While it’s natural to feel out-of-sorts sometimes — sad, worried, scared or suspicious — if these feelings become frequent and begin to interfere with your or your loved one’s daily functioning and relationships, it may signal a mental illness. The term mental illness refers to a wide variety of mental disorders that affect mood, thinking and behavior. These include ADD/ADHD (attention deficit hyperactivity disorder), anxiety, bipolar disorder, depression, eating disorders, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder and schizophrenia, among many others.
As if a mental illness isn’t hard enough to admit to and manage, those with a mental disorder(s) often have an addiction(s), too. This is known as co-occurring disorders or dual diagnosis, which can be made up of any combination of a mental disorder (anxiety, depression, bipolar disorder, etc.) and addiction (drugs, alcohol, sex, gambling, etc.). Living with two serious mental health conditions can make it very hard to do well in school, stay employed, develop strong relationships, parent effectively or simply maintain a stable life. These stresses can, of course, worsen your or your loved one’s mental illness and addiction.
This complicated connection makes it even more important that you develop a basic understanding of co-occurring disorders, including the causes, telltale symptoms and risk factors that may be involved. Here are some facts you should know about the link between mental health and addiction:
- Mental illness is a serious health problem that can’t be overcome simply through willpower. Similarly, mental disorders have nothing to do with a person’s character or intelligence.
- Nearly 50 percent of people diagnosed with severe mental illness are affected by substance abuse disorder (SUD); mood disorders such as depression and bipolar disorder the most common problems. On the flip side, about 37 percent of alcoholics and 53 percent of those with a drug addiction have at least one serious mental illness, according to the Journal of American Medical Association.
- Failing to get help for co-occurring disorders is a huge problem. Only 7.4 percent of those who could benefit receive treatment for both the addiction and the mental illness, with 55.8 percent receiving no treatment at all.
- Because good mental health is almost impossible to achieve while battling addiction, most experts agree that an integrated approach — meaning one that treats both conditions — is most effective.
While no one can say which comes first — mental illness or addiction — experts agree on the major factors that play a role in co-occurring disorders: One explanation is that people who are chronically depressed or struggle with unmanageable anxiety, for example, self-medicate to blunt these troubling emotions. In other words, they use a convenient, fast-acting “tool” — whether that’s alcohol, pot, gambling, sex or some other substance or behavior — to escape overpowering feelings brought on by their mental illness. Genetics, environment and brain function play crucial roles, too, in the complicated dance between mental issues and addiction. Here’s how:
Genetics. Experts attribute up to 60 percent of an individual’s vulnerability to addiction to genetics; variations in DNA also account for a large percentage of mental illness. Genes, for example, influence how someone responds to stress and how much he or she enjoys taking risks or seeking out things that are new, different or otherwise stimulating. Any of these could affect the development of both a mental illness and an addiction.
Environment. Stress and trauma, such as physical or sexual abuse or being neglected as a child, along with early exposure to drugs, can do a lot to encourage co-occurring disorders. This is especially true in those with a genetic predisposition to it. For example, one of the risk factors for developing bipolar disorder is having experienced stress, abuse, significant loss or other trauma — experiences that also make someone more prone to co-occurring disorders.
Brain. Some of the same areas of the brain affected by mental disorders are also affected by addiction. For instance, abnormalities in the neurotransmitter dopamine, the body’s pleasure hormone, can increase the risk of schizophrenia and heighten the feel-good effects of drugs like nicotine. (Which makes it unsurprising that smoking rates among the mentally ill are double that of people without a mental illness.) Early exposure to drugs of abuse can also change the brain in ways that increase the risk for mental illness.
Symptoms of Mental Illness
The signs of co-occurring disorders will vary depending on the type of illness and the type of addiction. For example, if you or a loved one is struggling with depression and alcoholism, the signs of these issues will naturally be different than if a dual diagnosis combines, say, bipolar disorder and a gambling addiction. (The specific symptoms of alcoholism, are explored in depth in other sections on Addiction.com.)
