Anxiety. Depression. Bipolar disorder. Borderline personality disorder. It is common for those who abuse substances to also have a mental health condition, or co-occurring diagnosis.
But how closely are mental health and substance use linked?
A new study of addiction treatment center clients found that nearly nine out of 10 (86%) had a mental health disorder.
How mental health feeds addiction
“A major panic attack feels like you’re in immediate danger or dying. Sometimes it feels like you’ve been hit with a bucket of freezing water. Heart palpitations, dizziness, shortness of breath. It’s honestly terrifying and that only continues the vicious cycle of panic.” – Catherine B. (Gander, 2017)
When you feel bad, you want to feel better.
Babies cry when wet or hungry. Breakups can cause ice cream and favorite movies to beckon. We reach for the ibuprofen when have a headache.
Mental illness, likewise, can feel uncomfortable. It can even make you physically ill. Some reach for illicit drugs and/or alcohol to relieve their anguish.
Angst over economy drives addiction
The connection between lack of mental well-being and substance use has been demonstrated in scientific studies.
Most notably, recession and high unemployment increases drug and alcohol use.
In an review published in International Journal on Drug Policy, most studies found that psychological distress during bad economic times fueled increased drug use. (Nagelhout, et al., 2017)
Likewise, a Health Economics study found that recessions increase alcohol consumption. (Mann, 2011)
Suffering at the heart of addiction
“Human distress and psychological suffering, whether resulting from a psychiatric disorder or not, are at the root of most addictive behavior.” Understanding Addiction as Self Medication: Finding Hope Beyond the Pain (Khantzian & Albanese, 2008)
The founder of the self-medication hypothesis of addiction, Edward J. Khantzian, emphasized in his book that distress and suffering are the cause.
The fact that adverse childhood experiences (ACEs) are nearly universal in those suffering with addiction further underscores this point.
From bullying to a parent’s death or divorce, ACEs are common among drug and alcohol rehab patients. A 2018 study of inpatient addiction treatment clients found that 93% had experienced an adverse childhood experience (called an ACE). (Kilburi, et al., 2008)
Similarly, a Kaiser Permanente and CDC study also found that ACEs predicted later substance use. In a two-wave survey of 17,000 individuals, they found that as the number of ACEs increased, so did illicit drug and alcohol use. (Felitti, 2002)
Self-medication: Everybody does it
“It’s like I have this deep pit of sadness in my stomach that I can’t get rid of. I watch the world go on, and I continue to go through the motions and plaster a smile on my face, but deep down, I’m hurting so much. It feels like there is a huge weight on my shoulders that I can’t shrug off, no matter how hard I try.” – Allyson B., describing major depression (Byers)
The definition of self-medication is trying to make yourself feel better by using substances. Without the guidance of a medical professional, that is.
This can be a conscious decision or an unconscious urge, and it happens with over-the-counter medication all the time.
If you feel a cold coming on, you may pick up vitamin C and echinacea. Stomach upset? You may take Pepto-Bismol. Feeling tired? You may reach for that cup of joe or an energy drink.
Does it make a difference if it’s not an illicit substance?
The self-medication hypothesis of addiction specifically applies to illegal substances.
However, the line between prescription drugs and illegal ones can be thin.
Marijuana, once outlawed everywhere, is now legal for adult use in 16 states and for medicinal purposes in another 22. Opioids, once widely used to manage pain of all kinds, has swung in the opposite direction. They are now tightly controlled all over the nation.
There is a difference, though, between your morning coffee and, say, methamphetamine.
Java blocks the reabsorption of dopamine, causing levels to rise. However, it does not overwhelm your body’s reward circuits as illegal substances do.
What does this mean?
You may grow dependent on coffee to the point where you’ll get a headache if you don’t have as much as usual. But you won’t become self-destructive if you decide to cut the caffeine.
On the other hand, with illicit substances, addiction is more likely.
Illicit substances more likely to cause consequences
The definition of addiction is continuing to use a substance despite negative consequences. And when it comes to illicit drugs, there are plenty of dire consequences.
It goes beyond financial problems, destroyed relationships and legal issues.
Unregulated substances can harbor varying levels of fentanyl. This means you can be taking your very life in your hands by using them.
