Is Addiction a Mental Illness?
Yes. According to the National Institute on Drug Abuse (NIDA) , substance abuse can change the brain’s function and structure, taking a person’s normal desires and needs and replacing them with the urge to seek and take drugs. These changes in the brain impair the ability to control impulses that can lead to addiction, where a person cannot stop taking drugs despite negative consequences.
Individuals with substance use disorder have an intense focus on using a particular substance(s) such as alcohol, tobacco, or illicit drugs, to the point where the person’s ability to function in day-to-day life becomes impaired. People keep using the drug even when they know it is causing or will cause problems. The most severe substance use disorder is sometimes called addiction. .
What is a Co-Occurring Mental Health Issue?
Co-occurring disorders are basically the term used to describe two or more illnesses or disorders that occur or happen in the same individual. They can exist at the same time, or one after the other.
Co-occurring disorders are sometimes referred to as comorbidity. It also means interactions between the disorders that can worsen both. Comorbid mental illnesses and substance use disorder are common, with about half of people who have one condition also having the other .
Another term for co-occurring disorder and comorbidity is dual-diagnosis. An individual with a dual diagnosis has both a mental health disorder and an alcohol or drug problem. These conditions occur together frequently. According to the National Institute of Health (NIH) , About half of people who have a mental health disorder will also have a substance use disorder at some point in their lives and vice versa.
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The Link Between Mental Illness & Substance Use Disorders
The high occurrence between substance use disorder and mental disorders does not necessarily mean that one caused the other. According to NIDA, establishing causality or directionality is difficult. However, it is established that mental illness may contribute to substance use and addiction. Moreover, substance use and addiction can contribute to the development of mental illness.
Data from the National Institute on Drug Abuse show high rates of co-occurring substance use disorders and anxiety disorders, which include generalized anxiety disorder (GAD), panic disorder, and post-traumatic stress disorder (PTSD) 
Substance use disorders also co-occur at a high percentage with mental health disorders, such as bipolar disorder and depression, psychotic illness, attention-deficit hyperactivity disorder (ADHD), borderline personality disorder (BPD), and antisocial personality disorder. A person with schizophrenia has higher rates of alcohol, tobacco, and drug use disorders than the general population.
Mental health problems and substance use disorders sometimes happen at the same time. According to the National Institute of Mental Health (NIMH) , this is because:
- Certain illicit drugs can cause individuals with an addiction to experience one or more symptoms of a mental health problem
- Mental health problems can sometimes lead to alcohol or drug use, as some individuals with a mental health problem may misuse these substances as a form of self-medication
- Substance and mental use disorders share some underlying causes, including changes in brain composition, vulnerabilities, genetic, and early exposure to stress or trauma
- More than one in four adults living with serious mental health issues also experience substance use problem
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Risk Factors on Co-occurring Mental Health Issues & Addiction
Genetics is attributed to around 40 to 60 percent of an individual’s vulnerability to substance use disorders . This is caused by complex interactions among multiple genes and genetic interactions with environmental influences. Research suggests that there are many genes that may contribute to the risk for both addiction and mental disorders, including those that influence the action of neurotransmitters—these are the chemicals that transmit messages from one neuron to another—that are influenced by drugs and commonly dysregulated in mental illness, such as serotonin and dopamine.
Scientists are also starting to understand the very powerful ways that environmental and genetic factors interact at the molecular level. Epigenetics refers to the study of changes in the regulation of gene expression and activity that are not dependent on gene sequence; that is, changes that affect how genetic information is read and acted on by cells in the body. Environmental factors such as trauma, chronic stress, or drug exposure can induce stable changes in gene expression, which can change or alter functioning in neural circuits and ultimately impact behavior.
Brain Region Involvement
Certain areas of the brain are affected by both mental and substance use disorders, such as the abuse of acid drugs. For instance, the circuits in the brain that mediate reward, impulse control, decision making, and emotions may be influenced by addictive substances and disrupted in substance use disorders, schizophrenia, depression, and other mental disorders. Moreover, multiple neurotransmitter systems have been influenced in both substance use disorders and other mental illnesses including, but not limited to, serotonin, glutamate, dopamine, Gamma-aminobutyric acid (GABA), and norepinephrine.
Several environmental factors are associated with an increased risk for mental illness and substance use disorders, including chronic stress, trauma, and adverse childhood experiences. Many of these factors are modifiable and therefore, prevention interventions will usually result in reductions in both disorders.
