Is There a Connection Between Mental Health and Substance Use?

Summary: Yes, there is a connection between mental health and substance use. In addition, there is a connection between mental health and substance misuse, and a connection between mental health and substance use disorder (SUD).

Key Points:

• Substance use disorder (SUD) is the clinical name for what most people think of as addiction.
• Presence of a clinically diagnosed mental health disorder increases risk of developing a substance use disorder and/or an alcohol use disorder (AUD).
• A nationwide survey reports the percentages of people with mental illness who also have a substance use disorder.
• The integrated treatment model is the gold standard of care for people diagnosed with both a mental health and substance use disorder.

The Connection Between Mental Health and Substance Use

When a person receives a clinical diagnosis for a mental health disorder and also receives a diagnosis for an alcohol or substance use disorder, they have what clinicians and healthcare providers call co-occurring disorders.

Let’s take a look at the latest data on substance use and mental health, and learn about the scope of the co-occurring disorder problem in the U.S. today. We retrieved the following data form the 2024 National Survey on Drug Use and Health (2024 NSDUH).

We’ll start with the latest rates of mental illness among adults.

Mental Health Among Adults 18+: 2024

• 23.4% of adults had a mental illness
  • 5.6% had a serious mental illness
• 8.2% had a major depressive episode
  • 5.6% had major depressive episode with severe impairment
• 21.7% had an anxiety disorder
  • 7.4% had moderate to severe anxiety

8.1% of adults in the U.S. had a clinically diagnosed mental illness and a clinically diagnosed substance use disorder.

Now let’s look at the data on adolescents.

Mental Health Among Adolescents 12-17: 2024

• 9% had an anxiety disorder
  • 18.8% had moderate to severe anxiety
• 4% of adolescents had a major depressive episode
  • 11.3% had a major depressive episode with severe impairment
• 1% had serious thoughts of suicide
  • 4.6% made a suicide plan
  • 2.7% attempted suicide

3.2% of adolescents in the U.S. had a major depressive episode and a clinically diagnosed substance use disorder.

Next, let’s look at rates of substance use among adolescents with a major depressive episode or an anxiety disorder.

Connection Between Mental Health and Substance Use: Adolescents

With MDE:

• Any illicit drug use in past year: 32.6%
  • No MDE: 11.8%
• Marijuana use in past year: 25%
  • No MDE: 7.8%
• Binge alcohol use, past month: 6.3%
  • No MDE: 3.0%

With Anxiety:

• Any illicit drug use in past year: 25.6%
  • No anxiety: 10.1%
• Marijuana use in past year: 17.5%
  • No anxiety: 6.7%
• Binge alcohol use, past month: 5.5%
  • No anxiety: 2.4%

Now, let’s review rates of substance use among adults with any mental illness, serious mental illness, and moderate to severe anxiety.

Connection Between Mental Health and Substance Use: Adults

With Any Mental Illness (AMI) or Serious Mental Illness (SMI):

• Any illicit drug use in past year
  • AMI: 44.1%
  • SMI: 57.4%
  • No mental illness: 21.2%
• Marijuana use in past year:
  • AMI: 38.7%
  • SMI: 50.5%
  • No mental illness: 18.8%
• Binge alcohol use, past month:
  • AMI: 25.5%
  • SMI: 26.8%
  • No mental illness: 20.6%

With Anxiety:

• Any illicit drug use in past year: 48.9%
  • No anxiety: 22.0%
• Marijuana use in past year: 43.1%
  • No anxiety: 19.5%
• Binge alcohol use, past month: 27.6%
  • No anxiety: 20.5%

Finally, we’ll report the latest rates of treatment among people with co-occurring mental health and alcohol/substance use disorder:

• Adults with AUD/SUD: 20% received treatment
• Adults with co-occurring mental illness and AUD/SUD: 14.5% received treatment for mental health and AUD/SUD
• Among Adults with serious mental illness: 70% received treatment
• Adolescents with AUD/SUD: 30.2%received treatment
• Adolescents with mental illness and AUD/SUD: 18.1% received treatment for mental health and AUD/SUD
• Among Adolescents with MDE: 60% received treatment

That’s where we are. The data above show an unmistakable connection between mental health and substance use. Millions of adolescents and adults in the U.S. need help for both.

