It is great to see the ongoing conversations and media campaigns that address mental health issues. We do need to end the stigma of having mental illness. We need to increase our awareness of the struggles that millions of people face every day. It is crucial that we provide understanding, support, and resources to help those struggling with anxiety, depression, bipolar disorder, PTSD ADHD, or any other form of mental illness. And it's important to address substance misuse and addiction among those who experience mental illness.
The overlap of mental health issues and substance misuse is one aspect of mental health that always benefits from more compassion, more education, and more resources for diagnosis and treatment.
The term “co-occurring disorder” is used when a mental health disorder and a substance use disorder occurs at the same time for someone. It has also been referred to as a “concurrent disorder” or “dual diagnosis”. The bottom line is this: a person with a co-occurring disorder has two issues that need addressing.
Here are 7 facts about the overlap of mental illness and substance misuse:
1. Co-occurring disorders are common.
A high number of people who are diagnosed with anxiety disorders abuse alcohol. For example, someone with an anxiety disorder is 2-4 times more likely to be diagnosed with alcohol dependence.
Substance use disorder (SUD) is experienced by about 13% of the general population, but statistics tells us that between 25-37% of people with panic disorder are addicted to alcohol.
Besides anxiety disorders, other mental health issues such as post-traumatic stress disorder (PTSD), depression, bi-polar disorder, and schizophrenia all carry a substantially increased risk of substance misuse.
2. The mental health issue most often develops first.
The National Comorbidity Survey studied how often a person experiences more than one disorder at the same time. It shows that 89% of people with co-occurring mental illness and substance abuse developed their mental illness first.
3. Co-occurring disorders lead to worse outcomes.
Having a mental health diagnosis or a substance use disorder has significant negative impacts – but those who have both have a much worse prognosis (especially for those with major depression or PTSD who are substance dependent).
Co-occurring disorders lead to worse symptoms for both disorders.
Substance use has a tendency to prolong a mental health disorder – it can severely impair the ability to address the mental health issue in positive ways.
There is increased rates of severe disability for those with co-occurring disorders.
The use of alcohol as a way to cope with mental health symptoms such as anxiety or depression leads to much more significant negative consequences from drinking.
4. Both disorders tend to maintain each other – a process known as “mutual maintenance”.
Prolonged use of alcohol can lead to significant increases in overall levels of anxiety.
One example of this occurs when people use alcohol to get relief from certain symptoms of anxiety or PTSD. Although they might experience temporary relief from unmanageable symptoms by consuming alcohol, their symptoms often return with greater severity once the alcohol has worn off. This can create a vicious cycle where each disorder can lead to the escalation of the other.
5. People with co-occurring disorders are less likely to get treatment.
A significant number of individuals with co-occurring substance and mental health disorders will never seek out treatment. Of those who do seek some form of treatment, most receive help for just their mental health issue. Statistics show that less than 10% of people with co-occurring disorders will receive treatment for both problems.
Treatment programs often do not adequately address both issues simultaneously. Mental health programs often will not treat people in active addiction. And many addiction treatment programs do not adequately diagnose or treat mental health issues.
Getting the help needed to deal with both substance misuse and mental health issues can be challenging. If both issues are not recognized and addressed at the same time, treatment is often not as helpful, and the chance of recovery is poorer.
6. Co-occurring disorders often lead to a quicker transition into addiction.
This is especially true for people who have anxiety disorders. Statistics show that their progression from their first drink to the onset of alcohol dependence is several years faster than those without an anxiety disorder.
7. A history of trauma compounds co-current disorders.
People with substance use disorders are much more likely to have significant mental health challenges if they experienced trauma as a child.
Even when a person has a strong desire to address their unhealthy substance use, unresolved trauma issues increase the likelihood of a quick relapse following a treatment program.
Studies show that individuals with both PTSD and alcohol dependence are twice as likely to report a history of suicidal ideation compared to those who have PTSD but without a substance use disorder. They are also much more likely to have attempted suicide.
We should always encourage more opportunities for learning and sharing more about the mental health and addiction challenges people struggle with. It is an invitation to develop greater compassion and curiosity about the pain endured by many of those around us. Most of all, it is a chance to find better ways of supporting people who experience co-occurring disorders.
We can all speak up for mental health and addiction issues.