The link between substance use and mental illness

Does addiction cause mental health issues or do mental health issues lead to addiction?

There are two issues here: does a person with an existing mental health issue become an addict or alcoholic because of this? Or does a person take substances which cause mental health issues that were not previously present?  Quite a few of the enquiry telephone calls that we get at The Haynes Clinic are from a family member suggesting that their loved one has underlying mental health issues and that that is the reason why they drink or drug. 

There seems to be more of a need to justify why their son or daughter is an alcoholic or drug addict (putting it down to depression, anxiety or ADHD for example) when the reality may be that they have a predisposition for a dependency.  It is not a question of sorting out the mental health issues and that will resolve the substance dependency.  The two are usually interlinked, one feeding the other. It does not matter which came first as good treatment will address both.

Anti- depressants and addiction

A prime example of the confusion and connection between the two is the significant rise in GPs throughout the country prescribing anti-depressants for someone who is low in mood or has depressive episodes when is  also a clear history of alcohol abuse.  Alcohol is a depressant in itself. It also nullifies any positive effect of an anti-depressant and the individual might as well have been prescribed polo mints, the medication is that ineffective. 

The prescription, though, actually makes the situation worse because the individual thinks that they should be feeling more positive but they continue on the emotional and mental downward spiral with their continuing alcohol consumption and can end up with thoughts of suicide or self-harm.  Their mental state has deteriorated simply because of their alcohol use. However, if they were to come into residential addiction treatment then their mood would lift simply by stopping drinking and not because the anti-depressants would start to work. 

The need to be free of alcohol and drugs in order to get a thorough mental health assessment

To get a clear picture  of anyone’s mental health then that person has to be free of alcohol or any illegal drug in order for a proper assessment to be made.  This is what most families find hard to accept and generally this will leave them feeling stuck between a rock and a hard place as well as feeling powerless in how to deal with the situation.  The NHS describe someone who has a mental health issue such as personality disorders, bipolar disorders, or schizophrenia as well a substance misuse problem as having a dual diagnosis. This can also be referred to as a co-occurring or comorbid disorder or condition. 

Dual diagnosis

A person may have a dual diagnosis problem if drugs or alcohol are used to overcome feelings of anxiety, stress or depression. Another criteria could be when substances are used to cope with symptoms of a pre-existing mental health condition such as anxiety, depression, panic disorders and PTSD. Having a family history of mental health problems could also lead to a dual diagnosis classification.  It is a complex link that can exist for a number of reasons and change over time. 

Commonly, drugs or alcohol can sometimes be used to self-medicate the symptoms of a pre-existing mental health illness.  This in turn can result in a substance misuse problem. Drug and alcohol use can also worsen or trigger new or existing mental health conditions. For example, if someone uses and abuses opioid painkillers, those that have a codeine content will often lead to a person suffering depression as the brain will eventually reduce levels of dopamine. Heavy cannabis use can lead to bouts of psychosis and schizophrenia.

Addiction and mental health conditions can usually be treated

Both mood disorders and alcohol and drug abuse problems are treatable conditions but in order to treat the mental health aspect then anyone will first need a medically assisted detox from either alcohol or drugs.  Usually, an alcohol detox will take 10 days, and an opiate or heroin detox up to 14 days. A diazepam detox can take 6 weeks, depending on amount and length of use. Following the detox and a period of ‘clean’ time for the mood and thought processes to settle, then medication can be prescribed to help with the mental health problem. 

In order to get a detox it may be that an admission to a residential addictions rehab or clinic is the only immediate option.  It should also be understood that the excuse used “that I am drinking a lot because I am feeling depressed all the time” is no longer valid and there needs to be a breakdown of our denial. We need to recognise that we drink a lot because we have an alcohol problem and to stop making excuses for our behaviour.

Mental health conditions are usually worsened if alcohol or recreational drugs are used

If it is established that an individual has a dual diagnosis then there also needs to be an acceptance by that person that they will need to refrain from drinking alcohol or drugging again. This is because there will be medication prescribed to help treat the mental health problems and it will either be ineffective or mixing the medication with alcohol or drugs could be extremely dangerous. 

Getting an alcohol detox or drug treatment

Getting a detox, within a residential addictions rehab setting, is just the beginning for anyone with mental health issues. Following that, mental health treatment needs to be continued. A sustained recovery also depends on learning healthier coping strategies and making better decisions when dealing with life’s daily challenges. For example, many people turn to alcohol or drugs to cover up painful memories and emotions such as loneliness, depression or anxiety and it is learning those new coping strategies that will prevent a relapse back to old behaviour.

Similarly, those with a substance abuse problem need to change their addictive thinking and behaviour. They need to realise that following a detox they should consider following on with the 12 Step programme of Recovery, that they will have started to get an understanding of in their addiction treatment.  Both forms of treatment will encourage communicating with others rather than keeping our thoughts and our feelings to ourselves.  The ability to start to share with others reduces the levels of negative power that our feelings have over us and reinforces our understanding that in order to get well and to get our lives back, even with the help of prescribed medication, then we will need the help of others and to stop trying to struggle with situations on our own.