[This is the second part of a series that explores the relationship between mental illnesses and substance abuse a means of self-medicating the illness.}

The theory that some people with mental health issues use substances for the purpose of finding relief from those issues is not new.

An article titled The Self-medication Hypothesis of Substance Use Disorders: A Reconsideration and Recent Applications, by psychiatrist Edward J. Khantzian, published in 1997, wrote that:

“Persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing.”

Nearly 26 years after Khantzian’s article, Columbia University’s Department of Psychiatry published Substance Use Disorder and Mental Illness Often Go Hand in Hand. Both Must Be Addressed, in September 2023.

The article reported that in 2021, 46.3 million people aged 12 and older (or 16.5% of the population) reported a substance use disorder in the past year, while nearly 19.4 million had both a substance use disorder and mental health condition, such as depression, acute anxiety, or bipolar disorder.

In other words, as the Substance Abuse and Mental Health Services Administration states, mental health problems can sometimes lead to alcohol or drug use, as some people with a mental health problem may misuse these substances as a form of self-medication. Mental health and substance use disorders share some underlying causes, including changes in brain composition, genetic vulnerabilities, and early exposure to stress or trauma.

“When you have both a substance abuse problem and a mental health issue such as depression, bipolar disorder, or anxiety, it is called a co-occurring disorder or dual diagnosis. Dealing with substance abuse, alcoholism, or drug addiction is never easy, and it’s even more difficult when you’re also struggling with mental health problems,” wrote co-authors Lawrence Robinson, Melinda Smith, M.A. and Jeanne Segal, Ph.D. in the HelpGuide.org article The Link Between Substance Abuse and Mental Health.

In co-occurring disorders, the article says, both the mental health issue and the drug or alcohol addiction have their own unique symptoms that may get in the way of your ability to function at work or school, maintain a stable home life, handle life’s difficulties and relate to others. To make the situation more complicated, the co-occurring disorders also affect each other. When a mental health problem goes untreated, the substance abuse problem usually gets worse. And when alcohol or drug abuse increases, mental health problems usually increase too.

According to a report in the Journal of the American

Medical Association (JAMA):

• Roughly 50 percent of individuals with severe mental disorders are affected by some form of substance abuse or dependence.

• Thirty-seven percent of people who are dependent upon or abuse alcohol and 53 percent of people who are dependent upon or abuse street drugs also have at least one serious mental illness.

Those with untreated co-occurring disorders have a greater likelihood of violence, failure to respond to treatment and higher risk of illness, homelessness, incarceration and death.

Having co-occurring disorders can impact all aspects of daily life and over all functioning by causing problems with memory, attention and decision making. It can also affect all the organs in the human body.

Because of the stigma surrounding both mental illness and substance use disorder, however, many of those most in need of medical care neither seek it or receive it.

Mental health stigma prevents two-thirds of people from getting the help they truly need, says Granite Mountain Behavioral Health Care, of Arizona. For those with mental illness and addiction, mental disorders are often the part that is left undiagnosed, which is not only dangerous, but can result in severe complications, including coma, overdose, or death.

“People who experience stigma regarding their substance use disorder or mental health condition are less likely to seek treatment due to the fear of being associated with something that is viewed negatively by society,” wrote Maria Senecal-Reilly for the Onondaga County, NY Health Department.

“Having a substance use disorder or mental health condition often goes along with never feeling comfortable with who you are,” Senecal-Reilly wrote. “This could mean that a person feels that there is something that makes them feel less than, different or set-apart from ‘normal’ people. Or perhaps they feel disappointed at things they have not accomplished. As a result, the ordinary facets of life that are happy and satisfying to most people do not feel that way to someone with a mental health condition or a substance use disorder.'”