#49 mental health and substance abuse often go together

In thinking about substance use it is important to recognize the close relationship between substance use disorder and mental health issues.  According to the Substance Abuse and Mental Health Services Administration, at least fifty percent of those involved in substance use also struggle with mental illness, and vice-versa.
Professionals in mental health and addiction services refer to this as comorbidity.  Comorbidity refers to the presence of more than one disorder in the same person.  There can be comorbidity or overlap with diabetes and heart disease, or infectious diseases and dementia.   Mental disorders that tend to show comorbidity include substance abuse, eating and anxiety disorders.  Comorbidity is often associated with more complex treatment requirements, more negative health consequences, and increased healthcare costs.  In comorbidity the interactions between the illnesses make them both worse. 
Mental illness and substance abuse have many of the same risk factors.  Trauma is often associated with both. People with mental health issues are more likely to self medicate with illicit substances as a coping strategy.  They often use substances to reduce anxiety, avoid dealing with past trauma and mask its consequences.  Although some drugs may temporarily reduce the symptoms of mental illness, they can also make symptoms worse and actually contribute to the progression of the illness.
Both mental illness and substance use can cause changes to the brain, making an individual more vulnerable to increased substance use.  Both can affect the reward center of the brain, decrease awareness of consequences for behavior, decrease impulse control, and increase drug cravings.  Substance use can also change the structures of the brain that can contribute to mental illness.
Substance use and mental health issues are often treated by different treatment providers. It can be difficult to find a facility or provider that integrates all of these needs.    Those with comorbidity are less likely to follow their treatment plan and drop out of treatment more frequently than those with only one of the factors.  People with this comorbidity often use more than one substance, further complicating treatment
 
Those with both mental illness and substance abuse issues tend to have the most difficulties with life in general.  They tend to have higher rates of interpersonal problems, homelessness, unemployment, arrest, and medical need.  It is important to connect them to community agencies to help secure housing, food, health care, job training and legal support.
 
Progress is being made in research and development of effective integrated treatment.  Treatment providers are recognizing the complexities of this comorbidity and programs for treatment continue to be developed.  . Increasing interpersonal skills and coping skills that support motivation and further recovery has been helpful in treating comorbidities of substance use disorder and mental illness. Even in these challenging situations, there is hope. Treatment works.  Recovery is possible. If you or someone you know is struggling with substance abuse, please call to talk to a live person: 765-490-0381.

​