Mental Health

Aspects of Recovery

Mental health and wellness inspires self-care, coping skills, stress reduction and the development of inner strength. This is imperative to Substance Use Disorder recovery. The ability to be attentive to both positive and negative feelings and be able to understand how to handle these emotions is the foundation for emotional health. Mental wellness also includes the ability to adapt, learn and grow from experiences.



Mental Health in Recovery

One of the most difficult aspects in recovering from substance use disorders is learning to address our mental and emotional health to help us sustain our abstinence.

For most of us, our addictions didn’t just pop up one morning-they were created over time or circumstances. And for many, our use began as our attempt to self-medicate illnesses, circumstances or events from our pasts that haunted us.

For some of us, our use began as an escape from our memories. For some of us, our use began as a result of tolerance from medications given to us over time: we suddenly found the dose given us was no longer effective, but more of it was.

For some of us, our use came first; our drugs created illnesses, circumstances or events that began haunting our present. We find ourselves seeking more, different, better drugs to bring peace and silence to our nights. Maybe just to function in life.

But whatever the reason, we find ourselves here today-we are now dependent on a substance, sometimes many substances-that are raging havoc in our lives. We can’t ignore it any more. We find ourselves awakening to the understanding that we can’t function if we use, and we can’t function if we don’t use.

Mental health problems and substance use disorders sometimes occur together. This is because:

  • Certain drugs can can create one or more symptoms of a mental health problem
  • Certain drugs can mimic one or more symptoms of a mental health problem
  • Mental health problems can create an addiction to alcohol or drugs through misuse and self-medication

Mental and substance use disorders share more than a few underlying causes, including changes in brain composition, genetic vulnerabilities, and early exposure to stress or trauma. Today, at least one in four adults living with serious mental health problems also has a substance use problem.



Substance use problems occur more frequently with certain mental health problems, including:

  • Depression
  • Anxiety Disorders
  • Schizophrenia
  • Personality Disorders

Both substance use disorders and mental health disorders must be addressed to attain and sustain recovery

Understanding Comorbidity

Comorbidity refers to the fact that two conditions, such as a specific mental health disorder and a substance use disorder, often co-exist together. Many people with addictions experience an underlying mental health issue.  Neither condition actually causes the other, they do often exist together and one condition can exacerbate the symptoms of the other.

  • With a substance use disorder, the brain has been permanently ‘re-wired’ by the substance abused. The brain functions differently than before the addiction. In the same way as diabetes or heart disease, addiction can be managed to remission – what we call Recovery – and must be managed for the rest of our life; addiction recovery is not merely abstinence.
  • Likewise, mental illnesses are also considered brain disorders, and affect the same brain areas impacted by substance abuse. It is not surprising that there is a high rate of comorbidity between addiction and other mental illnesses such as bi-polar disorder, schizophrenia, depressive disorders and anxiety disorders.

While the link between these are complex, some mental health issues increase the risk factors for substance abuse. What this means is that some people with mental illnesses will turn to alcohol or drugs to cope with the pain of their mental health issues.

Comorbidity Causes and Contributions

While a high rate of comorbidity exists between mental illnesses and substance use disorders, one does not necessarily cause the other—regardless of which condition appeared first.  According to the National Institute on Drug Abuse:

  • Drug abuse can cause people to experience one or more symptoms of another mental illness. (psychosis is not rare in some marijuana use disorders)
  • Mental disorders can lead to drug or alcohol abuse because some people use substances to self-medicate. (nicotine in tobacco can lessen certain symptoms of schizophrenia)
  • Evidence indicates that certain drug use disorders and mental illnesses are caused by underlying
    brain deficits
    • genetic influences, and/or
    • exposure to trauma early in life.​

It is estimated that 40 to 60 percent of a person’s predisposition to drug use disorders can be attributed to genetics.
In addition, several regions of the human genome that have been linked to an increased risk both for substance use disorders and mental illness.
People who are physically or emotionally traumatized are at a much higher risk of substance use disorders.

Diagnosing Difficulties

Co-occurring disorders have symptoms that are often complex and can vary in severity. It is not uncommon for people to receive treatment for one disorder while the other disorder remains untreated. Symptoms are similar and both include biological, psychological, and social components.

