Substance Use and Mental Illness: The Chicken and the Egg?


20-year-old: I drink and smoke weed because I have anxiety and those are the only things that help me.

Me: Is it possible that alcohol and weed could also make things worse? Some people have “rebound” symptoms when the substances wear off- their anxiety skyrockets. And sometimes mental health problems get worse when you are using substances, even if you don’t feel bad when the substances wear off. Drinking and smoking weed changes your brain.

20-year-old: Maybe. But what am I supposed to do? Just quit? I’d probably kill myself in that case. Nothing else helps me. Those medicines you gave me didn’t do sh*t.

Me: I’m not sure the medicines can work properly when you’re still drinking and smoking weed every day.

20-year old: That’s possible, but I don’t want to quit dinking and smoking, and find out the meds still don’t work.

Me: So you’re stuck with the drinking and smoking weed? Because you’re afraid you’ll get worse if you stop? But you know they might be causing part of the problem?

20-year-old: Basically yes.

Mental illness and substance abuse are highly correlated. The two issues are intertwined. People with a mental health diagnosis use more substances than the general population, and people with substance abuse problems have higher rates of mental illness than the average for other groups.

You might wonder, why the high correlations between the two? Do people with mental illnesses use substances to “self-medicate” symptoms, or do those who abuse substances develop mental illness? The answer is complex. People self-medicate to feel better in the short term, but may make the overall course of illness worse in the long term. And substance use changes the brain, in some cases causing illness to blossom where it otherwise would not have.

The connection goes in both directions: Using substances can bring about, or worsen mental illness. Having a mental illness can increase the risk for substance use to mitigate symptoms.

Most people in recovery from substance use and mental illness say that healing comes when both problems are addressed at the same time. Get sober. Get mental health treatment. (Dual diagnosis programs treat both mental illness and substance use issues).

So to the 20-year-old above, I say, “You’ll have to take a leap of faith and give up the substances while you get help with your anxiety. Otherwise, you’re going to stay stuck right where you are now.”

Posted on July 16, 2018 .