It is important to understand that many people who suffer from an addiction issue also suffer from a mental health issue.
In fact, understanding why this is, and whether addiction or mental illness comes first is one of the most common and most misunderstood questions when it comes to addiction recovery.
For individuals entering drug and alcohol rehab, families seeking answers about their loved one’s addiction, and for professionals working in recovery settings, this ‘chicken or egg’ dilemma can feel frustrating and complex to understand.
The truth is far more complex than many people expect it to be. In most situations, addiction and mental illnesses are deeply intertwined. They are often developed together, and they tend to influence each other over time.
This article explores the relationship between addiction and mental health issues, as well as what the research tells us and how effective drug and alcohol rehab and detox programmes are in addressing both issues at the same time.
As discussed above, addiction and mental illness often occur together, in what is known as a condition called a dual diagnosis.
This means that a person may experience both a substance use disorder and a mental health condition such as depression, anxiety, or PTSD at the same time. This can sometimes make seeking help especially more difficult [1].
Research shows that this overlap is extremely common. In fact, around half of all people who experience addiction issues will also face a mental health disorder at some point in their lives and vice versa.
These conditions often interact in ways that make each other worse.
For example, a substance abuse issue can intensify symptoms of mental health issues including anxiety or depression, and poor mental health can increase the likelihood of someone becoming addicted to drugs or alcohol. Both conditions impact the other and can feed into a cycle that becomes difficult to break.
Clinically speaking, there is no single answer when it comes to what comes first. Many studies have now shown that it can be extremely difficult, if not impossible, to determine which condition develops first.
Instead, it is important to understand that there are a number of common ways that explain how addiction and mental illness become linked in the first place. Some of these situations are explained below for you.
For example, those suffering from a mental health issue are likely to try to self-medicate with addictive substances. Those suffering from anxiety, depression, trauma or mood issues are likely to experiment with medication, alcohol or drugs in an attempt to feel better.
Whilst addictive substances may offer short term relief for their mental health issues, they often worsen symptoms over time.
Over time, what began as a coping mechanism can develop into a full blown addiction, requiring a structured medical detox and professional rehab treatment.
Likewise, the reverse is also true, in that an addiction can lead to mental health problems. This is because addictive substances alter an individual’s brain chemistry, affecting the neurotransmitters such as dopamine and serotonin in the brain.
Prolonged drug or alcohol abuse over time is likely to increase the risk of depression, trigger anxiety, cause paranoia or psychosis and also worsen any addictive mental health issues that existed prior to becoming addicted.
In some cases, individuals might not have shown any signs of mental illness before developing an addiction. However, long term substance abuse can create new psychological challenges.
This is particularly true when it comes to individuals who require medical detox as part of their treatment plan, as withdrawal symptoms themselves can often create or intensify mental health issues.
Another explanation is that addiction and mental illness often begin as a result of underlying factors and issues, rather than one directly causing the other to happen.
These shared risk factors include genetics, childhood trauma, chronic stress, environmental influences such as a parent or sibling abusing in front of you, as well as isolation and loneliness.
In fact, the research suggests that these factors can increase the likelihood of both substance use disorders and mental health conditions developing together.
For example, a person exposed to a traumatic event might develop PTSD and then later turn to substances in an attempt to cope. Likewise, someone with a genetic predisposition may be vulnerable to both depression and addiction as they grow older.
Although the question is important to understand, it is also important to understand that treatment for both conditions focuses less on which condition came first and more on how both conditions can be treated alongside one another.
Attempting to treat addiction without addressing mental health issues often leads to a relapse later down the line.
Likewise, attempting to treat a mental illness without treating a substance addiction can limit how well someone does during their treatment. This is why treating both together is considered best practice.
So, it is important to understand that it does not always matter what comes first when it comes to treating these issues.
What matters most is that you seek help in the first place and then get access to the right kind of help and treatment.
When it comes to addiction recovery, detox is often the first step, especially when a physical dependence to alcohol or drugs is present.
During a medical detox, the body clears any addictive substances from the individual’s system. Likewise, withdrawal symptoms are highly likely and will have to be managed by professionals around the clock.
During this time, individuals are likely to experience mild, moderate or severe withdrawal symptoms depending on the severity of their physical dependence.
These withdrawal symptoms can involve the shakes, anxiety, tremors, stomach issues and even flu-like symptoms. For some people with the most severe addictions, these withdrawal symptoms can become life threatening.
Once you have completed your medical detox, which usually lasts approximately 10 days, your body should no longer require the addictive substance in order to function.
Whilst detoxes are used to rid the body of the addictive substances, a medical detox alone is not enough, especially when someone suffers from a mental health illness.
Without follow-up care in the form of therapy, individuals are at risk of relapsing in the future, especially if underlying mental health issues remain untreated.
Most rehab treatment centres offer programmes especially for a dual diagnosis. These programmes address both addiction and mental health issues at the same time.
After a medical detox, treatment for a dual diagnosis typically includes therapy including cognitive behavioural therapy, motivational interviewing and family therapy.
They will then also manage your medication to help to stabilise any mental health issues that you might still be struggling with.
Most treatment centres will then also look into aftercare support, including relapse prevention strategies.
It is also recommended that those suffering from a mental health issue alongside addiction treatment should continue their therapy sessions for months, or even sometimes years after first seeking treatment.
Recognising an addiction and mental illness is key when it comes to seeking the right help for them. Common signs of a dual diagnosis include some of the points listed below [2].
If some of the above signs and symptoms are present, then you or your loved one will need a professional assessment in a rehab setting.
When it comes to whether an addiction or mental health issue comes first, it is important to understand that it usually depends on the individual.
For some people, mental health issues lead to addiction. For others, substance abuse triggers mental health issues. In many cases, both of these issues develop together due to a number of different shared risk factors.
However, it is important to understand that what matters most when it comes to addiction recovery is not always identifying the cause but recognising the link between mental health and addiction and then seeking appropriate treatment.
[1] https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC6876494/
Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an advisor with more than 20 years in the field. His knowledge covers a broad of topics relating to addiction, rehab and recovery. Boris is an advisor and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the Verywell Mind and Healthline. You can connect with Boris online at LinkedIn or X.com.