Stress is a well-known risk factor for a lot of mental illnesses and therefore provides one likely common neurobiological connection between the disease processes of mental disorders and substance use disorders. In addition, exposure to stressors is also a major risk factor for relapse to drug use after periods of recovery. Stress responses are processed through the HPA axis or hypothalamic-pituitary-adrenal, which in turn can affect brain circuits that control motivation.
During higher levels of stress, it has been shown that there is a reduction of activity in the prefrontal cortex and increases responsivity in the striatum. This leads to increased impulsivity and decreased behavioral control. Chronic stress and early life stress can cause long-term alterations in the HPA axis, which affects limbic brain circuits that are involved in learning, motivation, and adaptation, and are impaired in individuals with substance use disorders and other mental illnesses.
Trauma & Adverse Childhood Experiences
Emotionally or physically traumatized individuals are at much greater risk for drug use. The co-occurrence of these mental disorders is associated with inferior treatment outcomes. Individuals with post-traumatic stress disorder (PTSD) may use alcohol or drugs in an attempt to reduce their anxiety and to avoid dealing with the effects of trauma.
The connection between PTSD and substance use disorder is of special concern for service members returning from tours of duty in Afghanistan and Iraq. According to NIDA , from 2004 and 2010, approximately 16 percent of veterans had untreated alcohol or drug addiction, and 8 percent needed treatment for serious psychological distress (SPD).
Does Self-Medication for Mental Disorder Work?
Only trained medical professionals have the knowledge and expertise to determine the most effective and safest ways to manage the effect of mental disorders. Although some substances may briefly help with mental illness symptoms, they can sometimes worsen and even lead to addiction. Additionally, when an individual develops mental disorders, brain changes may enhance the rewarding effects of the drugs, making it harder to stop using.
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How Do I Know If I have a Co-occurring Disorder?
If a person drinks or uses drugs and has other mental health disorders like depression or anxiety, it is crucial that the person be evaluated by a health professional. There are effective medications and behavioral treatments for mental conditions and addiction. For a person with symptoms of a mental disorder, the earlier treatment is started, the more effective it can be. Early treatment can help prevent more lasting, severe problems.
Treating Drug Addiction & Mental Health Disorder Through Integrated Treatment Program
An integrated treatment program screens and assesses clients for substance use disorders and other mental health illnesses. In an integrated treatment program, it is advised that clients receive therapeutic intervention and intensive medical care for both disorders simultaneously. This will allow them to manage the symptoms caused by the mental health disorder without abusing alcohol and drugs that can worsen those symptoms and allow untreated mental health conditions to increase the urge to drink or get high. Treating drug addiction along with mental health disorders is done through comprehensive care. It will start during detox and continues through aftercare support is the best route to achieve a new level of recovery from co-occurring disorders.
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Benefits of Integrated Care for Treating Drug Addiction & Mental Health Disorder
The integrated care treatment model is considered by the Substance Abuse and Mental Health Services Administration (SAMHSA)  a best practice when treating drug addiction by treating co-occurring mental health issues. Clients are more likely to participate and engage in treatment when care is comprehensive and integrated.
Treating drug addiction by treating co-occurring mental health issues through an integrated recovery program aims to lessen the negative side effects of mental health illnesses, including feeling depressed, problems paying attention, and reluctance to socialize with others.
Integrated treatment programs are tailored to match the individual needs of each client. The treatment program has been linked to many positive results. According to the Substance Abuse and Mental Health Service Administration (SAMHSA) , research has shown that individuals who engage in integrated treatment are more likely to:
- Stay sober
- Live independently
- Visit the hospital less often
- Maintain steady employment
- Report feeling happier with their lives
- See a significant reduction of their symptoms
Treating just one disorder will not cause the other to automatically improve. And separate, parallel care for the disorders does not result in one, effective treatment plan. To be effective, both disorders must be treated at the same time, in the same place, by the same treatment team.
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 NIDA – https://teens.drugabuse.gov/drug-facts/mental-health#topic-3
 American Psychiatric Association – https://www.psychiatry.org/patients-families/addiction/what-is-addiction
   NIDA – https://www.drugabuse.gov/publications/drugfacts/comorbidity-substance-use-disorders-other-mental-illnesses
 NIH – https://medlineplus.gov/dualdiagnosis.html
 NIMH – https://www.mentalhealth.gov/what-to-look-for/mental-health-substance-use-disorders
 SAMHSA – https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-02-01-004_Final_508.pdf