Dealing with a mental health disorder can be a challenge for both patient and caregiver. When a problem with substance use is also involved, the healing process can get more complex.
A mental health disorder and a drug or alcohol addiction have separate symptoms that can make everyday life more difficult. In addition, one problem can affect the other.
If a mental health disorder is ignored, substance use can get worse. This increased use of substances, in turn, can often make mental health illness worse.
It is an unfortunate and common connection between the two that calls on providers to address both conditions. Co-occurring mental health and substance use disorders are best dealt with before they start, but when that can’t happen, specialized treatment of separate issues may be necessary.
“Nobody chooses to have a mental health illness, and no one chooses to be an addict,” said Kristi Spitzer, a behavioral health therapist at Sanford Aberdeen Clinic in Aberdeen, South Dakota. “But anybody can develop those issues under certain circumstances. Sometimes it takes a team approach of a doctor and a therapist and others to help get someone back on the right road.”
Can substance use worsen symptoms of mental health disorders?
When explaining how substance use disorder can affect mental health disorders, Marcus Ibrahim, M.D., a family medicine provider at Sanford Aberdeen Clinic, told the story of a hypothetical patient.
Dr. Ibrahim described a person who is dealing with depression. This patient is also using substances.
The chemically driven dopamine surge that comes with substances they’re using starts on a positive note. But when the surge dissipates, the patient often feels worse than they did before they took the drug.
“The patient now feels like they are well below their depression baseline, but they may be just back down to where they normally are,” Dr. Ibrahim said. “Now we have to decide: Is this person truly more depressed, or is it just a chemical reaction to the substance they’re taking?”
This scenario describes how a person dealing with a mental health disorder can complicate the healing process by dealing with a substance use disorder at the same time.
“Substance use changes people who have already been diagnosed with a mental disorder to the point where we cannot truly anticipate where they’re headed,” Dr. Ibrahim said. “Based on history, however, they’re going to trend downward.”
Substance use disorders can also make mental health worse by affecting the lives of those close to the patient.
“A lot of substances are acquired illegally, and a person is spending great sums of money to acquire it,” Dr. Ibrahim said. “It can mean you’re not taking care of your family or yourself.”
What is a substance use disorder?
The American Psychiatric Association defines substance use disorder in four categories:
- Impaired control: a craving or strong urge to use the substance; desire or failed attempts to cut down or control substance use.
- Social problems: substance use causes failure to complete major tasks at work, school or home; social, work or leisure activities are given up or cut back because of substance use.
- Risky use: substance is used in risky settings; continued use despite known problems.
- Drug effects: tolerance (need for larger amounts to get the same effect); withdrawal symptoms (different for each substance).
“The tolerance and withdrawal symptoms are probably the most crucial,” Dr. Ibrahim said. “They give us an indication of how far along the patient may be in their substance use disorder.”
What are the long-term effects of substances on the brain, mental health and physical health?
In clinical terms, the brain is made of a network of neurons. Drugs and alcohol can interfere with the way the brain cells work and function, altering the way they can send, receive and process signals.
This can lead to a number of neurological and behavioral conditions.
“Substance use disorders have both immediate and long-term effects,” Dr. Ibrahim said. “In the short term, substance use can affect your behavior, memory and cognition. Long-term use can lead to impairments across multiple domains, including memory, attention and executive function.”
Long-term effects of substance use do not show up right away. It can make it difficult for a person to realize the damage being done.
“Nobody who is using marijuana, cocaine or alcohol today will in three weeks say, ‘Oh, my memory is not the same,’ or ‘Oh, I can feel my blood pressure rising,’” Dr. Ibrahim said. “It’s something that happens over time.”
Spitzer, who has worked in the field of addiction science for more than two decades, can tell you that most of those dealing with mental health and substance use disorders are not thinking about long-term ramifications.
