Anxiety, Depression, and Substance Use Disorder

There’s no denying that mental health conditions and substance use disorder go hand in hand, whether it’s a case of substance use leading to mental health issues or vice versa. In fact, many people who suffer from one problem also suffer from the other.

That’s why it’s so important to address both challenges together when working with someone who has either or both of them. In the United States, it’s estimated that more than 20 million people have a mental health condition in any given year. But according to SAMHSA (the Substance Abuse and Mental Health Services Administration), just over half of these people receive treatment or counseling to help manage their symptoms.

The Link Between Substance Use Disorder and Mental Health

When it comes to substance use disorder (SUD), there’s an undeniably close relationship between it and mental health. A large majority of individuals with SUD also have a diagnosis of depression, anxiety, or other mental health conditions, such as borderline personality disorder, bipolar disorder, schizophrenia, ADHD, or PTSD.

Mental Health and Substance Use concerns often occur together, so much so that they are called “co-occurring disorders”. In fact, according to a systematic review and meta-analyses published in the Journal Addictive Behaviors: “43% of people in SUD treatment for nonmedical use of prescription painkillers have a diagnosis or symptoms of mental health disorders, particularly depression and anxiety.” [1] These patients have similar risk factors for both mental health conditions and substance use, including genetic factors, the prevalence of stress, and trauma. It may be difficult to successfully treat individuals with a mental health condition without treating the co-occurring substance use disorder. At the same time, using substances is a common mechanism to self-medicate, which may be further triggering a substance use disorder, and at the same time can trigger changes in the brain that make mental health conditions worse.

The Impact of Stress and Anxiety on Substance Use Disorder and Mental Health Conditions

Stress and anxiety are known risk factors for many mental health disorders, as well as SUD. In fact, stress can negatively impact behavior control and inhibit recovery. People with depression or anxiety are particularly vulnerable to increased stress, which can lead to substance use for self-medication purposes.

People with increased levels of stress are also more susceptible to decreased behavioral control and increased impulsivity. When this occurs, it becomes more difficult for the individual to resist using substances, which can directly contribute to a return to use, even after a long recovery period.

According to the National Institute on Drug Abuse (NIDA), “dopamine pathways have been implicated in how stress can increase vulnerability to substance use disorders.” [2] In other words, dopamine – a neurotransmitter associated with the reward center of your brain – is released when we engage in any activity that provides pleasure.

After drug use, dopamine is released in the brain, creating a feeling of pleasure and further strengthening the neural pathway connected to the use of substances and pleasure, and making it harder to break the cycle once the path has been established.

Depression and Substance Use Disorder (SUD)

Research shows that individuals with depression are more likely to develop a SUD when compared to people without depression. For example, results from the Epidemiologic Catchment Area (ECA) studies found that, compared with people who have never been diagnosed with a mood disorder, those diagnosed with depression are seven times more likely to develop a SUD. [3] It is important for people who have been diagnosed with both depression and substance use disorder to receive integrated care because these conditions can affect each other in many ways.

Both conditions can be associated with greater severity or chronicity, and both tend to cause relapses in recovery from either problem. Those who experience both problems may require different treatments from those who suffer from just one.

Depression is a delicate topic because it is often misunderstood. It is vital for people who experience depression to find the proper treatment (both clinical and psychological) that works for them.

Mental Health Treatment For Substance Use Disorder

When people with SUDs receive treatment for both their mental health conditions and their substance use simultaneously, they experience better outcomes than if they were treated for one condition without regard to the other.

Unfortunately, only about 18% of SUD treatment programs and 9% of mental health treatment organizations offer a combination of both types of care. [4] So, it’s important that people who need help for both issues know what’s the best treatment option while having access to the type of care that works for them.

Mental health treatment looks different for everyone. For some people, the best treatment is a combination of medication and therapy, while for others, it’s finding a support group or talking to a friend.

Resources for Best Practices in Integrated Treatment

Many healthcare providers realize the importance of integrated care, but far too few have the experience and expertise to treat co-occurring conditions simultaneously. Some effective resources to begin to close this gap are available below:

  • SAMHSA’s “Integrated Treatment for Co-Occurring Disorders”: Designed to help individuals struggling with Mental Health, based on evidence-based practices, this program offers valuable material on the SUD and Mental Health crisis, along with integrated and coordinated information about services and treatment. Click here to access their Integrated Treatment Program.
  • SAMHSA’s “Treatment Improvement Protocol (TIP) 42”: This updated version of their Treatment Improvement Protocol lays out the best practices for ensuring that individuals with co-occurring mental and substance use disorders are effectively treated, as well as a resource guide that addresses the needs of individuals who have both mental health and substance abuse problems. Click here to access.
  • NAADAC’s webinar “Integrating Treatment for Co-occurring Disorders: An Introduction to What Every Addiction Counselor Needs to Know”: A webinar featuring both video, audio, and text provides a comprehensive introduction to the treatment of co-occurring disorders. Click here to access.
  • Integrated Treatment of Substance Use and Psychiatric Disorders by Thomas M. Kelly and Dennis C. Daley: A study published in The Social Work in Public Health Journal that explores the many factors that psychiatric disorders have in common with SUD, navigating the solutions available in the field of Integrated treatment for comorbidity compared to treatment of individual disorders separately. Click here to access.
  • CHESS Health: Our Connections app offers a recovery community explicitly tailored for those in recovery from substance use disorder and managing a co-occurring mental health condition.
Let’s Make a Difference Together with CHESS Health

Recovery from both SUD and mental health issues can be challenging, but fortunately, we’re here to help people recover from both. As the leading technology provider supporting the addiction management and recovery lifecycle, CHESS Health offers evidence-based programs that foster meaningful connections on the lifelong recovery journey. By partnering with health plans, governments, and public and private organizations, we can increase abstinence rates, reduce relapses, and lower healthcare costs.