What does it do for you? Co-occurring disorders can determine drug of choice
“In our experience.. lethargic individuals who might or might not be depressed welcome the energizing and activating effects of a stimulant drug such as cocaine or “speed.” Stimulants also have special appear for hyper-energized and hyperactive individuals. The hyper-energized (manic-like) enjoy or appreciate the boost of stimulants [as] the hyperactive person benefits from the paradoxical calming effects…
A persona who is uptight and uncomfortable about expressing emotion might find repeated, low-to-moderate doses of alcohol appealing because he or she briefly can tolerate such feelings. Higher doses of alcohol may be required to quiet down those who are more extremely tense, anxious or agitated. And for those who become agitated, angry, and rageful, opiates provide a magical calming and comforting influence. – Understanding Addiction as Self Medication: Finding Hope Beyond the Pain (Khantzian & Albanese, 2008)
We know that drugs can alleviate mental suffering.
More to the point: Different drugs relieve different types of suffering.
Usually, the drug of choice chosen corresponds with a person’s desired mental state.
As you can see, just looking at someone’s drug of choice can offer a window into their psyche. It is just one of the tools at an addiction treatment center’s disposal that allows them to uncover mental issues that must be dealt with.
Temporary relief, long-term harm
“I felt lonely and hopeless, just in the disease. But then going through withdrawal by myself in a motel room in Mexico was just a feeling of emptiness and despair. I had … runny eyes, runny nose, diarrhea, dehydration, complete lack of appetite, overwhelming nausea, pain in every part of my body. The other punishment involved with opioid withdrawal is that you can’t sleep. So there’s no respite. There’s anxiety and panic and feelings of dread and thoughts of this never getting better. And the depression, the inability to function at all. [Until I had to fly home,] I didn’t leave my room for five or six days. I felt so awful, so dehydrated, overwhelmed with feelings of cravings to use again just to feel better. When I got off the airplane, immediately went to an emergency room and complained of headache and other pain symptoms so that I could get opioids.” – Dr. Marc Myer (Williams, 2014)
Initially, drugs can make you feel good. They activate parts of the brain that release chemicals we experience as pleasurable.
Over time, however, users build a tolerance to their drug of choice. You need to use more and more to achieve the same effect. Eventually, the good feelings fade altogether, and you find yourself using just not to feel bad.
Tolerance develops to all drugs – illicit or prescription.
That in itself is a problem.
But when consequences start occurring due to addiction, it can cause anxiety, depression, shame and more. This exacerbates whatever problem was driving you to use in the first place.
It’s a vicious circle of mental anguish, drug or alcohol use… and more mental anguish, driving more drug and alcohol use.
In fact, your own brain is driving you to use. It has been programmed for the drug. Any time you try to step off the ride, it wreaks havoc and causes intense cravings.
That’s why fighting this yourself is a very tough proposition.
Bust the cycle: How to recover from addiction
Whether it’s a co-occurring condition, adverse childhood experiences, or something else, underlying issues need to be dealt with.
The first step is detoxing from the drugs and alcohol.
After that, the real work begins. And without doing the work, the chance of relapse remains very high.
Effective addiction treatment must include addressing co-occurring conditions.
It also includes learning alternative strategies for coping with stress. It encourages building a new, supportive social network. The best treatment centers also have brain mapping and neurofeedback, re-wiring the brain to support sobriety.
Finally, look for ongoing support through a healthy alumni program, help with finding a job and a place to live, and a long-term treatment options.
A treatment center that employs multiple approaches offers you the best shot at recovery.
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Byers, A. (n.d.). What It’s Really Like Going Through a Deep, Dark Depression. Retrieved February 21, 2021, from Healthline
Felitti, V. (2002). The Relation Between Adverse Childhood Experiences and Adult HEALTH: Turning Gold into Lead. Retrieved February 21, 2021, from the National Center for Biotechnology Information
Gander, K. (2017, February 17). 6 people describe exactly what their mental illness feels like. Retrieved February 21, 2021, from Independent
Khantzian, E. J., & Albanese, M. J. (2008). Understanding addiction as self medication: finding hope behind the pain. New York: Rowman and Littlefield Publ.
Kilburi, S.K., Molebatsi, K., Obondo, A., Kuria, M.W. (2018, June 18). Adverse childhood experiences among patients with substance use disorders at a referral psychiatric hospital in Kenya. Retrieved February 21, 2021, from National Center for Biotechnology Information
Mann, D. (2011, October 13). As economy goes down, drinking goes up. Retrieved February 21, 2021, from WebMD
Nagelhout, G. E., Hummel, K., De Goeij, M. C., De Viries, H., Kaner, E., & Lemmens, P. (2017, April 25). How economic recessions and unemployment affect illegal drug use: A systematic realist literature review. Retrieved February 21, 2021, from National Center for Biotechnology Information
Williams, S. (2014, February 24). What’s it really like to withdraw from heroin and painkillers? Retrieved February 21, 2021, from Minneapolis Post