Since mental illnesses rarely appear without warning signs, recognizing even early symptoms can be an all-important first step to getting help — and starting on the road to better mental health. Here’s a look at some of the main symptoms of the most common mental illnesses, according to the National Institute of Mental Health:
- Difficulty staying focused and paying attention
- Difficulty controlling behavior
- Hyperactivity (over-activity)
Generalized Anxiety Disorder
- Inability to set aside or let go of worry
- Restlessness; difficulty concentrating; trouble falling and staying asleep
- Physical symptoms such as fatigue, headaches, muscle tension, difficulty swallowing, trembling, irritability, nausea, lightheadedness, feeling out of breath and hot flashes
- Repeated thoughts or images about fear of germs, dirt or intruders; acts of violence; hurting loved ones; sexual acts; conflicts with religious beliefs; or being overly tidy
- Doing the same rituals over and over (i.e., washing hands, locking and unlocking doors, counting, keeping unneeded items or repeating the same steps again and again)
- Inability to control unwanted thoughts and behaviors
- Sudden and repeated panic attacks that last for several minutes
- Fear of impending doom or loss of control
- Physical symptoms including rapid heart rate, sweating, shortness of breath and chest pain
- Uncontrollable panic, terror or dread when exposed to source of phobia
- Inability to function normally because of anxiety
- Physical and psychological reactions such as sweating, rapid heartbeat, difficulty breathing, a feeling of panic and intense anxiety
- Re-experiencing symptoms: flashbacks, racing heart, bad dreams and frightening thoughts
- Avoidance symptoms: staying away from reminders (places, events or objects) of the experience or trouble remembering the dangerous event
- Hyperarousal symptoms: easily startled, feeling tense, difficulty sleeping
Social Anxiety Disorder
- Anxiety about being with other people
- Feeling self-conscious or embarrassed in front of others
- Blushing, sweating, trembling and feelings of nausea when with other people
- Mania or manic episode: extended periods of feeling “high,” or overly happy; talking very fast; behaving impulsively and engaging in pleasurable, high-risk behaviors
- Depression or depressive episode: long periods of feeling sad or hopeless; feeling tired or “slowed down;” trouble concentrating, remembering and making decisions; thoughts of suicide
- Persistent sadness, anxiety or an “empty” mood
- Feelings of hopelessness, pessimism, guilt, worthlessness, helplessness
- Decreased energy, fatigue, being “slowed down”
- Difficulty concentrating, remembering, making decisions
- Thoughts of death or suicide; suicide attempts
- Extreme thinness (emaciation) and restricted eating
- A distorted body image and relentless pursuit of thinness
- Lack of menstruation
- Loss of control over eating
- Feeling guilt, shame and distress about binge-eating, leading to more binge-eating
- Frequent yo-yo dieting, or losing and gaining weight repeatedly
- Recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes
- Forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise – or a combination of these behaviors
Eating Disorder Not Otherwise Specified (EDNOS)
- Constant worry over food and weight
- Excessive exercising, purging or other behaviors designed to restrict eating or compensate for eating
- Having rules about food (good foods vs. bad foods) and becoming entrenched in these rules and particular thinking patterns
- A knack for flattery and manipulating other people’s emotions
- Disregard the safety of self and others
- Frequent lying, stealing and fighting, without guilt or remorse
- Easily hurt when others criticize or disapprove of actions
- Reluctant to become involved with people
- Shy in social situations out of fear of doing something wrong
Borderline Personality Disorder
- Having extreme reactions (panic, depression, rage or frantic actions) to abandonment, whether real or perceived
- Patterns of intense and stormy relationships with family, friends and loved ones
- Impulsive and often dangerous behaviors (spending sprees, unsafe sex, substance abuse, reckless driving and binge eating)
Dependent Personality Disorder
- Avoiding being alone and fear of being abandoned
- Hypersensitivity to disapproval or criticism
- Feeling of helplessness when relationships end, leading to urgently seeking another relationship
- Acting or looking overly seductive
- Having a low tolerance for frustration or delayed gratification
- Needing to be the center of attention
