such as:3,4
- Certain types of neurological deficits, such as lower-than-normal activity in certain brain circuits.
- Adverse childhood experiences.
Research also suggests that adolescents who use drugs are more vulnerable to developing an addiction or mental health disorder.3 When a person is young, important parts of their brain, such as their prefrontal cortex, are still maturing. Exposing a still-developing brain to certain drugs can have harmful and long-lasting effects.3
THE LINK BETWEEN SUBSTANCE ABUSE AND SCHIZOPHRENIA
Those who are genetically vulnerable to some types of mental illness may increase their risk with the abuse of certain drugs. Studies find, for example, that heavy marijuana use may increase the risk for schizophrenia and other psychotic disorders in those with a particular gene variant.3 Daily users of marijuana had increased risk of psychotic symptoms compared to non-cannabis users.5
It's worth noting that studies have also documented higher rates of schizophrenia among methamphetamine users compared to cocaine, opioid, and alcohol users—similar to the rates seen in marijuana users.6 Researchers believe that methamphetamine abuse is a risk factor for schizophrenia and that brain abnormalities associated with methamphetamine use may contribute to the development of schizophrenia.6
Across the board, there is a high prevalence of substance abuse among people who suffer from schizophrenia. Studies have investigated this connection and found that potential contributing factors may include:5
- Genetic vulnerability.
- Neurobiological factors.
- Medication side effects.
- Psychosocial issues.
Substances commonly abused by people with schizophrenia include alcohol, nicotine, cocaine, marijuana, and methamphetamine. Some studies estimate that as many as 50% of patients with schizophrenia struggle with alcohol or illicit drug dependence and over 70% are dependent on nicotine.5 The same deficits in certain brain functioning that render an individual more vulnerable to schizophrenia may also increase the rewarding effects of nicotine and make cigarettes more difficult to quit. This phenomenon may help to explain why rates of smoking may range as high as 90% among those with schizophrenia.3
Facts About Co-Occurring Conditions
Being exposed to traumatic events can increase a person’s likelihood of developing co-occurring conditions. Among veterans, there is a compelling link. Nearly 1 in 5 military service members returning from Iraq or Afghanistan reported symptoms of post-traumatic stress disorder (PTSD). Recent studies find that almost half of all veterans who are diagnosed with PTSD also have a substance use disorder.3
Other notable facts about dual diagnoses include the following:3
- In the United States, mental illness and substance abuse are usually treated separately and not in a dual diagnosis program.
- Women are more likely than men to seek help from mental health providers for a co-occurring disorder, while men are more likely to seek help through substance abuse treatment providers.
- Some substance abuse treatment centers have a potentially harmful bias about using any medications, including those needed to treat mental illnesses, such as depression.
- Many treatment centers do not have staff members who are qualified to prescribe, monitor, or dispense psychiatric medications.
- As many as 45% of individuals who are incarcerated have a mental health problem as well as a substance use disorder. Unfortunately, the care necessary to treat these conditions is often lacking within the criminal justice system.
It takes a well-equipped, professional treatment facility to properly diagnose and treat dual diagnosis disorders.
When a dual diagnosis is at play, it’s vital that treatment addresses both the mental health issue and the substance abuse. Those who have both a substance use disorder and another mental health disorder may exhibit symptoms that are more severe and treatment-resistant than those with only one or the other.3 It's widely acknowledged that treatment that addresses both issues will lead to better outcomes. Anyone who is potentially struggling with both addiction and mental health issues should be thoroughly assessed for the presence of a dual diagnosis and treated accordingly.3
It's widely acknowledged that treatment that addresses both issues will lead to better outcomes.
Some treatment facilities today offer specialized dual diagnosis treatment. The first step is often detox. Detoxification is the set of interventions used to manage substance withdrawal. Depending on the drug that the individual is detoxing from, withdrawal symptoms can be severe.
