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Comorbidity: When Mental Illness and Substance Use Disorders Coexist

Mental illness and addiction are all too common in the United States. Around 19.1 percent of all Americans have at least one diagnosed mental health condition; 19.7 percent have a substance use disorder. That’s nearly a fifth of the entire population for each separate condition.

These numbers are often startling, especially to people who don’t have much of a direct connection to the mental health or addiction world. What is perhaps even more startling is just how common it is for people to have both issues at the same time.


Comorbidity Statistics

When people are diagnosed with both a mental illness and substance use disorders, medical professionals define it as experiencing “comorbidity.” This is sometimes also referred to as a concomitant or coexisting illness.

Around half of all people diagnosed with a mental illness will also struggle with addiction at some point throughout their lives. This means the risk for someone with a mental health disorder to become addicted is about 50 percent – much higher than the average population.

According to the SAMHSA 2017 NSDUH Annual National Report, 9 million Americans were officially diagnosed with co-occurring mental health and substance use disorder in 2017 alone. This is equal to around 3.7 percent of the population, which makes it almost as common as schizophrenia, bipolar disorder, panic disorder, and obsessive-compulsive disorder (OCD).


The Stigma of Being Sick

So why, if the statistics are so damning, does it seem as if we hear so little about initiatives to serve patients with both mental illness and addiction? Although awareness has improved considerably over the past decade, it comes down to the stigma of addiction and mental health.

Many people still have the notion that people who are addicted have simply made a bad choice. They think people who are addicted are just bad people, or that if they would just will themselves to be more responsible and pull themselves up by the bootstraps, everything would be okay.

This just isn’t reality. Even for someone who only suffers from addiction, simply taking out the addiction without addressing other environmental influences (e.g., home life, career, family dynamic) is rarely enough to effectively treat the problem.

Similarly, people who are addicted and mentally ill won’t heal just from sheer will alone. Instead, it’s extremely important for providers to treat the whole patient at the same time – mental illness, addiction, and environmental life factors included.


Why Comorbidity Happens

Studies into comorbidity reveal that patients who do not receive integrative addiction and mental health care are significantly more likely to relapse. Until the underlying mental illness is treated, they are also far less likely to adhere to a program at all.

But why exactly does the connection between mental health and addiction even exist? Is there something that predisposes people to both conditions, or is it possible that drugs and alcohol make people more likely to develop anxiety, depression, and other mental illnesses?

The first thing you need to know is that while mental illness and addiction do exist alongside each other, and can even influence or exacerbate one another, one does not necessarily cause the other. Not everyone who has a mental illness will become addicted, and not everyone who is addicted will be diagnosed with mental illness.

The key is in a few important facts:

      • First, both mental illness and addiction permanently change or “rewire” the brain in different and unique ways. This can deeply affect the way people think and function. They are for this reason considered chronic brain diseases. As an example, bipolar disorder can result in hypomania or full-blown mania. This can impair judgement or even cause psychosis. These symptoms, which can be extremely uncomfortable or even unbearable, might encourage someone to seek out substances in an effort to relieve their symptoms (called self-medicating) or because they lack impulse control.
      • Then, there is the influence of all the hardships most addicts face when in active addiction. Loss of income. Homelessness. Health problems. Being ostracized from loved ones, children, and family members. All of these can lead to depression, anxiety, or even panic attacks for obvious reasons.
      • Certain drugs may cause symptoms commonly associated with mental illness, such as anxiety, depression, paranoia, and psychosis. This can worsen a pre-existing mental illness or even cause someone to develop one in the first place. For example, most amphetamines are linked to anxiety, panic attacks, and panic disorders due to the way meth “speeds up” the brain.
      • Genetics may also predispose someone to experiencing comorbid mental illness and substance abuse disorders. If you have a parent who was diagnosed with a mental illness and alcoholism, for example, you are more likely to experience both issues yourself. The exact increase in risk varies depending on the substance and the mental illness in question.
      • We also know that extremely negative experiences can raise someone’s risk for addiction and mental health disorder. This includes physical abuse, emotional abuse, violence (witnessed or experienced), and nearly all other forms of physical and emotional trauma. The risk is especially high for children and military veterans returning from war zones with.


Treating Comorbid Mental Illness and Addiction

Now, the good news: with the right treatment, it is almost universally possible to improve or even fully recover from both mental health disorders and addiction. The most important first step is to get diagnosed by a professional who fully understands the connection between comorbid conditions.

Often, this occurs for the first time in inpatient or outpatient rehabilitation programs. This is ideal because the facility can help the person create a plan to address both concerns during their time in treatment.

Diagnosing comorbidity isn’t always easy, especially during the early days when someone is already struggling to detox or withdraw from their drug of choice. But starting to address both facets from day one is extremely important; without the right diagnosis, the individual cannot be treated effectively for either condition.

The good news is that the earlier integrative treatment starts, the more likely a patient is to fully recover. Today is always the right day to take your first steps towards a better life – you don’t need to suffer in silence anymore. Just reach out.