What families overlook: Addiction is often a symptom, not the whole story

When a loved one struggles with addiction, it’s easy to become resentful. Families see the addicted person prioritizing their substance above all else, but what they often don’t see are the underlying challenges leading to those actions. For many people who struggle with addiction, as AdCare Rhode Island explains below, there’s a mental illness for which alcohol or drug use is a misguided attempt to cope.

Addiction and mental health disorders present frequently together; they’re almost like thunder and lightning. Of course, they exist apart from one another, but they’re a classic combination. About half of all adults in the U.S. with a serious mental illness also have a substance use disorder. Unfortunately, adults with substance use and mental health disorders often get treated for one disorder but not both.

In her blog, Nora Volkow, director of the National Institute on Drug Abuse (NIDA), discusses the significant difficulty of recovering from addiction. She highlights that in many cases “a critical element is overlooked: co-occurring mental health conditions.” She also discusses the difficulty many find in accessing care for mental health, stating that some communities are so lacking in resources that “it is easier to get illicit drugs than adequate mental health care.”

Co-Occurring Addiction and Mental Illness: The Rule, not the Exception

With more than 18.4 million adults in the U.S. struggling with co-occurring mental illness and addiction, families attempting to help an addicted loved one should always consider the possibility that their family member has at least one mental health concern, even if they’ve never been diagnosed or expressed concern about it.

Addiction and mental illness frequently occur together for numerous reasons. For starters, they share many risk factors, which include trauma and adverse childhood experiences (ACEs), genetic vulnerabilities and biology, chronic stress, history of family substance misuse, and self-medication early in life.

Trauma, specifically, is a major factor for many patients in treatment for addiction. Many patients with substance use disorders have some form of trauma (often multiple). Research demonstrates a strong link between exposure to traumatic events and substance use. Nearly 45% of people with lifetime PTSD meet criteria for a substance use disorder (SUD). Not only does trauma increase the risk of developing an SUD, but having an SUD increases the risk of trauma. Individuals living in active addiction are more likely to experience traumatic events than those without. Many individuals find themselves in a vicious cycle in which exposure to traumatic events produces increased alcohol and drug use, which then produces new traumatic experiences.

There is also the issue of self-medication. It’s not uncommon for individuals experiencing distressing symptoms of a mental health disorder to “medicate” those symptoms with drugs and/or alcohol, according to the National Alliance on Mental Illness (NAMI). Volkow emphasized in her blog that self-medication is a common way for people with mental health issues to cope, stating that many people use drugs or alcohol “to cope with temporary stress to manage symptoms of chronic mental health problems that they may not even know they have.”

This tends to work in the short term, to some extent, alleviating the immediate distress. However, over the long term, NAMI notes, it tends to worsen the same symptoms the person was trying to treat and may cause many other stressors that can worsen the severity of the disorder.

Substance use may also contribute to the development of mental health issues by causing long-term changes in the areas of the brain typically impacted by mental health disorders.

The Impact of Mental Illness on Early Recovery

Experts say that mental illness may complicate addiction recovery. Early recovery is a period that is already intensely challenging and may be made even more so by the presence of untreated psychiatric disorders. Getting sober brings emotional difficulties that are amplified when mental health issues are untreated. Anxiety, depression, trauma, or mood instability can trigger cravings, increase relapse risk, reduce therapy engagement, and make coping with withdrawal and stress harder.

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Because substance use is often adopted as a coping strategy for managing symptoms of mental illness, leaving those symptoms unaddressed leaves the patient vulnerable. Patients treated only for their substance use disorder and not their co-occurring mental illness are given little support in dealing with their distress and may find recovery unattainable. This may lead them to return to drugs or alcohol quickly to alleviate their suffering.

According to the National Institute on Drug Abuse, an integrated approach to co-occurring disorders offers the best outcomes for individuals facing both substance use and mental health issues. When exploring treatment options for a loved one, families should prioritize programs that treat both conditions together, and providers who can explain clearly how they are doing so. Families can, and should, ask questions like:

• What therapies do you use?
• Do you offer medication management for mental health disorders?
• Do you offer trauma-informed care, and what does that look like?
• What are the credentials and specialties of the staff employed?

Addiction Shouldn’t Be Treated in a Vacuum

A person’s whole health, not just their substance use, must be addressed for lasting recovery. Per the Substance Abuse and Mental Health Services Administration (SAMHSA), integrated treatment “leads to a better quality of care and health outcomes for those living with co-occurring disorders by treating the whole person.”

Treating a patient who struggles with a disorder like depression for their drinking or drug use alone is like prescribing medication for chest pain without evaluating the reason for the pain. This would leave the patient at risk for a heart attack or other serious cardiac events.

It’s the same for a patient experiencing addiction and a mental health disorder. While a person may be able to white-knuckle abstinence for a while, they are ill-equipped to sustain long-term recovery when their care plan doesn’t include treatment for their mental health concerns.

Asking individuals to stop using substances without giving them proper alternative coping skills can lead to the adoption of other maladaptive or dangerous coping behaviors. Equipping individuals with effective coping strategies is essential to help them manage intense withdrawal, severe psychological distress, and the high risk of relapse.

Mental Health is the Foundation of Sustained Recovery

Mental health stabilization improves recovery outcomes by helping patients manage mood, anxiety, trauma, or other psychiatric symptoms, thus allowing them to engage more fully in therapy, build positive coping skills, and make healthier decisions. Addressing mental health early and consistently doesn’t just support recovery, it makes it possible.

If siloed treatment harms a patient’s recovery efforts, integrated treatment does the opposite. It bolsters a patient’s ability to thrive. Truly integrated treatment addresses both substance use and mental health disorders together through a coordinated, patient-centered approach.

You wouldn’t expect someone to recover from a physical illness while ignoring a major underlying condition, and recovery from addiction should be no different. For loved ones, this means seeking out care that treats both at the same time, giving your loved one the support they need for a more stable and lasting recovery.

This story was produced by AdCare Rhode Island and reviewed and distributed by Stacker.