How We Help People With Co-Occurring Mental Health and Alcohol/Substance Use Disorders

When a person has co-occurring mental health and alcohol/substance use disorders, it’s essential to create a treatment plan for both. It’s also essential to understand that the simultaneous treatment of mental illness and AUD/SUD must be integrated, holistic, comprehensive, and tailored to the specific needs of each patient.

In a new publication in the Journal of the American Medical Association (JAMA) called “Mental Health and Substance Use Linked in New Survey,” mental health and substance use disorder experts indicate the following:

“Individuals with mental health conditions are at increased risk of developing a substance use disorder often because they may self-medicate with drugs or alcohol.”

Self-medication refers to the practice of using alcohol or substances to minimize, manage, or avoid powerful and uncomfortable emotions associated with stress, distress, and mental health disorders such as depression, anxiety, and bipolar disorder.

For people with co-occurring disorders, there’s a specific, evidence-based approach to treatment called integrated care.

Here are the seven principles of integrated care for co-occurring disorders, as published by the Substance Abuse and Mental Health Services Administration (SAMHSA) in the 2019 treatment guide, “Evidence-Based Practices Kit: Integrated Treatment for Co-occurring Disorders.”

The Seven Principles of Integrated Treatment for Co-Occurring Disorders

1. Patient-centered: Mental health and AUD/SUD treatment should meet the unique needs of people with co-occurring disorders.
2. Qualified providers: Integrated treatment should be delivered by specialists who receive specific training tailored to the needs of people with AUD/SUD and mental illness
3. Step Wise Coordination: Different treatment approaches should be used at different stages, to match the stage of recovery for the patient.
4. Counseling and therapy: People with co-occurring disorders should participate in an appropriate mode of therapy or counseling, with cognitive-behavioral therapies preferred during the treatment and relapse prevention stages.
5. Multimodal treatment: People in treatment for co-occurring disorders should receive all types of therapy that work for them, including individual counseling, group therapy, self-help classes and workshops, and family participation in treatment.
6. Medication-assisted treatment (MAT): When a treatment plan includes medication such as Suboxone for opioid use disorder (OUD) or Acamprosate or Naltrexone for AUD, medication should be integrated with counseling and psychosocial support
7. Motivation: Techniques such as motivational interviewing can help resolve hesitation about treatment, can help during all stages of recovery, and are most effective during the pre-treatment, persuasion/decision stage.

The relative mix and timing of substance use treatment and mental health treatment depends on factors unique to the individual. For instance, a person with co-occurring depression and AUD will most likely complete a detoxification program before beginning intensive therapy for depression.

The Future of Treatment for Co-Occurring Disorders

In a commentary that accompanies the 2024 NSDUH, Dr. Art Kleinschmidt, a member of the SAMHSA leadership team, observes:

“We have to be strategic and intentional in developing systems of care that will meet the needs of individuals with behavioral health conditions, recognizing that people struggling with mental health issues may also have substance use challenges and those with substance use challenges may also have mental health challenges.”

He elucidates a national plan to address the increasing problem of co-occurring disorders in the U.S.:

• Identify behavioral health issues early
• Establish programs to prevent substance misuse
• Create programs that promote mental health and well-being
• Expand services for crisis intervention care and acute care
• Expand and improve access to mental health and AUD/SUD treatment
• Promote programs and initiatives that help people achieve long-term recovery

That’s a plan we’re behind on hundred percent. We’re here to offer the highest quality of integrated treatment for co-occurring disorders available, with expert clinicians trained in the latest therapeutic techniques and complementary modalities that help our patients change their lives and create a vibrant and full life in recovery.