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Substance abuse and mental illness often go hand in hand, with one often leading to the other. But what exactly is the relationship between these two conditions?

When a mental health disorder co-occurs with a substance use disorder, this is called a dual diagnosis or comorbidity. The term “co-occurring disorders” refers to the presence of two or more mental health conditions or disorders occurring simultaneously in an individual.

While these two disorders often co-occur, this does not necessarily mean that one caused the other. It is difficult to establish causality or directionality because the severity may vary from one patient to another. People may also find it difficult to remember which condition manifested first. [1]

However, the interaction between these disorders can often complicate treatment. This is why treatment requires a specialized approach that addresses both conditions simultaneously for effective management and recovery.

Here we will explore the relationship between substance abuse and mental illness, as well as the impact it has on behavioral health. Let’s take a closer look.

The Connection Between Substance Abuse and Mental Illness

Substance abuse and mental illness are closely linked, with one often leading to the other. In fact, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 9.2 million adults in the US have co-occurring disorders.

However, it’s worth noting that the relationship between substance abuse and mental illness is complex and often interconnected. They can co-occur for a variety of reasons. For example, many people with mental health disorders turn to substances as a way to self-medicate. They might use drugs or alcohol to alleviate symptoms or cope with the challenges posed by their mental health conditions.

Interestingly, it could also happen the other way around. Substance abuse can increase the risk of developing mental health issues. Prolonged substance use can disrupt brain function and contribute to the onset of mental disorders or exacerbate existing conditions.

Another thing to consider is the fact that both conditions share several risk factors, such as genetic predisposition, trauma, stress, and environmental influences. These overlapping factors can expose a person to more than one condition. [1]

There are some cases wherein people don’t seem like they have a mental health disorder simply because their substance abuse is already masking these symptoms.

Because of the bidirectional relationship between these two conditions, effective treatment involves a comprehensive approach that addresses both of them simultaneously. This can include therapy, medication, support groups, lifestyle changes, and sometimes residential treatment programs.

Understanding and addressing the connection between substance abuse and mental illness is crucial for providing appropriate care and support to those who are dealing with these challenges.

Substance Abuse as a Coping Mechanism

Many people turn to substance abuse as a way to cope with underlying mental health issues. For example, someone struggling with depression may turn to alcohol or drugs to numb their feelings and escape from their reality.

Unfortunately, this often leads to a cycle of self-medication, where the person relies on substances to cope with their mental health symptoms, but the substances ultimately worsen their mental health. This can even lead to the development of addiction.

Substance abuse often emerges as a coping mechanism for those who are struggling with mental illness.

There are some people who use it as a way to cope with stress, which is a known risk factor for a range of mental illnesses. Stress is therefore a common factor between substance use disorders and mental health disorders. [1]

Drugs and alcohol are often used as coping mechanisms when the person lacks access to proper mental health treatment or is unable to cope with the distressing symptoms.

Addictive substances can provide a temporary escape or relief from overwhelming emotions or thoughts associated with mental health issues.

However, while substance use might offer temporary relief, it often exacerbates mental health issues in the long run. It can lead to addiction, worsen the symptoms of mental illness, and create additional problems in various aspects of life, such as relationships, work, and physical health.

Substance Abuse as a Trigger for Mental Illness

Substance abuse can trigger the onset of mental illness. This is because substances can alter brain chemistry and lead to changes in mood, behavior, and cognitive function.

When people abuse drugs and alcohol, it can result in the development of mental health disorders such as anxiety, depression, impulse-control disorders, and psychosis. [1]

While it might not directly cause mental illness, substance abuse can still act as a trigger, exacerbating or contributing to the development of mental health disorders in several ways. For example, the way drugs can induce changes within the brain makes people more susceptible to mental health issues.

Additionally, when someone tries to quit or cut down on substance use, withdrawal symptoms can mimic or exacerbate mental health symptoms. This makes it challenging to differentiate between the effects of substance use and an underlying mental health issue.

The Impact on Behavioral Health

The co-occurrence of substance abuse and mental illness can have a significant impact on a person’s behavioral health.

The interplay between these conditions complicates diagnosis, treatment, and overall prognosis. Mental health symptoms can exacerbate substance use, and vice versa, creating a cycle that can be challenging to break.

This pattern often leads to more severe and chronic conditions. It’s easy to see how this can affect someone’s ability to function in daily life.

Integrated treatment models that consider the interconnected nature of these disorders are crucial. Addiction treatment for co-occurring disorders should focus on therapies that simultaneously address both issues to promote sustained recovery and improved behavioral health outcomes.

Here are some ways in which this dual diagnosis can affect an individual’s well-being.

Increased Risk of Suicide

Individuals with co-occurring disorders are at a higher risk of suicide than those with just one disorder. According to the National Alliance on Mental Illness (NAMI), 30% of those with a substance use disorder also have a mental health disorder, and these people are six times more likely to attempt suicide than those without a dual diagnosis.

Furthermore, people with a dual diagnosis are more likely to have certain comorbidities like pain disorders and brain injuries that can further increase the risk for suicidal behaviors. [2]

Having two disorders amplifies the vulnerability and stress an individual experiences. Mental health issues and substance abuse can independently heighten feelings of hopelessness, despair, and isolation. The combination of these factors intensifies the risk of suicidal thoughts or actions.

We’ve mentioned that the symptoms of mental health disorders and substance abuse can exacerbate each other. A person with both an alcohol use disorder and depression may experience increased depressive symptoms when under the influence of alcohol, potentially leading to impulsive or self-destructive behaviors.

