Struggling with a substance use disorder can turn your world upside down, affecting everything from your relationships and career to your physical and emotional health. At Talk Online Counselling BC, we work with many individuals who may not realize an important truth: substance use doesn’t just impact the body; it can significantly increase the risk of developing mental health disorders as well.
In fact, the 2023 National Survey on Drug Use and Health revealed a striking connection: 35% of American adults with a mental health disorder also experience a substance use disorder (Substance Abuse and Mental Health Services Administration, 2024). This overlap is both concerning and often overlooked, but it’s something we’re here to address.
In this article, we’ll explore the complex relationship between substance use and co-occurring mental health disorders. We’ll shine a light on some of the most common conditions that tend to go hand-in-hand with problematic substance use. If you’re struggling, know that you’re not alone—and our team of licensed professionals is here to help.
Substance Abuse and
Substance Use Disorder Overview
Substance Use Disorder (SUD) happens when someone’s use of substances like alcohol, tobacco, or other drugs becomes difficult to control. SUD isn’t about willpower. It’s a complex condition that affects the brain, leading to intense cravings and compulsive use despite harmful consequences.
SUD symptoms fall into four main areas:
1. Impaired Control: Feeling strong cravings to use the substance and struggling to cut back or stop, even when you want to.
2. Social Problems: Substance use can get in the way of responsibilities at work, school, or home and may lead to giving up hobbies or time with loved ones.
3. Risky Use: Continuing to use in unsafe situations or even when it’s clearly causing harm.
4. Drug Effects: Needing more of the substance to feel the same effect (tolerance) or feeling withdrawal symptoms when you stop.
Substance use also changes how the brain works, which can make cravings stronger and decision-making harder. These brain changes explain why it can be so difficult to quit without help. But with the right support and understanding, recovery is absolutely possible.
Common Co-Occurring Disorders
When substance use disorder overlaps with mental health challenges, it’s often referred to as a co-occurring disorder. These conditions frequently occur together, creating unique challenges for individuals seeking recovery. Let’s explore the most common disorders.
ADHD
Attention-Deficit/Hyperactivity Disorder (ADHD) is a developmental condition characterized by ongoing patterns of inattention, hyperactivity, and impulsivity. Common symptoms of ADHD include:
Inattention: Difficulty staying focused, staying organized, or completing tasks.
Hyperactivity: Feeling restless, moving excessively, or engaging in inappropriate physical activity.
Impulsivity: Acting without thinking, such as interrupting others or struggling to wait one’s turn.
While these behaviours can occur occasionally in anyone, for individuals with ADHD, they affect multiple areas of life, including school, work, and relationships. There is substantial research linking ADHD with an increased risk of developing a substance use disorder (SUD). Studies show that the likelihood of developing an SUD is twice as high for those with ADHD.
A meta-analysis revealed that youth with ADHD are 2.4 times more likely to smoke cigarettes and 1.5 times more likely to develop an SUD compared to their peers without ADHD. This connection underscores the importance of early intervention and support for individuals with ADHD to reduce the risk of future substance use issues (Curr Psychiatry Rep, 2014).
Personality Disorders
Personality disorders are more common than many realize, affecting an estimated 10-14.8% of the general population. However, they are significantly more prevalent among individuals struggling with substance use. Among those receiving SUD treatment, the rate of personality disorders rises dramatically to 34.8-73% (Parmar & Kaloiya, 2018). The most common personality disorders seen alongside substance use are antisocial and borderline personality disorders. These disorders typically begin in childhood, and the patterns of thinking and behaviour tend to get more deeply ingrained as time goes on. There’s no one cause, but the following factors can increase the likelihood of a personality disorder :
● A family history of similar conditions
● Chemical imbalances in the brain
● Tough life experiences, like abuse or neglect, or inconsistent parenting
For some people with personality disorders, substances become a way to cope with difficult emotions. This is often referred to as “self-medication. “Certain personality traits can also play a role in how someone uses substances:
● People with antisocial traits may use substances as part of a rebellious or risky mindset.
● Those with avoidant traits might use substances to feel less anxious or more comfortable in social situations.
Over time, some people develop a tolerance, needing larger amounts of a substance to achieve the same effects, which can create even greater challenges. Excessive substance use can also amplify difficult personality traits, making it harder to manage relationships and navigate daily responsibilities.
Mood Disorders
Mood disorders, like depression and bipolar disorder, profoundly impact how individuals feel and navigate daily life. Living with depression can feel like being weighed down by persistent sadness, often accompanied by anxiety that makes even simple tasks overwhelming. Bipolar disorder, on the other hand, brings intense mood swings. One moment you might feel completely drained, sad, or irritable, and the next you could experience a rush of euphoria or extreme happiness. These mood changes can be incredibly challenging to manage.
