Common Underlying Mental Health Issues in Addiction

Addiction is a disease that must be considered in context. According to the Substance Abuse and Mental Health Administration, nearly 9 million Americans struggle with addiction and co-occurring mental health problems. Dealing with addiction and another mental health issue is often called a “dual diagnosis” in treatment settings.Despite being very common, dual diagnosis situations do impact the course of treatment. Most experts agree that it’s best to treat the substance abuse problems and the mental health issues simultaneously. Although any mental health problem can co-occur with addiction, some are more common than others.

Major Depressive Disorder

In a major survey called the National Comorbidity Study, researchers found that men struggling with alcoholism were three times as likely to be depressed as people in the general population. Among women, depression rates were four times higher in alcohol dependent women than non-dependent women. This relationship between depression and addiction remains true for other drugs of abuse, including marijuana, cocaine, heroin, and prescription medications.

Most researchers agree that there is a bidirectional relationship between addiction and depressed mood. For some people, struggling with addiction leads to considerable emotional turmoil. Depression is a natural byproduct of dealing with the strained relationships, guilt and shame, work problems, and other stressors that come along with addiction. In other people, the depression comes first. Turning to drugs or alcohol is common way to numb the pain of deep depression.

Although sadness is a key feature of depression, this mental health problem manifests differently in different people. Symptoms may include loss of interest in previously enjoyed activities, changes in appetite, sleeping more or less than usual, low sex drive, thoughts of suicide, weight gain or weight loss, and feeling sluggish. In treatment settings, individual and group psychotherapy can be very beneficial for those dealing with co-occurring addiction and major depressive disorder. Learning skills to cope with emotional pain may make it easier to forgo drugs or alcohol in deeply distressing situations.

Anxiety Disorders

A large proportion of people dealing with addiction also have problems with anxiety. Part of this may be due to the similar brain structures involved in these processes. Addiction changes a set of brain structures called the limbic system. These structures are involved in processing reward information, which can make taking drugs and alcohol seem irresistible. However, the limbic system is also implicated in the development of anxiety.

The major symptoms of anxiety disorders are constant worry about common life circumstances. This may manifest in constantly thinking about things that could go wrong, restlessness, increased heart rate, faster breathing, sweating, and sensations of panic. Fortunately, a type of therapy called cognitive-behavioral therapy (CBT) can be useful in retraining the brain to worry less and have less anxious interpretations of events.

Serious Mental Illness

Substance abuse is also common among individuals dealing with serious mental illness. In fact, 25.7% of adults with serious mental illness also have co-occurring substance abuse or dependence. Serious mental illness includes conditions such as bipolar disorder and schizophrenia.

Bipolar disorder is characterized by periods of mania, in which a person may have very elevated mood, irritability, impulsivity, risk-taking behaviors, and racing thoughts. Individuals with bipolar disorder also struggle through periods of deep depression. This cycle between mania and depression can be very challenging to deal with, and those suffering from bipolar disorder often report that they feel out of control of their own lives. Using drugs or alcohol can numb the pain and make it feel less scary to have this condition.

People with schizophrenia experience hallucinations, delusions, and bizarre thoughts. Like those with bipolar disorder, individuals with schizophrenia may experience significant distress about their symptoms, have difficulty holding a job, and struggle to maintain normal relationships. Although drugs and alcohol provide an outlet for this distress, professional medical care can reduce mental health symptoms and also address the problems fueling drug addiction.

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