Other reasons include inadequate training or screening in both mental health and substance abuse facilities. Regaedless, the consequences of undiagnosed, untreated, or undertreated co-occurring disorders can lead to a higher likelihood of experiencing homelessness, jail time, medical illnesses, and even suicide.

People with mental health issues who also abuse substances like drugs or alcohol are at an increased risk for impulsive or violent acts. Achieving lasting sobriety is increasingly difficult for them.

Integrated Treatment

Co-occurring disorders have the best outcomes when treated at the same time. Integrated treatment, utilizing both doctors and counselors, can address and treat both disorders at the same time. This creates better outcomes for patients.

It is important to note that people who have both an addiction and another mental illness often have symptoms that are more persistent, severe and resistant to treatment compared with patients who have either disorder alone. For this reason, maintaining sobriety may be very difficult for them.

Substances such as

  • Marujuana is linked to an increased risk of schizophrenia
  • Marijuana and methamphetamine may cause prolonged psychotic reactions
  • Alcohol can make depression and anxiety symptoms worse
  • Alcohol and Drugs use, mixed with medications negatively affect antidepressants, anxiety medications and mood stabilizers, make them less effective at managing the symptoms
  • Opioid users are at greater risk for depression and heavy cannabis use has been linked to an increased risk for schizophrenia.

Co-Occurring Diagnosis

It can be difficult to identify co-occurring disorders if mental health disorders have not been addressed, diagnosed or treated prior to the development of a substance use disorder.

Symptoms of mental health disorders and substance use disorders are similar, impact each other, and one may have preceded the other without a clear or obvious path. Methamphetamine use disorders can mimic bi-polar mania phases, among others. It takes time to decipher what might be a mental health disorder and what might be a drug or alcohol problem.

The signs and symptoms also vary depending upon both the mental health problem and the type of substance being abused, whether it’s alcohol, recreational drugs, or prescription medications. In addition, street drugs may be packaged to appear as a prescription, but may contain very little, if any, of what it is purported to be. Non-regulated drugs, such as Kratom or salts, may include anything, including fentanyl, combinations of prescription ingredients, or even pet medications.

Warning Signs of a Co-Occurring Disorder

There are some general warning signs that you may have a co-occurring disorder:

  • Do you use alcohol or drugs to cope with unpleasant memories or feelings, to control pain or the intensity of your moods, to face situations that frighten you, or to stay focused on tasks?
  • Have you noticed a relationship between your substance use and your mental health? For example, do you get depressed when you drink? Or drink when you’re feeling anxious or plagued by unpleasant memories?
  • Has someone in your family grappled with either a mental disorder or alcohol or drug abuse?
  • Do you feel depressed, anxious, or otherwise out of balance even when you’re sober?
  • Have you previously been treated for either your addiction or your mental health problem? Did the substance abuse treatment fail because of complications from your mental health issue or vice versa?

Points to Remember

  • When seeking treatment, provide your doctors with any history of a pre-existing diagnosis (pre meaning prior to substance use)
  • Make your doctors aware of any family history or mental health disorders. Many mental health disorders, such as bi-polar or schizophrenia, have dominant hereditary traits
  • Make your doctors aware of family history of addiction or alcoholism
  • If you are self medicating with unprescribed medications and entering treatment, you will most likely not be provided these, as the facility will work with the medical and psychiatric team to tease out the symptoms of intoxication and use from mental health symptoms.
  • Integrated treatment for co-occurring disorders is available, and referrals from your doctor will be of great assistance.
When beginning, and throughout your recovery journey, it is vital to engage with professionals experienced and credentialed with substance use and mental health disorders for diagnosis and subsequent treatment:

The Treatment Locator website above will provide you with information about the treatment facilities as they report them; always check Google reviews and ask questions! Many facilities state they offer mental health but may not provide a Licensed Board Certified Addiction Mental Health Professional on site.

Need Some Answers?

On the other hand, the addictive potential of some drugs may be so strong that what seems to be an immediate addiction may develop. However, for the vast majority of people struggling with addiction, there are stages of substance use or abuse that lead to the circumstances resulting in the person becoming addicted. In general, these stages include: