Substance Use and Co-Occurring Mental Disorders
A substance use disorder (SUD) is a mental disorder that affects a person’s brain and behavior, leading to a person’s inability to control their use of substances such as legal or illegal drugs, alcohol, or medications. Symptoms can range from moderate to severe, with addiction being the most severe form of SUDs.
Individuals who experience a substance use disorder (SUD) during their lives may also experience a co-occurring mental disorder and vice versa. Co-occurring disorders can include anxiety disorders, depression, attention-deficit hyperactivity disorder (ADHD), bipolar disorder, personality disorders, and schizophrenia, among others. For more information, please see the National Institute on Drug Abuse (NIDA)’s Common Comorbidities with Substance Use Disorders Research Report.
While SUDs and other mental disorders commonly co-occur, that does not mean that one caused the other. Research suggests three possibilities that could explain why SUDs and other mental disorders may occur together:
- Common risk factors can contribute to both SUDs and other mental disorders. Both SUDs and other mental disorders can run in families, suggesting that certain genes may be a risk factor. Environmental factors, such as stress or trauma, can cause genetic changes that are passed down through generations and may contribute to the development of a mental disorder or a substance use disorder.
- Mental disorders can contribute to substance use and SUDs. Studies found that people with a mental disorder, such as anxiety, depression, or post-traumatic stress disorder (PTSD), may use drugs or alcohol as a form of self-medication. However, although some drugs may temporarily help with some symptoms of mental disorders, they may make the symptoms worse over time. Additionally, brain changes in people with mental disorders may enhance the rewarding effects of substances, making it more likely they will continue to use the substance.
- Substance use and SUDs can contribute to the development of other mental disorders. Substance use may trigger changes in brain structure and function that make a person more likely to develop a mental disorder.
Diagnosis and Treatment
Generally, it is better to treat the SUD and the co-occurring mental disorders together rather than separately. Thus, people seeking help for a SUD and other mental disorders need to be evaluated by a health care provider for each disorder. Because it can be challenging to make an accurate diagnosis due to overlapping symptoms, the provider should use comprehensive assessment tools to reduce the chance of a missed diagnosis and provide targeted treatment.
It also is essential that treatment, which may include behavioral therapies and medications, be tailored to an individual’s specific combination of disorders and symptoms, the person’s age, the misused substance, and the specific mental disorder(s). Talk to your health care provider to determine what treatment may be best for you and give the treatment time to work.
Research has found several behavioral therapies that have promise for treating individuals with co-occurring substance use and mental disorders. Health care providers may recommend behavioral therapies alone or in combination with medications.
Some examples of effective behavioral therapies for adults with SUDs and different co-occurring mental disorders include the following:
- Cognitive Behavioral Therapy (CBT): CBT is a type of talk therapy aimed at helping people learn how to cope with difficult situations by challenging irrational thoughts and changing behaviors.
- Dialectical Behavior Therapy (DBT): DBT uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. DBT also teaches skills that can help control intense emotions, reduce self-destructive behaviors (e.g., suicide attempts, thoughts, or urges; self-harm; and drug use), and improve relationships.
- Assertive Community Treatment (ACT): This is a form of community-based mental health care that emphasizes outreach to the community and an individualized treatment approach.
- Therapeutic Communities (TC): TCs are a common form of long-term residential treatment that focuses on helping people develop new and healthier values, attitudes, and behaviors.
- Contingency Management (CM): CM principles encourage healthy behaviors by offering vouchers or rewards for desired behaviors.
Behavioral Therapies for Children and Adolescents
Some effective behavioral treatments for children and adolescents include:
- Brief Strategic Family Therapy (BSFT): BSFT therapy targets family interactions thought to maintain or worsen adolescent SUDs and other co-occurring problem behaviors.
- Multidimensional Family Therapy (MDFT): MDFT works with the whole family to simultaneously address multiple and interacting adolescent problem behaviors, such as substance use, mental disorders, school problems, delinquency, and others.
- Multisystemic Therapy (MST): MST targets key factors associated with serious antisocial behavior in children and adolescents with SUDs.
Effective medications exist for treating opioid, alcohol, and nicotine addiction and lessening the symptoms of many other mental disorders. Some medications may be useful in treating multiple disorders. For more information on behavioral treatments and medications for SUDs, visit NIDA’s Drug Facts and Treatment pages and treatment for mental disorders at the National Institute of Mental Health’s (NIMH) Health Topics page.
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides the Behavioral Health Treatment Services Locator for finding substance use and mental health treatment facilities and programs. SAMHSA also offers FindTreatment.gov for finding substance use disorder treatments and programs across the country.
For additional resources about finding help, visit:
NIMH: Help for Mental Illnesses page
National Cancer Institute: Smokefree.gov and their smoking quitline: 1-877-44U-QUIT (1-877-448-7848)
If your loved one is thinking about harming themselves or others or attempting suicide, seek help right away:
Join a Study
Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.
Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you.
To learn more or find a study, visit:
- NIMH’s Clinical Trials webpage: Information about participating in clinical trials related to mental disorders
- Clinicaltrials.gov: Current studies on mental illness and substance misuse: List of clinical trials funded by the National Institutes of Health (NIH) being conducted across the country
- NIDA Clinical Trial Locator: Searchable database of clinical trials related to substance abuse
Brochures and Other Educational Resources
- National Institute on Alcohol Abuse and Alcoholism (NIAAA): Publications Order Form
- NIDA: Publications
- SAMHSA: Publications and Digital Products
- NIH Experts Discuss the Intersection of Suicide and Substance Use: Learn about common risk factors, populations at elevated risk, suicides by drug overdose, treatments, prevention, and resources for finding help.
- NIDA Common Physical and Mental Health Comorbidities with Substance Use Disorders Research Report
- NIDA Tobacco, Nicotine, and E-Cigarettes Research Report
- SAMHSA National Survey on Drug Use and Health
- NIMH Director’s Messages:
- NIMH’s Role in the NIH HEAL Initiative
Last Revised: March 2021
Unless otherwise specified, NIMH information and publications are in the public domain and available for use free of charge. Citation of the NIMH is appreciated. Please see our Citing NIMH Information and Publications page for more information.