The Chicken or the Egg? A Comprehensive Look at the Relationship Between Mental Health Diagnoses and Addiction

Written By Family Recovery Collective

The question of whether mental health issues lead to addiction, or addiction exacerbates or even causes mental health problems, is a complex one. It's a bit like the age-old riddle of the chicken and the egg – which came first? The truth is, the relationship between mental health diagnoses and addiction is often intertwined and cyclical, making it difficult to pinpoint a single cause and effect. This blog post will delve into this complex relationship, exploring the different facets of this co-occurrence.

Let’s start with a common example.

Sarah’s story:

Sarah was a bright and ambitious young woman, always striving for perfection. But beneath her polished exterior, she battled with crippling anxiety. Social situations left her paralyzed with fear, and even simple tasks like ordering coffee could trigger panic attacks. To cope, she turned to alcohol. A few drinks would quiet the racing thoughts and ease the tension.

At first, it seemed like a manageable solution. But over time, Sarah's alcohol use escalated. What started as a few drinks after work turned into a daily habit, and soon, she couldn't function without it. Her anxiety worsened, and she began experiencing bouts of depression. The alcohol, once a refuge, now amplified her negative emotions.

Sarah's life spiraled out of control. She lost her job, her friends, and her sense of self. One night, after a particularly heavy drinking session, she woke up in a hospital bed with no recollection of how she got there. The doctor informed her that she had been found unconscious and was lucky to be alive.

That was Sarah's wake-up call. She realized that she needed help, and she needed it urgently. She entered a dual diagnosis treatment program, where she received therapy for her anxiety and addiction. It was a long and arduous journey, but with the support of her therapists and fellow patients, Sarah slowly began to heal.

The Dual Diagnosis Dilemma:

As illustrated in Sarah’s story, the simultaneous presence of a mental health disorder and a substance use disorder is known as a dual diagnosis, or co-occurring disorder. This isn't just a coincidence; these conditions often influence each other, creating a challenging cycle for individuals. Understanding this connection is crucial for effective treatment and recovery.

Mental Health as a Gateway (or a Refuge):

For some individuals, mental health conditions can make them more vulnerable to addiction. Substances might seem like a temporary escape from distressing symptoms, offering a sense of relief or numbing the pain. This self-medication, however, can quickly spiral into addiction, creating a new set of problems. The initial relief is often short-lived, and the underlying mental health issues remain unaddressed, often worsening with substance use. Let's look at some specific categories:

  • Trauma: Individuals who have experienced trauma, especially in childhood, are at a significantly higher risk for both mental health disorders and addiction. Trauma can disrupt normal development and coping mechanisms, leading individuals to seek solace in substances. The pain of trauma can be overwhelming, and substances can offer a temporary escape, but this often leads to a destructive cycle.

  • Mood Disorders: Conditions like depression, bipolar disorder, and anxiety disorders can significantly increase the risk of addiction. The emotional pain and instability associated with these disorders can make individuals more susceptible to the allure of substances as a way to self-medicate. For example, someone with severe depression might turn to alcohol to numb their feelings, while someone with bipolar disorder might use stimulants during a depressive episode and depressants during a manic episode.

  • Thought Disorders: Schizophrenia, schizoaffective, and other disorders that include symptoms of psychosis can also co-occur with substance use disorders. Sometimes, individuals may use substances to manage distressing symptoms like hallucinations or delusions.

  • Personality Disorders: Certain personality disorders, characterized by inflexible and unhealthy patterns of thinking and behaving, can also increase the risk of addiction. For example, individuals with borderline personality disorder, who experience intense emotional instability, may use substances to regulate their mood. Those with antisocial personality disorder may engage in substance use as part of a broader pattern of impulsive and risky behavior.

Addiction's Impact and Exacerbation of Mental Well-being:

Addiction doesn't just co-occur with mental health disorders; it actively impacts and exacerbates them. Prolonged substance use can alter brain chemistry, leading to or worsening existing mental health conditions. In recent years, even a single use episode of certain drugs (marijuana and other stimulant medications) can trigger a psychotic episode and the onset of a chronic thought disorder. Mental health consequences from substance use are particularly true for: 

  • Mood Disorders: While substances might offer temporary relief from mood symptoms, they often lead to a "crash" afterward, worsening depression and anxiety. For example, alcohol, a depressant, can initially alleviate anxiety, but long-term use can lead to rebound anxiety and worsen existing anxiety disorders. This is true for other substances as well. In addition, substance use can also interfere with the effectiveness of medications prescribed for mood disorders.

