There’s often more to addiction treatment than just treating addiction. Addiction frequently co-occurs with one or more mental health conditions, and treating them together in a coordinated and integrated way, leads to the best outcomes.
Sometimes multiple conditions arise independently, but they’re often connected. There are different ways that substance use disorders and other disorders of the brain can interact. They can both stem from the same cause, the mental health condition can contribute to or worsen a substance use disorder, or substance use can contribute to or worsen a mental health condition.
Addiction and mental health challenges can arise from the same cause.
Addiction is generally considered a biopsychosocial disease, with biological, psychological and social contributing factors. Some of these factors may also contribute to other conditions. A study published in the journal Frontiers in Genetics found that people with a genetic predisposition to mental illness were also at higher risk for substance abuse.
Highly stressful life experiences, especially early in life, can also contribute many different conditions. Adverse Childhood Experiences (ACEs) affect the developing nervous system and change the way people respond to stress. The Centers for Disease Control links ACEs to physical illness, mental illness and substance abuse.
Neurotransmitters and the link between the substance and symptom relief.
The mental health condition can contribute to or worsen a substance use disorder. It’s common for people to turn to substances to manage another condition’s symptoms, leading to addiction. The link between drugs or alcohol and symptom relief is often through the action of neurotransmitters.
Neurotransmitters are chemical substances that brain cells (neurons) use to communicate. They cross the gap between cells and latch onto cell receptors. This action signals to the cell to send the message to the next neuron in the chain. Then the neurotransmitter gets recycled back into the cell from which it came.
Many substances mimic the body’s natural neurotransmitters. They latch onto the receptors designed for the body’s own chemicals. Heroin and other opioid drugs like prescription painkillers work this way. So does marijuana. Other drugs work in the brain in a way that increases the effects of natural neurotransmitter chemicals.
Suppose a mental health condition causes an imbalance in neurotransmitter levels and using drugs or alcohol temporarily addresses it. In that case, it’s easy to understand why people would turn to substances to manage their symptoms. Unfortunately, this can lead to an addiction, and because of the way the body adapts, it can lead to even greater neurotransmitter imbalance over time.
Substance use can contribute to or worsen a mental health condition.
Again, this is often related to neurotransmitters. The body is self-corrective to a degree and is always trying to maintain balance.
When it senses that neurotransmitter levels are too high (such as what happens in substance abuse), it reacts. The body can release a smaller amount, make neurotransmitter receptor cells less sensitive or decrease their number.
Some mental health symptoms are related to dopamine levels. The abuse of all drugs initially raises dopamine. The rise in dopamine is part of what makes substances addictive. As the body reacts to the use of the substance over time, dopamine levels fall.
Several symptoms and conditions that often require mental health treatment have been associated with abnormal dopamine levels. An article in the journal Neuropspychiatry notes that dopamine controls most psychological events in humans.
Dopamine may be involved in depression, bipolar disorder, attention-deficit hyperactivity disorder (ADHD) and schizophrenia.
Different substances affect different neurotransmitters. Some substances, including alcohol, affect levels of GABA. A Psychology Today article notes that low GABA is associated with anxiety, depression and concentration and memory problems.
There are many other substance use and mental health connections. The National Institute on Drug Abuse reports that marijuana use has been associated with a higher risk of developing psychosis. Mayo Clinic notes that substance abuse is a risk factor for developing or triggering bipolar disorder.
Anxiety disorders involve intense feelings of fear and distress in situations that aren’t objectively threatening. You may feel tense, restless, irritable, apprehensive or overly vigilant. You may also have physical symptoms like a racing or pounding heart, sweating, tremors, headaches, shortness of breath, upset stomach or insomnia.
There are multiple types of anxiety disorders. Social anxiety disorder involves fear about interactions with other people. People may worry about saying the wrong thing or otherwise embarrassing themselves. It can cause people to avoid social situations and interactions.
Generalized anxiety disorder (GAD), on the other hand, isn’t directly tied to a specific trigger but involves worry about everyday life. It can be challenging for people with GAD to focus on their daily responsibilities.
Panic disorder (PD) is the type of anxiety in which people experience panic attacks. Physical symptoms can mimic a heart attack and include heart palpitations, shortness of breath and chest pain. Other types of anxiety disorders include separation anxiety, agoraphobia and other phobic fears, such as animals or heights.
