Addiction, Mental Health, and Trauma
To save lives, it’s important to understand these connections and discuss them openly.
As researchers discover more about how addiction affects the brain, they’re also starting to understand how and why substance use disorders and mental health conditions often go hand in hand.
There are still many questions, but this is what we know today.
What is a co-occurring disorder?
A co-occurring disorder, also called comorbidity or dual diagnosis, is a medical issue that occurs either simultaneously, or successively after another disease. These conditions may be mental or physical or a combination of the two. Often, the existence of co-occurring conditions makes each disease worse than if it as it experienced individually.
The co-occurrence of substance use and mental health disorders is particularly common because similar areas of the brain are involved with both.
These behavioral health disorders commonly co-occur with addiction:
- Anxiety and mood disorders
- Bipolar disorder
- Major depressive disorder
- Conduct disorders
- Post-traumatic stress disorder (PTSD)
- Attention deficit hyperactivity disorder (ADHD)
How many people with addiction have co-occurring mental health disorders?
In 2014, SAMHSA found that approximately 7.9 million people in the United States experienced addiction and a mental health disorder simultaneously. That’s nearly 40% of the total population who experienced addiction in that year.
Nearly 40% of those with addiction also have a mental health disorder.
Statistics from The National Institute on Drug Abuse (NIDA) on co-occurring disorders show that patients with mood-related mental health disorders or anxiety are twice as likely to also suffer from addiction. Similarly, patients with addiction are roughly twice as likely to be diagnosed with those types of mental health disorders.
Why does it happen?
The “why” of comorbidity is more difficult to establish.
Research is ongoing.
With co-occurring disorders, it’s hard to say for certain if the two conditions are related, or if one caused the other, or if the condition that’s diagnosed first isn’t necessarily responsible for additional conditions that arise. It’s really a “which came first, the chicken or the egg” situation.
Drug use affects the brain and can aggravate the symptoms of existing mental health conditions. Some with a mental health condition may try to self-medicate, treating symptoms of depression or anxiety by using drugs or alcohol, which can then lead to an addiction. Research is still trying to prove if there’s a definite causal relationship.
Trauma increases addiction risk
Most people who develop an addiction are looking for healing in some way or another. Substances, as harmful as they may be, may seem to provide that—especially for people who’ve endured trauma.
The Substance Abuse and Mental Health Services Association (SAMHSA) defines trauma as specific events or experiences that create “long-lasting adverse effects” for an individual. Trauma could result from physical, emotional, or sexual abuse. It could result from enduring a natural disaster or a war. No matter the root cause of the trauma, it increases a person’s risk of developing a substance use disorder.
Childhood trauma, specifically, plays a big role
New research is showing the influence of Adverse Childhood Experiences, or ACEs, on lifelong health.
Adverse Childhood Experiences (ACEs) increase risk for addiction and other health problems.
According to the CDC, the most common ACEs include witnessing violence or experiencing abuse or neglect. Being frequently intimidated or humiliated by adults, being hit so hard it left a mark, not having enough to eat, sexual abuse, persistent loneliness—these are all examples of experiences that cause problems later in life. ACEs add up, too. The more ACEs an individual has experienced, the more at-risk they are of later health problems.
ACEs are more common than you might think: The CDC reports, “61% of adults surveyed across 25 states reported that they had experienced at least one type of ACE, and nearly 1 in 6 reported they had experienced four or more types of ACEs.”
ACEs don’t just put a person at risk of diseases of the brain, like behavioral health or substance use disorders. ACEs also put people at greater risk of chronic health problems in the body, like cancer, diabetes, and heart disease.
How to prevent ACEs
ACEs are preventable, and many of the problems that cause ACEs are structural: Financial hardship, inequitable access to health care and social supports, inadequate school systems and outdated social norms. The CDC has created a comprehensive guide for states and local communities to use evidence to prevent ACEs and to encourage supportive, nurturing homes for all children.
To be successful, addiction treatment must be informed by a patient’s experiences with trauma or mental illness.
Effective, evidence-based treatment for addiction exists. Decades of research show what approaches work best.
When it comes to treatment, one size doesn't fit all.
When it comes to patients with co-occurring disorders, treatment plans should be comprehensive, individualized, and seek to treat all behavioral health disorders simultaneously. Plans should also take a patient’s gender, race, sexual orientation, community, and other identity factors into consideration.
One size never fits all for addiction care, especially when trauma and mental illness are involved. When treatment effectively addresses a patient’s complete, and often complex, needs, it sets those patients up for long-lasting health and recovery.
Science of Addiction
Addiction is a treatable medical illness. Here’s what research shows about how drugs affect the brain and body.
Substances and Effects
Learn about their effect on the body, the risks of misuse, and the potential for medical use.
Get help for substance use
Add up the number of symptoms that apply to find out if it's time to seek treatment.