- Believing you’re better than others
- Fantasizing about power, success and attractiveness
- Exaggerating your achievements or talents
Obsessive-Compulsive Personality Disorder
- Excessive devotion to work that impairs social and family activities
- Excessive fixation with lists, rules and minor details
- Perfectionism that interferes with finishing tasks
Paranoid Personality Disorder
- Concern that other people have hidden motives
- Fear of confiding in others
- Inability to work together with others
Schizoid Personality Disorder
- A tendency to prize independence and prefer being alone
- Confusion over how to respond to normal social cues
- Little (if any) desire for sexual relationships
Schizotypal Personality Disorder
- Discomfort in social situations
- Inappropriate displays of feelings
- Odd beliefs, fantasies or preoccupations
When mental illness is at its most extreme, someone may consider suicide. Signs of a potential suicide include talking about wanting to die or to kill oneself; looking for a way to kill oneself, such as searching online or buying a gun; and talking about feeling hopeless or having no reason to live. Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) if you or someone you know is contemplating suicide. For ongoing support, you can find help at Suicide Anonymous.If you or someone you love has several symptoms of a mental illness and these are affecting work/school, relationships and/or the ability to function, it may signal the need for professional help. According to the American Psychiatric Association (APA), any of these early warning signs should raise a red flag:
Are you or a loved one experiencing…
- Social withdrawal or a recent loss of interest in connecting with others?
- An unusual drop in functioning, especially at school or work, such as quitting sports, failing in school or difficulty performing familiar tasks?
- Difficulty with concentration, memory or logical thought and speech that’s hard to explain?
- Heightened sensitivity to sights, sounds smells or touch; avoidance of over-stimulating situations?
- Loss of initiative or desire to participate in any activity, or apathy?
- A vague feeling of being disconnected from oneself or one’s surroundings, or a sense of unreality?
- Unusual or exaggerated beliefs about personal powers to understand meanings or influence events, or illogical or “magical” thinking typical of childhood in an adult?
- Fear or suspiciousness of others or a strong nervous feeling?
- Uncharacteristic, peculiar behavior?
- Dramatic sleep and appetite changes or deterioration in personal hygiene?
- Rapid or dramatic shifts in feelings or “mood swings”?
As mentioned above, mental health disorders are often linked to many of the same factors that raise someone’s risk for addiction — including genetics, brain chemistry and a history of trauma. In addition, the following may increase your or your loved one’s risk of developing a mental illness:
Family history. Some mental illnesses run in the family. This means that if you have a blood relative — especially a parent or sibling with a mental illness — your risk may be higher.
Gender. While both men and women can suffer from a mental illness, gender does play a role. For example, men are more likely to suffer from antisocial personality disorder, while women have higher rates of mood and anxiety disorders; all of these are also risk factors for substance abuse. In general, overall rates of drug abuse and dependency are higher among males than females.
Personality. Researchers have found that individuals suffering from mental illness and addiction tend to have lower inhibitions and are likelier to take risks, including buying and using illegal drugs, drinking to excess or acting impulsively, such as going on out-of-control spending sprees, gambling, binge eating or participating in risky sexual behavior.
Military. Serving or having served in the armed forces seems to increase the likelihood of suffering from co-occurring disorders. In fact, as many as half of all veterans diagnosed with post-traumatic stress disorder (PTSD) also have substance use disorder (SUD). And rates of gambling addiction among vets are twice the national average, according to a Veterans Administration study.
On the flip side, there are factors that can lower your or your loved one’s chances of having both a mental illness and addiction; these include developing good self-control, practicing religious beliefs, having healthy relationships with family and friends and being involved in social activities in the community, reports the Substance Abuse and Mental Health Services Administration (SAMHSA).