Mental health is a complex and deeply personal topic that touches every part of life from relationships, education, work, and health. For individuals living with conditions like ADHD, Autism, Depression or Anxiety, the challenges can feel especially overwhelming. Unfortunately, these struggles can also increase the risk of alcohol and substance abuse, often as a means of coping.
Understanding this connection is crucial, not only to reduce stigma but to empower those affected to seek support. In this blog, we’ll explore how mental health disorders intersect with substance use, and what steps can be taken toward recovery and support.
Understanding Dual Diagnosis
Dual diagnosis or co-occurring disorder refers to the condition in which a person experiences both a mental health disorder and a substance use disorder simultaneously. In this context, a person is not just struggling with one isolated issue, but with two complex, interacting conditions that can deeply affect one another.
For example, someone might have major depressive disorder and also be dependent on alcohol, or they may live with schizophrenia while misusing methamphetamine. These combinations can vary widely, and the symptoms of one disorder often mask, mimic, or worsen the symptoms of the other, making diagnosis and treatment particularly challenging. Making their treatment tough and difficult to understand both introspectively and from an outside perspective.
They are also incredibly prevalent in modern societies. According to the Journal of the American Medical Association:
- Around 50% of people with severe mental health disorders also struggle with substance abuse.
- 37%of those with alcohol dependency and 53% of those with drug addiction also have at least one serious mental illness.
- About 29% of people diagnosed with a mental illness abuse either alcohol or drugs.
Why Do Mental Health and Substance Use Disorders Co-Occur?
While there is no single cause for dual diagnosis, several factors may contribute to the development of both conditions:
Self-Medication: Many individuals with undiagnosed or untreated mental health disorders may use drugs or alcohol to relieve symptoms. For example, someone with anxiety might misuse alcohol to feel calmer, while someone with depression might use stimulants to feel more energetic. This self-medication can provide temporary relief but often leads to addiction and worsens the underlying mental health condition.
Substance-Induced Mental Health Symptoms: Long-term or heavy use of certain substances can actually trigger mental health disorders in vulnerable individuals. For example, Cannabis has been linked to an increased risk of developing schizophrenia, especially in those with a genetic predisposition, whilst alcohol and opioids can increase the risk of depression.
Shared Risk Factors: Mental health disorders and substance use disorders often share common risk factors, such asgenetics, trauma and adverse childhood experiences, chronic stress and environmental factors (e.g., poverty, social isolation)
How Do These Disorders Interact?
The interaction between mental illness and substance abuse can affect each other. Meaning that mental health symptoms can lead to increased substance use as a coping mechanism. substance use can worsen mental health symptoms or reduce the effectiveness of treatment.
This can create a vicious cycle. For instance, someone with PTSD may use drugs to numb emotional pain, but that substance use may impair sleep, judgment, or emotional regulation, making PTSD symptoms even harder to manage.
How to recognise a dual diagnosis
Dual diagnoses can be incredibly hard to identify, often individuals will do their best to ignore the symptoms in themselves, or hide these symptoms from others. The symptoms of a dual diagnosis can vary widely from person to person, depending on the specific mental health condition involved and the type of substance being abused. Furthermore, denial is a major obstacle to treatment for both substance use and mental health disorders. Individuals often underestimate the extent of their dependence on drugs or alcohol or fail to recognize how significantly it impacts their daily functioning. Fear of judgment, stigma, or being perceived as weak can also reinforce denial. As a result, individuals may avoid acknowledging their struggles altogether, hoping the issues will resolve on their own. This avoidance delays diagnosis and treatment, often allowing both the substance use and the mental health condition to worsen over time.
What to look out for
In others
It can be challenging to spot a dual diagnosis in someone else, but certain signs may stand out. You might notice mood swings, erratic behaviour, or emotional distress that seems out of proportion or a persistence of these symptoms even when the person appears sober. They may use substances to “manage” anxiety, depression, or trauma, and their substance use might escalate during periods of emotional strain. Pay attention to patterns of behaviour, such as these symptoms occurring consistently over prolonged periods, and especially if the person avoids conversations about their behaviour or downplays concerns.
A list of symptoms to look out for may be:
- Sudden or drastic changes in behaviour or mood
- Social withdrawal or isolation
- Difficulty managing responsibilities at work, school, or home
- Using substances to cope with emotions or stress
- Increasing tolerance to a substance or withdrawal symptoms
- Risky or impulsive behaviour
- Suicidal thoughts or self-harm
- Poor hygiene or neglecting self-care
In yourself
Recognizing a dual diagnosis in yourself means being honest about how your mental health and substance use interact. Do you turn to alcohol or drugs when you’re feeling low, anxious, or overwhelmed? Do you feel emotionally unstable even when you’re not using? Maybe you’ve tried treatment before, but it didn’t work out as you had wished? If your emotional wellbeing and substance use seem connected in a cycle that’s hard to break, it may be time to consider that both issues need attention, together.
Treatment
Self help
In addition to professional treatment, self-help plays a crucial role in managing both substance abuse and mental health issues. Achieving sobriety is just the beginning; ongoing recovery depends on developing healthier coping skills and making better decisions when facing life’s challenges.
Managing stress and emotions is essential. Since many people turn to drugs or alcohol to handle stress or unpleasant feelings like loneliness and anxiety, learning healthy stress management techniques is vital to prevent relapse. It’s important to identify personal triggers, from stressful events to disrupted sleep, and have a clear plan in place to avoid falling back into substance use when these inevitable hurdles occur.
