Substance abuse is not a choice. It is, instead, a complicated mental health condition that affects every aspect of a person’s life, including their relationships, work, health, and their overall quality of life. It is important that those struggling with substances as well as their family members get the support they need to ensure everyone has a chance to heal.

How Prevalent Is Comorbidity?

Due to the complex nature of this mental illness, it is related to other mental health conditions. Substance use disorder often carries with it comorbid mental health disorders, which means that other disorders often occur alongside addiction. In fact, according to the National Institute on Drug Abuse (NIDA), half of those with substance use disorder also have another mental health condition. This prevalence actually goes up by about 10% in the adolescent population. 

Of people who have a serious mental illness (which is any mental health condition that severely impairs functioning and quality of life), 25% are found to have substance use disorder. This significant number points to the reality that addiction is intertwined with mental illness more broadly, which underscores the importance of finding a provider who can therapeutically treat each of these concerns. 

Common Comorbidities and Causes

Substance abuse is correlated with many disorders, which can include the following:

  • generalized anxiety and panic disorder
  • PTSD
  • depression
  • psychosis
  • bipolar disorder
  • borderline personality disorder
  • ADHD
  • antisocial personality disorder

Some of these conditions can be seen as stemming from addiction, while others commonly precede addiction. Substance abuse and other mental health conditions share many of the same risk factors, such as genetics, brain circuitry, environment, stress, and adverse childhood experiences. This means that if an individual is at an increased risk of developing a mental health condition, they are simultaneously at an increased risk of acquiring substance use disorder. In this case, the two conditions are independent of each other with overlapping risk factors.

Substance use can also put an individual at a greater risk of developing a mental health condition. Drugs and alcohol change the brain in a way that makes it more vulnerable to disordered cognition and emotional dysregulation. Addiction greatly impacts the reward system of the brain by hijacking neurotransmitters, the messengers of the brain, leading to imbalances that could trigger conditions such as anxiety and depression.

Similarly, mental health conditions increase a person’s risk of misusing substances. When a person is struggling with intense mental and emotional discomfort, they might seek out drugs and alcohol as a way to self-medicate. While this may seem to do the trick in the short term, using substances can worsen the symptoms of a mental illness. This then creates a vicious cycle of using to numb the pain, but inadvertently making it come back stronger each time.

No matter whether the addiction or the mental illness came first, these comorbid conditions greatly influence the complexity of addiction and carry important considerations for treatment and recovery.

Treating Comorbid Addiction and Mental Health Issues

In order for treatment to be as effective as possible, it is best for addiction and a comorbid mental health condition to be treated together. This does not mean seeing one provider for treatment pertaining to addiction and seeing a separate provider to address the other condition. Rather, the best outcomes are seen in individuals who are able to receive an integrated model of care that tackles both problems as intertwined issues.

Different treatment modalities exist for different mental health conditions, and some work better for the specific intersection of substance use disorder and certain mental illnesses than others. For example, exposure therapy is typically used to treat anxiety disorders, such as phobias and obsessive-compulsive disorder. Here, individuals are slowly exposed to their triggers until they can safely tolerate them without intense anxiety symptoms. This model is helpful for those diagnosed with both substance use disorder and PTSD. 

Dialectical-behavior therapy (DBT) was designed to help people with borderline personality disorder and chronic suicidality to accept and tolerate intense emotions. It can be used to help people limit their use of self-destructive behavior, such as self-harm and substance use. 

Some interventions have been designed specifically to address mental health issues alongside addiction. For example, integrated group therapy is a model of group therapy used to simultaneously treat bipolar disorder and substance use disorder, while Seeking Safety is designed to treat individuals who struggle with both addiction and trauma.

A special consideration for individuals undergoing treatment for comorbid disorders is that the rate of dropout tends to be higher among these individuals. People can struggle to adhere to treatment even when they have one condition due to symptoms like lack of motivation or apathy, so co-occurring disorders can create more barriers.

Families and Mental Health

As discussed above, both substance abuse and mental illness can have roots in our genetics. This means that these conditions can impact family systems at multiple levels. Certain predispositions can be passed down through DNA, increasing the next generation’s risk of developing conditions that the previous generation also struggled with. 

Additionally, addiction and mental disorders can stem from or be exacerbated by adverse childhood events, stress, and trauma. These often are not individual experiences, and when multiple family members experience such traumatic situations, several people can suffer the effects.

If one person in the family lives with substance abuse or mental illness, it is not uncommon that other family members to share similar burdens. Effective and timely intervention can help families function better at both the individual and group levels while reducing risk for future generations.

Living with substance use disorder is an everyday fight that can consume a lot of time and energy, among other costs. Adding on the stress of another co-occurring disorder like depression or anxiety can make that fight even worse. If you understand this struggle, whether from your own experiences or those of someone you love, you might be feeling overwhelmed and alone. While everyone’s experience is unique, comorbidity between substance use disorder and depression, anxiety, PTSD, schizophrenia, and ADHD is far from uncommon. There is help available. Make your first step toward getting that help by reaching out to Family-Centered Services. We utilize individual and family therapy, a Family Recovery Program, case management, and sober monitoring to help you and your family reach your wellness goals. Your recovery is our priority, and our licensed clinicians are well-equipped to meet your needs. Call us at (509) 991-5822 to start working together.