The Connection Between Mental Illness & Substance Abuse

the connection between mental illness and substance abuse

The Connection Between Mental Illness & Substance Abuse

Both substance abuse and mental illness can be destructive and difficult in their own right.  They both can place a strain on relationships, jobs, finances, and stability.  What many people don’t realize, is that there is a strong correlation between people who abuse drugs or alcohol and those who suffer from a mental illness. In this article, we’ll discuss the connection between mental illness and substance abuse, and explore why the connections between these two conditions occur with such regularity.  

We will also discuss why the connection between substance abuse and mental illness is often missed during treatment, and outline how a facility that offers a dual-diagnosis treatment plan will give the greatest chances for a successful recovery and lifelong freedom from substance abuse and the anguish of undiagnosed mental illness. In discussing these issues, we hope that recovering addicts, or those that have an addict in their life, will gain greater insight into the connection between mental illness and substance abuse.  


Mental illness and substance abuse are considered to have a high rate of comorbidity. Comorbidity is when two or more disorders or illnesses are diagnosed in the same person. Until relatively recently, the study of the comorbidity between mental illness and substance abuse was largely ignored, leaving a large gap of knowledge about how the connection between mental illness and substance abuse. Once studies began to be conducted on the topic, researchers found that the rate of people who abused drugs or alcohol and also had a mood or behavioral disorder was significantly higher than the general population.  

There is currently no one answer as to why those that suffer from a mental illness are more likely to also have a problem with substance abuse or drug dependency. Despite this, there are a number of salient points about the comorbidity between mental illness and drug dependency that must be understood.

First, researchers have not yet proven or shown any clear factor that leads one to the other. Some people suffering from a mental illness such as anxiety, agoraphobia, or depression continue to suffer from those illnesses while also suffering from a substance abuse issue. In such cases, when the addict enters recovery and detoxes, they will still have a mental illness that needs to be treated.

Some researchers believe that the high rates of comorbidity between drug or alcohol abuse and mental illness stems from a series of shared risk factors that place certain people at higher risks for developing both. Again, this theory is not agreed upon by experts in the field. Other researchers believe that the high frequency of comorbidity between the two is due to the fact that substance abuse, which is a mental illness itself, resides in the same part of the brain that many mental illnesses occur.

Still, other researchers tend to see the confluence of substance abuse and mental illness as the result of environmental factors, such as stress, abuse, or trauma during development, that make a single person more prone towards developing certain types of mental illness and more susceptible towards developing a problem with substance abuse.

Lastly, some believe that substance abuse itself can manifest, in a sense, a latent mental illness in the person. By this line of thinking, if someone has latent schizophrenia and begins to use methamphetamine, the use of methamphetamine may activate or manifest their schizophrenia. While certain drugs can appear to result in the manifestation of mental health issues, experts have not agreed that this is in fact as common as was once believed.

Although the reason that a high comorbidity between substance abuse and mental illness remains hotly debated, and may never be fully understood, what isn’t debated any longer is the fact that this comorbidity occurs. The frequency with which those suffering from a substance abuse problem also suffer from one or multiple forms of mental illness, and vice versa, occurs in such high rates that it can no longer be seen as an anomaly. Rather, many medical professionals and mental health experts are instead beginning to focus their attention on how best to diagnose individuals that have a comorbid condition of substance abuse and a mental illness.

Why is Comorbidity So Often Missed?

It is a sad fact that too often, those people seeking treatment for a substance abuse problem often are not treated for an underlying mental illness issue that they are suffering as well. The difficulty lies in both correctly diagnosing, and treating, substance abuse and mental illness that are occurring simultaneously. In most cases, the substance abuse is noticed and treated, while the underlying mental illness is not.  

There are a few common reasons for this. The first is that the indicators of substance abuse are frequently much more obvious than underlying conditions. The physical effects of long term drug abuse of certain substances, like heroin, cocaine, benzodiazepines, and methamphetamine, are so destructive upon the body and psychological state that it can be extremely difficult for medical professionals to see past the immediate effects of substance abuse.

The second most common reason that substance abuse obscures an underlying mental health condition is due to the effects of substance abuse itself. Often, abused substances have effects that mimic the most common mental health conditions. Drugs like heroin, for example, will result in a mental state that very closely aligns with someone suffering from depression. The effects of other drugs, like methamphetamine and related stimulants, will produce in the user symptoms that are similar to mania, schizophrenia, and anxiety. In fact, these behavioral signs are commonly seen as an indicator of abuse of methamphetamine when the physical effects of the drug on the body, such as weight loss, dental decay, and skin lesions, are taken into account as well.

Not only must medical professionals attempt to see past the side effects that certain substances of abuse have on the personality and mood of the user, but they must also recognize that some substances suppress the signs and symptoms of an underlying mental illness. Depressants, such as benzodiazepines or heroin, produce such a profound effect on the brain chemistry and central nervous system that they can powerfully suppress an underlying medical condition such as acute anxiety.