The brain’s primary part associated with anxiety disorders seems to be the amygdala, but other regions also play a role. In general, we can think of the brain as having an area more focused on thoughts (the frontal lobe) and an area more focused on emotions (the amygdala). When signals from the amygdala are running the show, anxiety can be a result.
Various parts of the brain can work together to make anxiety stronger. The website Brain Facts explains a part of the frontal lobe, the dorsal anterior cingulate cortex (dACC), strengthens signals from the amygdala. In people with anxiety, it communicates with the amygdala in different ways than people without an anxiety disorder.
Another part of the frontal lobe, the ventromedial prefrontal cortex, works in the opposite way, turning down some of the amygdala’s signals. Often, people who experience damage to this part of the brain experience anxiety.
The journal Psychiatric Times published a review of the literature on the co-occurrence of anxiety and substance use disorders and how it affects mental health and addiction treatment. They note that the conditions are among the most frequent psychiatric problems in the United States and co-occur at rates higher than chance would dictate. The types of anxiety most tied to substance use disorders are GAD and PD.
In most cases (at least 75%), the anxiety disorder was present before the substance use disorder arose. Once both exist, however, they tend to perpetuate each other in a cyclical manner. People with anxiety disorder have higher relapse rates after addiction treatment, and people with substance use disorders are more likely to experience recurrence of GAD.
Medscape reports that the neurotransmitters most associated with anxiety appear to be dopamine, serotonin, GABA and norepinephrine, associated with the “fight or flight” response to threats.
Post-traumatic stress disorder (PTSD) is an ongoing response to a traumatic event. Symptoms include unwanted and disturbing memories of the event, attempts to avoid reminders of it, feelings of detachment and hypervigilance.
Part of what goes on in the brain of someone with PTSD is similar to what goes on in the brain of someone with an anxiety disorder. The amygdala becomes overactive. In addition, the memory center of the brain, the hippocampus, is involved.
Sometimes during a traumatic event, the memories don’t get filed and integrated correctly, so the hippocampus continues to work to make sense of what happened. A large-scale study reported in the journal Biological Psychiatry found that people with PTSD have significantly smaller hippocampi than normal.
Current Psychiatry Reports notes that about half of all people seeking substance abuse treatment meet the criteria for PTSD. Their cravings for drugs and alcohol tend to be stronger, and they often relapse more quickly than other addiction patients. The National Center for PTSD recommends that patients with co-occurring PTSD and addiction receive treatment for both conditions.
Depression symptoms include a sense of hopelessness and despair and a lack of joy from and interest in normal activities. There are often changes in patterns of appetite and sleep.
The National Alliance on Mental Illness notes that when people are experiencing depression, their frontal lobe is less active. The neurotransmitters that appear to be most associated with depression are serotonin, dopamine and norepinephrine. GABA, glutamate and acetylcholine may also be involved.
The journal Science and Practical Perspectives reports that one theory as to why mood disorders like depression often exist with substance use disorders is that both can be related to “kindling,” a process where brain cells become sensitized by repeated activity. The more sensitized they become, the more easily and quickly they react to stimuli.
Alcohol and certain drugs sensitize brain cells, and some researchers believe that mood disorders also worsen over time because of a kindling process. People with brains more prone to become sensitized may be more likely to experience mood disorders and substance use disorders.
Treating Co-Occurring Addiction and Mental Health Disorders
If all conditions aren’t treated together, people can end up in a cycle where the untreated condition reawakens the other. Treatment should be individualized and tailored to each person’s needs, but some treatments are commonly used.
Cognitive-behavioral therapy (CBT) has been proven effective in treating a wide variety of conditions. It helps people identify and change unhelpful patterns of thinking that can lead to unwanted feelings and behaviors. Dialectical behavioral therapy (DBT) is a specific type of CBT that balances the need for change with acceptance and validation that behaviors develop to meet specific needs.
Sometimes people have trouble accessing and communicating the emotions or memories that underlie mental health disorders and addiction. Expressive therapies involving things like music, art or drama can help them bypass cognitive barriers. People may also find activities like mindfulness meditation, journaling and breathing exercises to help reduce stress. Often a course of treatment will involve psychotherapy and medications that help bring balance to brain chemicals.
If you or a loved one are living with a mental health disorder and addiction, there’s hope for you. We can help you on the path to healing.
Call us at 844.675.1628.
By Martha McLaughlin