Substance use can also impair judgment and decision-making abilities, making it harder for people to think clearly or seek help when experiencing suicidal thoughts or emotions. This impaired judgment can lead to impulsive actions that they might not consider in a sober state.

Co-occurring disorders also typically result in difficulties in forming and maintaining relationships. The lack of a strong support system can exacerbate feelings of loneliness and despair, increasing the risk of suicide.

Difficulty in Diagnosis and Treatment

People with a dual diagnosis are more likely to be hospitalized than people with a mental or substance use disorder alone.

However, the presence of both substance abuse and mental illness can make it challenging to diagnose and treat either disorder. Symptoms of substance abuse and mental illness can overlap, making it difficult to determine which disorder is causing which symptoms. This can lead to misdiagnosis and ineffective treatment.

Through integrated treatment, health care providers can link patients to other providers as needed. [3]

There’s also the fact that people with co-occurring disorders are less likely to seek treatment They may feel overwhelmed and unsure of where to start. This can result in a lack of proper treatment for both disorders, leading to a cycle of relapse and worsening symptoms.

Substance use can exacerbate mental health symptoms or trigger new ones due to its impact on brain chemistry. This complicates treatment since addressing one disorder might not fully resolve the other.

Many symptoms of substance use disorders mimic or mask symptoms of mental health disorders. For instance, depression and substance abuse can share symptoms like fatigue or changes in sleep patterns, making it challenging to differentiate between the two.

With all of these challenges in mind, it’s easy to see why dual diagnosis is often difficult to diagnose and treat.

Increased Risk of Relapse

People with co-occurring disorders are also at a higher risk of relapse. This is because substance abuse and mental illness can feed off of each other, with one disorder triggering the other. For example, someone struggling with alcoholism may experience a depressive episode, leading them to turn to alcohol as a coping mechanism, which can then worsen their depression.

When this happens, some people are tempted to self-medicate in order to alleviate their symptoms. For example, someone with anxiety might use alcohol to calm their nerves. If the underlying mental health issue isn’t addressed, the temptation to self-medicate can persist, leading to relapse.

Substance use can directly impact the brain’s chemistry, exacerbating or triggering symptoms of the mental health disorder. Likewise, mental health conditions can influence cravings and the desire to use substances to cope.

Treating co-occurring disorders can be complex. If both disorders aren’t adequately addressed simultaneously through integrated treatment, the person may struggle with managing one condition while neglecting the other. Incomplete treatment can pave the way for relapse.

Successfully managing co-occurring disorders and reducing the risk of relapse often involves comprehensive treatment strategies that address both the substance use disorder and the mental health condition at the same time.

Seeking Help for Co-Occurring Disorders

If you or a loved one is struggling with both substance abuse and mental illness, it’s essential to seek help from a professional.

Regardless of which condition developed first, an integrated approach can go a long way towards your recovery. You can’t treat one without treating the other. As mentioned earlier, these conditions are interconnected and therefore require simultaneous treatment. [4]

Look for a dual diagnosis treatment program near you and find our how they address co-occurring disorders. These programs offer integrated treatment for both substance abuse and mental illness, addressing the underlying issues that contribute to both disorders.

In a dual diagnosis treatment program, both disorders are treated at the same time, rather than separately. This allows for a more comprehensive approach to treatment, addressing the interconnectedness of substance abuse and mental illness.

Dual diagnosis treatment programs often utilize evidence-based therapies, such as cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT), to address both substance abuse and mental illness. These therapies can help individuals develop coping skills and address underlying issues that contribute to their disorders.

Finally, it is important to create a supportive environment is crucial for patients with co-occurring disorders. This can include a strong support system of family and friends, as well as participation in support groups such as Alcoholics Anonymous or Narcotics Anonymous. A supportive environment can help individuals stay on track with their recovery and manage their mental health symptoms.

The Importance of Addressing Co-Occurring Disorders

Ignoring co-occurring disorders can have severe consequences for an individual’s well-being. Here are some reasons why it’s essential to address both substance abuse and mental illness simultaneously.

Improved Quality of Life

Addressing both substance abuse and mental illness can lead to an improved quality of life. With proper treatment, patients can learn to manage their symptoms and develop healthy coping mechanisms, leading to a more fulfilling and stable life.

Reduced Risk of Relapse

By addressing both disorders simultaneously, recovering individuals can reduce their risk of relapse. This is because they are addressing the underlying issues that contribute to both disorders, rather than just treating the symptoms.

Increased Chance of Recovery

Individuals with co-occurring disorders who receive proper treatment have a higher chance of recovery than those who only address one disorder. By addressing both substance abuse and mental illness, individuals can achieve long-term recovery and improve their overall well-being.


Substance abuse and mental illness are closely linked, with one often leading to the other. The impact of co-occurring disorders on behavioral health can be significant, but with proper treatment, people can achieve recovery and improve their quality of life.

If you or a loved one is struggling with co-occurring disorders, seek help from a professional to address both disorders simultaneously and increase your chances of long-term recovery. Look for a rehab near you today.







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Fel Clinical Director of Content
Felisa Laboro has been working with addiction and substance abuse businesses since early 2014. She has authored and published over 1,000 articles in the space. As a result of her work, over 1,500 people have been able to find treatment. She is passionate about helping people break free from alcohol or drug addiction and living a healthy life.

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