Building strong connections with others helps support recovery. Regular face-to-face interactions with friends or family can provide emotional stability and calm. It’s equally important to follow medical advice carefully, especially regarding medications, to avoid relapse. Participating in therapy or support groups, like Alcoholics Anonymous or Narcotics Anonymous, further strengthens your chances of staying sober.
Adopting a healthy lifestyle also supports mental and physical well-being. Regular exercise, relaxation techniques like mindfulness or deep breathing, balanced nutrition, and sufficient sleep all contribute to reducing stress and improving mood. These habits create a stronger foundation for recovery and overall health.
Finally, finding new meaning in life is key to long-term sobriety. Engaging in fulfilling activities such as hobbies, volunteer work, or meaningful employment can help replace substance use with positive experiences. It may also require avoiding people, places, or activities that trigger cravings and being open to forming new social connections when partaking in these activities.
Helping someone with a Dual-Diagnosis
Supporting someone who struggles with both substance abuse and a mental health condition can be challenging and unpredictable. Supporting someone through such an issue is something we do out of love, but It’s common for your loved one to resist treatment, and the path to recovery may take time, placing a large amount of emotional and sometimes physical duress on the individual trying to help.
The most effective way to help is to recognize your limits, you can’t force someone to stay sober, take their medication, or attend appointments. However, you can focus on making healthy choices for yourself, encourage your loved one to seek help, and offer your support without losing sight of your own well-being. Talk openly with trusted friends or family, consider therapy, or join a support group to help manage your own feelings and stress. Setting clear boundaries is essential. Know how much care you can provide without becoming overwhelmed or resentful, and communicate limits on disruptive behaviours. Allowing the situation to take over your life isn’t healthy for either of you.
Furthermore, educating yourself about your loved one’s mental health and substance abuse challenges, is massively important. Researching the issues and listening to the stories of other is a great way to do this. The more you understand about their condition and treatment options, the better equipped you’ll be to support their recovery journey.
Finally, practice patience. Recovery from dual diagnosis is a gradual process, and setbacks are normal. With ongoing support and understanding on both sides, you can navigate this difficult time together and work toward rebuilding a healthier life.
Group support
Support groups can play a powerful role in recovery from co-occurring disorders, when someone is dealing with both a mental health condition and substance use. Like with other addictions, group settings not only help maintain sobriety, but also offer a safe, supportive space to share experiences and challenges. Many treatment programs for co-occurring disorders include group therapy as part of their aftercare, allowing individuals to stay connected and supported even after formal treatment ends. If you’re unsure where to start, your doctor or treatment provider may be able to refer you to a group that fits your specific needs.
Ideally, it’s best to join a group that addresses both your substance use and mental health concerns. These groups are tailored to the unique challenges of co-occurring disorders and can offer more targeted support. However, traditional twelve-step groups, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), can also be helpful. They are widely available, free to attend, and based on shared experiences and the guiding principles of the twelve steps. Even if they don’t specifically focus on mental health, many people find strength and community in them.
That said, it’s important to find a group where you feel accepted, especially regarding the use of psychiatric medication. Some members, though well-meaning, may mistakenly view psychiatric meds as just another form of addiction. This can create unnecessary judgment or pressure. Make sure the group you choose understands and respects the reality of your issues and choices in combatting them. The right support group should feel like a safe space where you can be open, understood, and never judged.
Helplines
Mental Health Services
- Samaritans – 116 123 (free) – For anyone in distress or suicidal
- Shout (text support)– Text “SHOUT” to 85258 – For anyone in crisis, text-based
- Mind Infoline– 0300 123 3393 – Mental health advice
- Rethink Advice Line – 0300 5000 927 – Help for people with severe mental illness
- SANEline – 0300 304 7000 – Emotional support for mental health issues
- Papyrus (HOPELINEUK) – 0800 068 4141 – Suicide prevention for under 35s
- CALM (for men)– 0800 58 58 58 – Support for men struggling with mental health
- The Mix (under 25s)– 0808 808 4994 / Text “THEMIX” to 85258 – Help for young people
- SupportLine – 01708 765200 – Emotional support for a range of issues
Substance Abuse Services
- FRANK– 0300 123 6600 / Text 82111 – Information on drugs and substances
- Drinkline– 0300 123 1110 – Support for alcohol misuse
- Alcoholics Anonymous– 0800 917 7650 – Help for alcohol addiction
- Narcotics Anonymous– 0300 999 1212 – Support for drug addiction recovery
- Cocaine Anonymous UK– 0800 612 0225 – Support for cocaine addiction recovery
- Marijuana Anonymous UK– 0300 124 0373 – Help with cannabis dependency
- Change Grow Live (CGL)– changegrowlive.org – Drug and alcohol treatment & recovery
- Release (legal advice)– 020 7324 2989 – Legal help related to drugs
References
NHS – Drug Addiction: getting help
NIH (National Institute of Mental Health) – Finding Help for Co-Occurring Substance Use and Mental Disorders
NIDA (National Institute of Drug Abuse) – Common Comorbidities with Substance Use Disorders Research Report
National Institute for Health and Care Excellence – Severe mental illness and substance misuse (dual diagnosis): community health and social care services
HelpGuide – Dual Diagnosis: Substance Abuse and Mental Health
Jama Psychiatry – Prevalence and Co-occurrence of Substance Use Disorders and IndependentMood and Anxiety Disorders, Results From the National Epidemiologic Survey on Alcohol and RelatedConditions