This ties into one connection that exists between mental illness and substance abuse; many people that abuse substances do so in part because their drug of choice alleviates some of the symptoms of their underlying mental health condition. Taking acute anxiety as an example, a person may first use benzodiazepines recreationally and find that the symptoms of anxiety are reduced when they are on the drug.

While they may continue to use the drug due to the high that is produced, they may also continue to use the drug in part because of the powerful suppressing effect it has on their undiagnosed mental health condition. Often, by the time they are seeking help for their substance abuse problem, the medical professional conducting the examination will first and foremost see a powerful chemical dependency that needs to be addressed. Additionally, the patient may not even be aware that they have an undiagnosed mental health condition, making an accurate diagnosis even more difficult.

One other significant factor in the lack of diagnosis of an underlying mental health condition in someone suffering from a substance abuse problem is the different levels of training and fundamental beliefs of mental health professionals. Some medical professionals are simply not adequately trained to recognize underlying mental illness in someone suffering from severe chemical dependency or long-term drug abuse.

Up until a few decades ago, the process of looking for signs of both substance abuse and any underlying mental health issues in the patient during intake or when formulating a treatment plan was not a common practice. Medical professionals in a recovery facility where instead trained to focus on the substance abuse and chemical dependency first, and to treat any mental health issues later in the recovery process.

This outlook has since changed as the scope of the comorbidity between mental illness and substance abuse became more fully understood. Now, medical professionals at top-rated institutions have begun to use the approach of dual-diagnosis treatment, and in doing so have had far greater success of catching both substance abuse and mental illness during patient intake.

The Power of Dual-Diagnosis Treatment

Dual-diagnosis treatment is a practice conducted by specially trained medical professionals that results in far more accurate diagnosis of comorbid substance abuse and mental illness at the time of patient intake. There are a number of difficulties in correctly assessing a patient for dual-diagnosis treatment. An accurate assessment requires the medical professional to be highly trained in both recognizing the signs and effects of substance abuse across drug types, while also being able to recognize and effectively treat an array of mental health conditions.  

The benefits of having exceptionally trained medical professionals capable of dual-diagnosis treatment are, however, immense. For this reason, many of the top-rated rehab facilities around the world are transitioning towards offering dual-diagnosis treatment and incorporating this into their intake process. Dual-diagnosis treatment relies on a medical professional that can discern the difference between the effects or side-effects of certain drugs and an underlying medical condition.

Often, these differences can be subtle and difficult to separate. This is particularly true if a patient is already going through withdrawal. The withdrawal process inherent in many of those suffering from long-term substance abuse further serves to mask or obscure underlying medical conditions. Acute withdrawal from alcohol, heroin, cocaine, methamphetamine, and benzodiazepines, as well as many other drugs, manifests symptoms that occur with many mental illnesses.

For example, a patient entering a rehab facility for addiction to heroin that is already going through withdrawal will almost certainly display signs of acute anxiety. In this example, let’s say that the patient has an undiagnosed mental health condition for anxiety. Often, when a person is going through withdrawal from heroin that has underlying anxiety, the effect from the withdrawal process will manifest that anxiety even more powerfully than in its original state.  

This process, known as the rebound effect, may further serve to obscure the exact nature of their condition and how best to treat it. Qualified medical professionals must then assess the patient and determine if the anxiety they are experiencing is the result of the withdrawal process from heroin, or if it is a symptom of an undiagnosed mental illness that must be treated alongside the heroin withdrawal.

Despite the challenges in accurately assessing patients for both substance abuse and mental illness concurrently, the advantages of this process are clear. An accurate dual-diagnosis treatment will ensure the greatest chances of a successful recovery and life-long freedom from further substance abuse.

Conversely, a missed diagnosis for an underlying mental illness will result in a recovery process that has a far greater chance of the recovering addict returning to substance abuse at some later point. As we pointed out, many people may continue to use drugs or alcohol because of the way that they suppress the symptoms of their underlying mental illness.

This process of self-medication leads to long-term substance abuse and an underlying mental illness that is never properly understood or treated. An accurate dual-diagnosis treatment, however, will treat both the substance abuse and mental illness or illnesses at the same time.  This will help alleviate the symptoms of the mental illness to a large degree, which allows the recovering addict to fully work through their substance abuse issue. Dual-diagnosis treatment plans result in much more effective therapy, and give a greater chance of success in long-term recovery.




Because dual-diagnosis treatment is such a powerful tool in addiction recovery, it is important when selecting a drug rehab center to inquire with them about their approach to assessing and treating patients. Top-level drug rehab programs that use highly trained medical professionals will approach assessment and treatment from a dual-diagnosis perspective.  

They will be able to identify and treat both substance abuse and any mental health issues that a patient is suffering from at the same time. This approach often alleviates many of the most difficult aspects from the detox and withdrawal, while also giving recovering addicts the tools and treatment they need to maintain sobriety for the rest of their lives.

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