“The people who end up using substances a lot of times are looking for that quick fix to avoid the emotional distress that they’re feeling in their life,” she said. “They’re looking for a fix in the moment that makes it go away.”
Continuing to use substances to deal with life stressors can become cyclical, causing more issues.
“It can affect a person’s ability to cope with the complexity of the world around us,” Spitzer said. “It’s not unusual for people with substance use disorder in adulthood to have the emotional development of a teenager. They may then continue to struggle throughout their life with those emotional issues.”
Are there certain mental health conditions where substance use disorder tends to occur more frequently?
According to a 2021 survey taken by the Substance Abuse and Mental Health Services Administration, about 9.2 million adults in the United States have a co-occurring disorder.
These substance use problems happen more frequently with those who are dealing with major depressive disorder, anxiety and mood disorders, schizophrenia, bipolar disorder, conduct disorders, PTSD and ADHD.
“A big problem in today’s society is that there are many people with anxiety, depression, or bipolar disorder or many other mental health disorders who are undiagnosed,” Dr. Ibrahim said.
In comparison to a headache or a sore ankle, it’s not an easy diagnosis to make on your own. People often do not seek professional help right away, or sometimes ever, when they’re feeling depressed.
“A lot of times when I see a patient who has been involved in self-medication, it’s most often because they didn’t know their diagnosis,” Dr. Ibrahim said. “They just take something because it makes them feel better.”
Genetics, family history, recent traumatic events and socioeconomic status can also be determining factors in susceptibility to substance use disorder.
“There is definitely a correlation between mental health disorders and substance use disorders,” Spitzer said. “That’s why we call it ‘co-occurring.’ When we treat them both we don’t necessarily look for which came first and which came second. We treat them both together.”
How can substance use disorder change your personality and behavior?
Providers do not see one precise pattern of personality changes from patient to patient. What they do see are departures from normal behavior that indicate problems.
If someone who is usually conscientious about work and home responsibilities is not following through like they normally do, it could indicate a problem.
Spitzer will often talk to people close to the patient to find out more about the degree to which a substance has become part of their life.
“When someone has a dramatic personality change, we look at how much time they’re spending securing, recovering, and ingesting that substance,” Spitzer said. “It’s a telltale sign of what is going on.”
From a basic physiological standpoint, substance use delivers dopamine to the brain, and feelings of euphoria often follow.
As Dr. Ibrahim explained it, a rousing Christmas party with family that includes lots of drinking can get pared down to just “lots of drinking” in the brain.
The dopamine your brain gets from substances can be more constructively delivered with a good workout, or when you receive good news. Most often those ways take more effort, of course.
“A substance use disorder changes your personality in a way because it changes your brain chemistry,” Dr. Ibrahim said. “It’s telling you that this is what it likes. Let’s get it.”
How do you get help if you or someone you love is struggling with substance use disorder?
Sanford Health has resources and support to help improve mental health and well-being. It is wise to begin with a primary care provider, who can help connect you to appropriate specialists.
It can start with online or in-person meetings with a therapist regarding a variety of mental health and substance use disorder concerns.
Spitzer is transparent with her patients. After deciding it’s time to get help, the next step is finding the right therapist.
“Different people need different things,” Spitzer said. “I tell people finding a therapist is like finding the kind of doctor you like. You have to find somebody you can connect to when you’re talking about changing your life or changing some of the ways things are working in your life.”
Dr. Ibrahim makes a point to gauge patients’ moods when he sees them, regardless of the reason for the visit. If he is dealing with a patient who is usually upbeat but is not on this occasion, he might ask a few more questions.
“I always stress to my patients that mental health is crucial,” Dr. Ibrahim said. “Whether you have a mental illness or not, going to see a therapist once a week or once a month is the equivalent of going to the gym, except it’s for your mind.”
As Dr. Ibrahim explained, physically fit people go to the gym. Mentally fit people can still use therapy.
“It’s a great avenue to preemptively nip things in the bud,” he said.
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