According to the federal Substance Abuse and Mental Health Services Administration, people with mental health disorders are more likely to abuse substances compared to the general population. The organization found that 45 percent of Americans receiving treatment for substance misuse are also diagnosed with a mental health disorder, sometimes called a co-occurring mental health disorder. Treating someone for substance misuse requires a comprehensive approach to treatment for successful results.
Statistics are helpful, but clinicians with experience often suggest the percentage of co-occurring disorders is higher. Perhaps that’s because government statistics only note those diagnosed with a mental health disorder, versus those who have undiagnosed disorders.
“What I’ve learned in my training and in my practice is that substance misuse issues are so common in terms of what we see in mental health treatment,” says Karen Hadley Leavitt, MD, a board certified child, adolescent and adult psychiatrist at Life Psychiatric Associates in Winter Park, Florida. “It makes sense, because people are trying to self-medicate their problems, and they get in trouble because of that.”
According to Dr. Leavitt, a lot of patients in recovery don’t know they have mental health issues, as it may not have been previously addressed. They go to a therapist or psychiatrist, and when asked what they’re trying to medicate, they are clearly baffled by the question before realizing they have focus issues or social difficulty around people, for example.
Why Do Substance Misuse and Mental Health Disorders Go Hand in Hand?
For Dr. Leavitt, it makes sense that they’re linked. “It’s really common to have both. In my practice, I’ve not really seen where anyone is ‘just an addict.’ And I hate that stereotype, because a lot of times, people are trying to manage something,” she says.
Clinicians try to help those in recovery figure out the reason for their substance misuse. “As I get to know people, I see that they started down this road because of bipolar disorder or a crippling social anxiety disorder. Alcohol or another substance was the only way they could cope with being around people. Or they were depressed, and that was the only way they would feel better,” she says.
But substance misuse itself can also result in mental health disorders, as marijuana can lead to psychosis development. “If you have a problem with a substance, and it starts to drive your life, there are natural consequences as a result of that use,” Dr. Leavitt says. As a result, a patient can become anxious or depressed about those consequences.
Mark E. Blair, MD, a psychiatrist and Chief Medical Officer of Columbus Springs Hospitals in Ohio agrees. “Most people with addiction — at least in the short term — have anxiety and depressive symptoms as a result of the addiction,” he says.
How Mental Health Treatment Fits into Substance Misuse Treatment
By identifying and then validating a person’s experience, the mental health issue can then be treated. According to Dr. Blair, most rehab facilities have a psychiatrist on staff to assess patients, even if their admission is purely related to addiction. A lot of facilities treat both because of the high co-morbidity rate. When a person in recovery doesn’t have a substance to mask it, his or her mental health issues may become more evident. “That’s why even in those programs that focus on recovery, it may touch on making sure mental health is addressed as well,” says Dr. Blair.
Mental health medications can help with stabilization. Disorders like anxiety, depression and bipolar disorder are related to neurotransmitter deficiencies or abnormalities. “When you address that, it provides a little more balance. It’s medical,” Dr. Leavitt says. Some people tell a person with mental health issues to just “suck it up” or “deal with it.” But if it’s medical, it may need to be treated with medication. Dr. Leavitt handles medication management in her practice, which helps patients stay sober, as treating their mental health problems helps eliminate the need to self-medicate.
A mental health medication may only be needed on a short-term basis. A person may get diagnosed with alcohol-induced depressive disorder when admitted, but once in recovery, he or she may no longer need the antidepressant that originally helped.
Group and individual therapy helps address some of these issues as well. Groups offer accountability, someone to fall back on and commiseration with people with a similar viewpoint. That support is important, with someone to call any time of day. In individual therapy, people can look inwardly to identify and admit to something that’s been bothering them for a long time. Overall, therapy can help patients understand how they perceive things and how thoughts influence emotions.
“It’s impossible to treat substance abuse and not address mental health,” Dr. Leavitt says. She describes treatment as an equation: A plus B equals C, with A being mental health, B as substance abuse and C as recovery. “You can’t separate the issue,” she says. You can’t take A out of the equation and still get recovery.
Why Don’t All Recovery Programs Treat Both?
One reason that not all recovery programs treat both is that there’s a stigma in American society about mental health, says Dr. Leavitt. “Everyone wants to deal with addiction, but very rarely do they look at it and say, ‘You’re doing this for a reason — what’s the reason?'”
In many states, the responsibility is on patients to realize what type of help they need. If they don’t have someone guiding them on the treatment route, they may not know what resources exist. They’re hard to find, and for people with substance misuse problems, admitting to it or to a mental health disorder is difficult.
With dual treatment, Dr. Leavitt has seen patients improve and lead successful lives. She gives one example of a patient who has stayed in treatment over the long term. The patient sees a therapist, takes antidepressants, has insight into her triggers and knows what causes her anxiety and cravings. With these tools, she can prevent herself from relapsing.
“You’ve got to address both. You can’t just look at things separately. It’s a myopic view to do that,” she says. Any medical treatment is worthwhile if you look at it from a systems perspective, a balanced approach, which might include therapy and medications.
