“Many addicts struggle with mental disorders. I myself struggle with bipolar one and it is the cause of much of my use (read my journals for more personal accounts). Using drugs to defeat things like that or depression and anxiety most often make things worse. It can further offset the symptoms despite the immediate satisfaction. Its important to see a psychologist, being as honest as you can, to seek proper treatment. I have found that treating my illness with prescription drugs has controlled my mental/emotional state far better than any illegal substance I have ever used. The effects are long-term and with the help of medial professionals, I am able to stay sober and sane.” – Love, Robyn
There is a complex relationship between addiction, such as alcoholism, and mental illness. Treatment needs to focus on both conditions at the same time, once the right diagnoses have been made.
The complexities of mental illness are often compounded by drug and alcohol abuse, making it a challenge to get the right diagnoses and treatment for both.
Drug Abuse and Mental Illness: A “Complex Dance”
“Mental illness and alcoholism or drug abuse interact in a complex dance, “says James Garbutt, MD, professor of psychiatry at the University of North Carolina at Chapel Hill and research scientist at UNC’s Bowles Center for Alcohol Studies. “Mental illnesses can increase the risk for alcoholism or drug abuse, sometimes because of self-medicating. On the other hand, alcoholism can lead to significant anxiety and depression that may appear indistinguishable from a mental illness. Finally, one disorder can be worse than the other.”
According to Stephen Gilman, MD, an addiction psychiatrist at New York University in New York City, “Alcoholism and drug abuse addictions and other psychiatric disorders often occur at the same time. However, they are distinct disorders that must be treated as such in order to get a good outcome for the patient.”
Drug Abuse and Mental Illness: Likely Conditions
Certain mental conditions are frequently associated with alcohol and drug dependency. They include:
- Depression. In some cases, individuals may start to abuse a substance to mask the symptoms of depression. Female substance abusers are particularly likely to have depression, but it also occurs in male substance abusers.
- Bipolar disorder. Those with bipolar disorder — a condition that causes alternating cycles of depression and an abnormally elevated mood — may attempt to smooth out mood swings with alcohol.
- Anxiety. Alcohol abuse is more common in both men and women with anxiety disorders.
- Schizophrenia. Psychotic symptoms, such as hallucinations and delusions, may lead to substance abuse as a way to ease the distress that these symptoms can cause.
Those with a mental disorder may also be less inhibited and more likely to show risk-taking behavior — like buying and using illegal drugs or drinking to excess — that could quickly lead to alcohol or drug abuse. “Individuals with a mental disorder could have impaired judgment and consume higher amounts of a drug or alcohol, says Dr. Garbutt.”
Drug Abuse and Mental Illness: Underlying Causes
There are also other factors that could explain the frequent simultaneous occurrence of addiction and mental illness, including:
- Genetics. Genetic factors seem to account for some of the co-morbidity (having both disorders at the same time) of substance abuse and mental disorders. Studies comparing identical and fraternal twins found more instances of having two disorders among the identical twins, indicating that genetics likely play some role.
- Chemical deficiency. Neuro-chemical factors were also found to be a common thread when mental disorders and addiction occur together. A reduction in the amount of serotonin, a chemical critical to brain functioning, may be the reason that alcoholism and anxiety disorders coincide so often. There is also evidence that addiction and mental disorders are associated with the dysfunction of a group of brain chemicals called monoamine oxidases.
- Shared environment. Studies surrounding twins also showed that environment plays a major role in having both a substance abuse problem and another mental disorder.
Drug Abuse and Mental Illness: What Is the Exact Relationship?
The answer is not entirely clear, but the connection works both ways. People with alcohol and drug addictions tend to develop mental illnesses. People with certain mental illnesses tend to develop substance abuse problems.
“Fifty percent of those with an addictive disorder will have a psychiatric disorder. And for those who have a psychiatric disorder, about 20 percent have an addiction problem,” says Dr. Gilman.
That number is even higher in those with certain mental conditions. “A variety of mental illnesses such as post-traumatic stress disorder, antisocial personality disorder [characterized by a lack of empathy toward other people], anxiety, sleep disorders, or depression, increase the risk of addiction. Those with the highest risk of addiction have bipolar disorder or schizophrenia — up to 50 percent [of people with these conditions] can have an addiction,” says Garbutt.
Researchers don’t yet know exactly why people with these particular disorders are at an increased risk for addiction, says Garbutt, but it has been noted that:
- Abruptly stopping alcohol intake can lead to withdrawal symptoms — including hallucinations — that may look just like schizophrenic symptoms.
- Alcoholism and drug abuse can cause changes in the brain, sometimes leading to changes in personality and mental disorders.
- Alcoholics of both genders frequently suffer depression and anxiety disorders, while men are more likely to exhibit antisocial personality disorder than non-abusers of alcohol.
Drug Abuse and Mental Illness: Treating Two Sets of Symptoms
According to Gilman, “It is very important, but often difficult, to distinguish which symptoms are psychiatric and which are addictive. A person must be substance-free for a period of at least two weeks in order to tease apart the various symptoms.”
“Clinically speaking, you have to treat the addiction and the psychological symptoms at the same time. Misdiagnosis, and therefore under-treatment, is common, such as when an alcohol addiction is masking bipolar disorder,” says Garbutt.
Garbutt and Gilman both believe that treating an addiction and a mental illness at the same time is possible, and when you treat them together you can begin the process of unraveling the underlying causes of each.