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An addict might suffer not only from his/her alcohol or drug addiction but also from some psychological difficulties like anxiety, depression, post-traumatic symptoms, or other mental illnesses. Some problems can already exist before the start of substance abuse, while others can be caused by it. However, ignoring mental issues along with addicts’ alcoholism or drug abuse can result in an inefficient recovery process.

Mental Illness and Drug/Substance Abuse Can Co-Occur

Having mental illness in combination with substance abuse is called co-occurring disorder. These disorders are rather widespread nowadays.

In 2024, SAMHSA found that about 21.2 million U.S. adults were diagnosed with both mental and substance use disorders.

One could note here that co-occurrence of addiction and mental disorder is not the same thing every time. Depression can go hand-in-hand with alcohol abuse, while anxiety, post-traumatic disorder, bipolar disorder and so on can coexist with different types of substance use.

The Relation Between Mental Illnesses and Substance Abuse Works in Both Directions

People can usually try to find the one main cause for the problem of substance abuse – either mental health difficulties led to addiction, or addiction caused mental problems. However, the reality is much more complex.

As SAMHSA says, this relation between psychological and physical problems of addicts is considered to be bidirectional – mental disorders can lead to development and/or aggravation of substance use disorder, and vice versa.

Moreover, there can be the same risk factors which lead to both kinds of disorders.

That is why determining what has happened first cannot guarantee the complete solution for the patient’s problems.

Using Substances as a Way to Escape from Emotional Distress

A patient can use drugs or alcohol in order to feel himself/herself temporarily relieved from his/her anxiety, sadness, traumatic experiences, feeling of loneliness, or other negative feelings.

Such behavior creates a dangerous cycle – the initial emotional problem remains, while using drugs or alcohol leads to some new complications and makes emotional distress worse.

According to SAMHSA, people experiencing mental difficulties use substances as a way of self-medication. Also, some substances can cause symptoms associated with mental illnesses.

Therefore, determining what a person is trying to escape from can become important in determination of his/her substance use disorder.

Difficult to Determine What Causes Different Symptoms

Mental and substance abuse disorders can cause many similar symptoms – sleeping problems, mood changes, inability to concentrate, loss of energy, lack of motivation, and behavioral changes.

This can complicate the process of assessment of mental problems of a patient. An anxiety can appear as a consequence of an existing disorder, substance effects, withdrawal, stressful environment, or as a result of other factors.

The professional assessment of co-occurring disorders requires information concerning substance-abuse patterns, psychiatric symptoms, physical health, medications taken by a person, previous diagnoses, and his/her life circumstances.

Therefore, SAMHSA recommends conducting routine screening in both ways – patients coming to mental health services should be screened for substance use disorders, and people receiving substance use services should be screened for mental disorders.

Concentration on One Kind of Disorder Can Leave Risks Unnoticed

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One may reduce his/her substance use and continue experiencing severe anxiety which has not been assessed properly. The other way can be when a patient receives treatment for depression, but his/her problematic substance use continues to cause sleep disturbances, affects relationships, medication adherence, or daily functions.

In this case, for people with co-occurring disorders, treatment of two disorders can be more efficient. As SAMHSA says, the integrated screening and treatment can help to address both mental and substance use disorders and improve the quality of care and outcomes.

It does not mean that everybody having an addiction suffers from another diagnosable disorder. It only means that one should take into consideration the possible mental illnesses of addicts.

The Integrated Treatment Approach Considers All Patient’s Issues

Integrated treatment means coordination of intervention rather than treatment of two separate problems.

Depending on individual needs, treatment can include behavioral therapies, medications, interventions concerning particular substances, psychiatric services, medical treatment, peer programs, and practical help.

According to NIDA, the integrated approaches for treatment of co-occurring substance use and mental health disorders proved to be more effective than separate treatments of these diagnoses.

However, the treatment should be always individualized – two people using the same substance can have different psychiatric history, family background, physical health concerns, and recovery plans.

Trauma Has to Be Assessed as Well as Other Problems

The problem of trauma is another reason why a comprehensive assessment can be necessary.

Such events as violent actions, abuse, accident, loss, combat situations, or some other traumatic experiences can cause psychological distress long after the situation occurred. In some cases, the addiction can become a consequence of attempts to cope with painful memories and emotions.

However, this fact does not mean that a patient should be considered to have trauma in every case. Clinicians should assess whether this aspect is really relevant for a particular patient instead of thinking about substance use.

Thus, when trauma-related symptoms are present, care can be planned in a proper way instead of ignoring the source of psychological distress of the person.

Professional Assessment Helps to Determine the Entire Picture

It can be rather difficult for a patient to try to assess his/her problems on his/her own. In addition, symptoms may change in dependence on substance use, withdrawal, stress, sleep problems, or other factors.

While seeking treatment, it can become useful for the patient to receive proper clinical assessment of his/her substance-use and mental health disorders in order to understand what kind of treatment he/she needs. SAMHSA distinguishes coordinated, co-located, and fully integrated models of service delivery for people with co-occurring disorders.

Assessment is an important stage because treatment has to consider the needs of the particular patient and not to apply the same program to everyone suffering from a particular substance abuse.

Recovery Involves Much More Than Just Symptoms

Recovery is not only about cessation of the substance use or alleviation of mental disorder. Everyday life becomes a part of it too.

Relationships, housing, physical health, job, financial situation, habits, sleep, and social contacts can influence a person’s stability. Problems in these spheres can increase the stress level of a patient, while improving them can strengthen the results of the treatment.

According to NIDA, the care for co-occurring disorders can sometimes require collaboration not only between providers of clinical services but also with people providing assistance in such areas as physical health, housing, employment skills, and law.

This kind of approach acknowledges that people treat their lives, and not isolated diagnoses.

More Efficient Care Needs Recognition of the Connection Between Addiction and Mental Illness

Addiction and mental illness do not necessarily have a simple causal relation. One problem may precede the other, both problems may influence each other through time, or there may be the same risk factors for both disorders.

However, the clinically important aspect is recognition of co-occurrence of these problems.

The SAMHSA reports that integrated approaches can be associated with such benefits as reduction of substance use, improvement of psychiatric symptoms and functioning, quality of life, and decrease in number of hospitalizations among people with co-occurring disorders.

Therefore, the treatment of mental disorders in addition to addiction treatment is not about including unrelated problems in recovery. It is about taking into account all factors influencing a particular patient.

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