  • Thought Disorders: Substances, particularly stimulants and hallucinogens, can trigger psychotic episodes in susceptible individuals and worsen existing psychotic symptoms in those with thought disorders like schizophrenia and schizoaffective disorder. This can make it difficult to distinguish between substance-induced psychosis and psychosis related to the underlying mental illness. Thought disorders triggered by substance use can turn into lifelong conditions.

  • Trauma: Substance use can impair memory and judgment, making individuals more susceptible to experiencing a traumatic event. It can also hinder the processing of past trauma, preventing individuals from healing and moving forward. The emotional numbing provided by substances can also mask the underlying trauma, delaying necessary therapeutic interventions.

Understanding how Suicidal Thoughts are Related to Both Substance Abuse and Mental Health 

The intersection of mental health disorders, addiction, and suicidality is a serious and concerning issue. It is important to highlight suicidality (suicidal thoughts or intentions) separately because it can be a symptom related to many mental health and addiction diagnoses. Suicidality is not a stand-alone mental health diagnosis, however, it can be associated with mood disorders, thought disorders, personality disorders, trauma and substance abuse. Individuals struggling with co-occurring disorders are at a significantly elevated risk of suicidal ideation and attempts. The presence of both a mental health condition, such as depression or bipolar disorder, and a substance use disorder can amplify feelings of hopelessness, despair, and isolation, all of which are risk factors for suicide.  Substance use can further impair judgment and increase impulsivity, making suicidal actions more likely.  Moreover, the cyclical nature of these co-occurring disorders can create a sense of being trapped, leading individuals to believe that suicide is the only escape.  It is crucial to recognize the heightened risk of suicidality in individuals with dual diagnoses and to provide them with the necessary support and resources. If suicidality is present in a person, this is considered a crisis and help should be sought immediately. (Please see resources at the end of this article).

Untangling the Complexity: The Importance of Integrated Treatment

Integrated treatment is not just a best practice; it's a necessity.  Addressing only one aspect of a dual diagnosis—be it the mental health disorder or the substance use disorder—is rarely effective and often sets the stage for relapse.  If, for example, someone receives treatment for their addiction, but their underlying depression remains unaddressed, they may be more likely to return to substance use as a way to cope with those lingering depressive symptoms.  Conversely, treating a mental health condition without addressing a co-occurring addiction can be equally problematic.  Continued substance use can interfere with the effectiveness of mental health treatment, mask underlying symptoms, and create new psychological challenges.  Essentially, leaving one side of the dual diagnosis untreated leaves the individual vulnerable and significantly increases the risk of experiencing further difficulties with the other.  Simultaneous treatment offers the best chance for long-term recovery and improved overall well-being by addressing the interconnected nature of these challenges.

Integrated treatment typically takes place at a substance use treatment center that specializes in dual diagnosis or co-occurring mental health care. The first step would be contacting a treatment center or professional who specializes in both addiction and mental health for an assessment. A person’s treatment is likely to include:

  • Therapy: Therapeutic modalities like Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) can help individuals develop coping mechanisms for both mental health symptoms related to mood disorders, thought disorders, and personality disorders, as well as help with cravings. Trauma therapies (EMDR, Somatic Experiencing, Psychodrama, etc.) can help people to address underlying trauma histories that might be exacerbating both mental health and addiction.

  • Medication: Medication may be used to manage mental health conditions like mood disorders, thought disorders, and some trauma symptoms, reducing the urge to self-medicate with substances.

  • Support Groups: Peer support groups provide a safe space for individuals to share their experiences and connect with others facing similar challenges. They give people an opportunity to build community which can be a protective factor for long-term recovery.

  • Holistic Approaches: Integrating mindfulness, exercise, and healthy lifestyle choices can support overall well-being and recovery as well as mitigate symptoms related to mental health diagnoses.

The relationship between mental health diagnoses and addiction is a complex and often cyclical one, resembling the classic "chicken and egg" dilemma.  As we've explored, mental health conditions can increase vulnerability to addiction, while substance use can exacerbate or even contribute to the development of mental health problems.  Trauma, mood disorders, thought disorders, and personality disorders all play a role in this intricate interplay, with substance use often complicating the picture further.  Integrated treatment, addressing both the mental health disorder and the addiction simultaneously, is crucial for effective and lasting recovery.  Ignoring one aspect of the dual diagnosis leaves the individual vulnerable to relapse and continued suffering.  Furthermore, the increased risk of suicidality in individuals with co-occurring disorders underscores the urgent need for professional intervention and support.  Ultimately, understanding the complexities of this relationship is the first step towards breaking the cycle and paving the way for healing and well-being.

 

If you or someone you know is experiencing suicidal thoughts, please seek immediate help.  You can contact the 988 Suicide & Crisis Lifeline by dialing 988, or reach the Crisis Text Line by texting HOME to 741741.  Help is available.     

Resources:

Family Recovery Collective
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