Studies show that people with mood disorders are at a higher risk of developing substance use disorders (SUDs). In an ECA (Epidemiologic Catchment Area) Study, researchers found that 32% of people with a mood disorder also struggled with substance use (Regier et al., 1990). Among those with major depression, about 16.5% also had an alcohol abuse problem and 18% had a drug use disorder. The link is even stronger for those with bipolar disorder. A staggering 56% of people with bipolar disorder also face a lifetime SUD (Quello, Brady, & Sonne, 2005). This overlap between mood disorders and substance use can intensify challenges and significantly increase the risk of suicide or self-harm.
Schizophrenia
Schizophrenia is a serious mental illness that can deeply affect how a person thinks, feels, and behaves. For those living with schizophrenia, it can sometimes feel like they’ve lost touch with reality, and that can be difficult for them and their loved ones to manage. Schizophrenia is typically diagnosed after a person experiences a psychotic episode, which usually occurs between the ages of 16 and 30. The symptoms of schizophrenia can make everyday life challenging, impacting everything from work and school to relationships and self-care.
Unfortunately, many people with schizophrenia experience delays in receiving proper treatment, which can make it harder to manage symptoms over time. Schizophrenia affects about 1% of the global population, and individuals with this condition are at a higher risk of developing substance use disorders (SUDs). Research shows that 47% of people with schizophrenia struggle with significant alcohol or drug problems during their lifetime, compared to just 16% of the general population (Regier et al., 1990).
What’s important to know is that subtle signs (changes in thinking, mood, or social behavior) can appear before the first episode of psychosis. Catching these early and connecting someone with the right treatment can make a big difference in their long-term care.
Diagnosing Co-occurring Mental Health Disorders
When someone has both a substance use disorder (SUD) and a mental health condition, it’s important to treat both at the same time. Treating these disorders separately can be less effective, as one can worsen the other. Therefore, individuals needing help with both should work with a healthcare provider who can address both conditions at the same time.
Diagnosing these conditions can be challenging because their symptoms often overlap. To ensure the most accurate diagnosis, healthcare providers use comprehensive assessment tools to capture all relevant details. This helps them develop a personalized treatment plan based on the individual’s specific situation. The provider will consider factors such as age, the substance being misused, and any co-occurring mental health disorders. Treatment plans should be tailored to address these needs, so it’s important to share all your symptoms with your provider and give the treatment enough time to be effective.
Treatment Options
Behavioural therapies are effective for individuals dealing with SUDs and mental health disorders. These therapies are often used alone or alongside medications to help manage symptoms and improve overall well-being. Here are a few behavioral therapies commonly recommended for people with co-occurring conditions:
● Cognitive Behavioural Therapy (CBT): CBT helps individuals identify and challenge negative thought patterns while teaching healthier coping strategies for managing stress and changing destructive behaviours.
● Dialectical Behaviour Therapy (DBT): DBT focuses on mindfulness and emotional awareness, helping individuals manage intense emotions, reduce self-destructive behaviours, and improve relationships.
● Assertive Community Treatment (ACT): ACT provides personalized, community-based care, offering outreach and support for managing mental health and substance use issues in real-world settings.
● Therapeutic Communities (TC): TC programs provide long-term, residential treatment where individuals can focus on building healthier behaviours, attitudes, and values for lasting recovery.
● Contingency Management (CM): CM encourages positive behaviour by offering rewards or vouchers for desired actions, helping individuals stay motivated on their recovery journey.
At Talk Online Counselling BC, we offer these effective therapies to help our clients work through both substance use and mental health challenges. With the right treatment plan tailored to your needs, recovery is within reach. Our supportive team is here to guide you every step of the way. If you want to learn more, please fill out our contact form and we will reach out right away.
References
Substance Abuse and Mental Health Services Administration. (2024). Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on Drug Use and Health (HHS Publication No. PEP24-07-021, NSDUH Series H-59). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2023-nsduh-annual-national-report
Curr Psychiatry Rep. (2014). Comorbidity in psychiatry: The complex relationships between mental disorders and substance use. Current Psychiatry Reports, 16(3), 436. https://doi.org/10.1007/s11920-013-0436-6
Parmar, A., & Kaloiya, G. (2018). Comorbidity of personality disorder among substance use disorder patients: A narrative review. Indian Journal of Psychological Medicine, 40(6), 517–527. https://doi.org/10.4103/IJPSYM.IJPSYM_164_18
Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L. L., & Goodwin, F. K. (1990). Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) study. JAMA, 264(19), 2511–2518.
Quello, S. B., Brady, K. T., & Sonne, S. C. (2005). Mood disorders and substance use disorder: A complex comorbidity. Science & Practice Perspectives, 3(1), 13–21. https://doi.org/10.1151/spp053113