Once you are stable enough for treatment, you may begin your addiction treatment; often this involves moving into a rehab center. You will undergo an intake assessment with a staff member. A physical examination and psychological assessment will be conducted. Treatment for any pertinent medical and mental health issues will be incorporated into your rehabilitation plan. Appropriate management of both mental health issues and addiction will increase the chances of sustained recovery.
During rehab, you will likely participate in both group and individual therapy. Several therapeutic approaches may be utilized to treat co-occurring disorders, including:7
- Cognitive behavioral therapy (CBT): This therapy helps individuals recognize and change negative behaviors and destructive thought patterns.
- Dialectical behavioral therapy (DBT): This type of therapy is unique in that it was created specifically to help individuals reduce their thoughts and behaviors related to self-harm. This includes cutting, drug use, and suicidal thoughts or attempts.
- Assertive community treatment (ACT): This type of therapy helps the individual engage with the community and utilizes an individualized approach.
- Therapeutic community (TC): This is a long-term, group treatment approach where the individual lives in a residential community. During this time, staff help them to "re-socialize" and prepare in various ways for their reintegration into their daily lives when they return home.
- Contingency management (CM): This type of treatment incentivizes individuals with vouchers or other small rewards for engaging in healthy behaviors or reaching certain milestones.
Other forms of treatment may include intensive one-on-one therapy with a psychiatrist or therapist who has experience dealing with the challenges associated with both mental health issues and addiction. Medication may be utilized to manage certain psychiatric disorders or to mitigate the withdrawal symptoms associated with detox. You may also attend support group meetings, such as AA or NA, during your time in treatment. Psychiatric medications may also be prescribed by staff physicians.
Behavioral modification therapies and experiential therapies can augment a treatment regimen, helping to alter thoughts and behaviors to better manage both disorders.
During your stay, you will work with your treatment providers to come up with an aftercare plan, as keeping a focus on your long-term mental and physical health is important to maintaining a positive recovery trajectory.
Finding a Program
If you are struggling with a dual diagnosis and you are looking for treatment, search through our online directory of programs in your area or in a location throughout the country. Given the high prevalence of dual diagnoses, more and more programs are utilizing an integrated treatment approach by combining mental health treatment and substance abuse treatment. Be sure to ask any potential programs you're considering if they provide specialized dual diagnosis care.
After you’ve found a few programs that look like potential fits, make a list of them, as well as a list of questions. You may want to ask about the way they approach treating mental health and substance abuse at the same time and see if it resonates with you. The most important thing when looking for treatment is finding a place that feels right to you.
Some question you may want to ask include the following:
- Are there staff members who specialize in treating dual diagnoses?
- What is your approach to managing dual diagnoses?
- Can I schedule a visit?
- Do you have pictures of the facility?
- Where can I read reviews online?
- What is your electronics policy?
- What types of therapies do you use?
- Do you use medication?
- How long is the average stay at your center?
- What insurance do you take?
- What types of aftercare do you provide?
Living with untreated co-occurring conditions can be exceptionally difficult. Don't wait another day to find the right treatment for you.
- Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health.
- Flynn, P. M., & Brown, B. S. (2008). Co-Occurring Disorders in Substance Abuse Treatment: Issues and Prospects. Journal of Substance Abuse Treatment, 34(1), 36–47. http://doi.org/10.1016/j.jsat.2006.11.013
- National Institute on Drug Abuse. (2010). Comorbidity: Addiction and Other Mental Illnesses.
- National Institute on Drug Abuse. (2018). Why is there comorbidity between substance use disorders and mental illnesses
- Winklbaur, B., Ebner, N., Sachs, G., Thau, K., & Fischer, G. (2006). Substance abuse in patients with schizophrenia. Dialogues in Clinical Neuroscience, 8(1), 37–43.
- Callaghan, R. C., Cunningham, J. K., Allebeck, P., Arenovich, T., Sajeev, G., Remington, G., ... & Kish, S. J. (2012). Methamphetamine use and schizophrenia: a population-based cohort study in California. American Journal of Psychiatry, 169(4), 389-396.
- National Institute on Drug Abuse. (2018). What is comorbidity?