Dual Diagnosis: Substance Abuse and Mental Health
Coping with addiction and a mental health problem
Drinking or using drugs to change your mood, face your fears, or deal with painful emotions? There are healthier ways than self-medication to cope with problems and improve how you feel.
In these times of great anxiety and distress, many of us are turning to substances to try to change the way that we feel. You might use food to give your mood a boost or alleviate boredom. You might smoke a joint to help you relax, or have a drink or two before going out to settle your nerves and ease any social anxiety. Or perhaps you turn to Xanax or Valium to help you sleep, ADHD medications to keep you focused during the day, or prescription painkillers to numb any grief or stress you’re experiencing at the moment?
When you use alcohol or drugs in this way to manage symptoms of a mental health issue, it’s known as “self-medicating”. You may be aware that you have a mental health problem but don’t know any healthier ways to cope. Or your condition could be undiagnosed and you simply use alcohol or drugs to cope with a specific symptom or situation. During the pandemic and resultant economic difficulties, for example, many of us started self-medicating stress, worry, and depression as our lives changed so much.
While self-medicating may offer some relief in the short-term, over time it only exacerbates your problems. Whether you turn to alcohol, illegal drugs, or prescription medications (or even food or cigarettes), regular self-medication can lead to addiction, a worsening of mood disorders, and increased health problems. It can also damage your relationships at home, work, and school.
But you’re not powerless. By better understanding the reasons why and when you self-medicate, you can find healthier and more effective ways of coping with your problems and improving your overall mood and well-being.
We all feel down, worried, and out of balance from time to time in response to life’s struggles and setbacks. But when feelings of hopelessness, fear, anger, sadness, or overwhelming stress start to interfere with how you function in daily life, it can be a sign that you need help for an underlying condition. Instead of seeking treatment, though, it can be tempting to try to cope on your own in the simplest way possible: by reaching for a drink or popping a pill.
In these times of widespread financial and social turmoil, many of us have tried to self-medicate our angst and uncertainty as the world seems to lurch from one crisis to another.
[Read: Dealing with Uncertainty]
Other people turn to substances to cope with unpleasant memories or feelings stemming from the past, such as unresolved traumatic incidents. Others use alcohol or drugs to face situations that frighten them or to stay focused on tasks throughout the day.
Just as the reasons for seeking comfort in drugs or alcohol vary according to the individual, so too can the methods of self-medicating.
Alcohol tends to be the most common method of self-medication—as well as the most commonly abused substance—since it’s so widely available. It may be used to self-medicate stress as well as depression and anxiety, even though beer, wine, and liquor are all depressants and will therefore only make symptoms worse.
Prescription drugs, including opioid pain killers, ADHD medication, and anti-anxiety medication are also widely available. Their uses can range from numbing pain or relaxation to increasing focus and energy.
Recreational drugs, such as marijuana, cannabis, or stimulants like cocaine and amphetamines are used to manage uncomfortable emotions, situations, and memories. Their use can lead to drug abuse and addiction.
Food can be used by emotional eaters to self-medicate unpleasant feelings and deal with stress, anxiety, or depression. Since most people crave foods high in sugar, calories, and unhealthy fat, emotional eating can play havoc with your waistline as well as your mood.
Nicotine contained in cigarettes and other tobacco products helps some people focus, although in the long-run tends to make symptoms of ADHD worse and can make it harder to quit smoking.
It’s not always easy to identify when you’re self-medicating. After all, drinking alcohol is a socially acceptable part of many cultures, prescription medications can be found in most bathroom cabinets, and even recreational drugs such as marijuana are now legal or easy to obtain in a lot of places.
To understand if you’re self-medicating, it’s necessary to examine your motives for drinking or taking drugs—as well as the impact it’s having on your life. For example, are you popping a pain pill because your back is hurting or because you’ve had a stressful day at work and you want to change how you feel? Are you having a drink to be sociable with friends or complement a meal—or are you trying to improve your mood or feel less anxious?
Signs that you may be self-medicating include:
It’s easy to slide from self-medicating an emotional or mental health problem into abusing drugs or alcohol.
A substance abuse problem is NOT defined by what drug you use or what you drink. Neither is it defined by when you use or even how much you use. It’s the EFFECTS of your substance use that define a problem.
If your drinking or drug use is causing problems in your life or relationships, you have a substance abuse problem.
Trying to self-medicate a mental health issue can create a myriad of problems beyond the risk of becoming addicted to your substance of choice. Self-medicating can also:
Make symptoms worse. Trying to self-medicate a mental health issue can worsen existing symptoms or even generate new symptoms.
Interact with prescription medications. Abusing alcohol or drugs can interact with any other medications you’re taking, either negating their effectiveness or causing unpleasant side effects.
Trigger new mental health problems. If you’re already at risk for a mental health disorder, drinking heavily or using drugs could lead to the development of new problems—beyond those that prompted your self-medication in the first place. For example, opioid and alcohol use has been linked with triggering depression, and marijuana and methamphetamine use with psychosis.
Delay or prevent you from seeking help. When you’re set on a course of self-medicating it can be hard to change direction and seek healthier, more effective methods of dealing with your problems. Once you recognize how your substance use is only adding to your problems rather than solving them, though, you can move on to tackling the issues once and for all.
In order to find healthier and more effective ways of dealing with your problems and managing your emotions, you need to first recognize when and how you’re self-medicating. That means being honest with yourself—and those closest to you who have your best interests at heart.
Whether you’re drinking or using drugs (or both), it’s common to try to rationalize your substance use, underestimate how much or how often you use, or simply deny that you have a problem at all. You may try to shift all blame for your relationship troubles or financial worries, for example, onto outside causes.
The pandemic, the downturn in the economy, and increasing unemployment can leave anyone feeling stressed, anxious, or depressed. But it’s also important to acknowledge how the time and money you spend drinking or using drugs could also be contributing to your problems.
Denial can also occur in mental health issues. You may feel ashamed to admit that you’re struggling to cope with symptoms of depression or anxiety, for example. While it can seem easier to ignore your problems and hope they go away, overcoming denial is the first step to recovery.
Admitting you have a mental health problem is not a sign of weakness or some kind of character defect. Whatever problems you’re facing, there are effective ways to cope and take back control of your life.
Keep a record of your substance use and moods. For several weeks, make a note of when you use alcohol or drugs, how much you use, and how you’re feeling when you start—stressed, anxious, sad, bored, for example. Reviewing the results, you should be able to identify patterns and mood triggers in your substance use habits.
Try to not use for several days each week. Are you even able to avoid drugs or alcohol on some days? Make a note of how you feel on these days—do you feel less or more anxious, stressed, or depressed when you don’t use? How well do you sleep? Can you fill the time by finding healthier and more effective ways of stabilizing your moods?
If you self-medicate your moods and emotions, chances are you look at your substance use in ways that make it seem more useful than it really is. For example, you may, like many people, drink alcohol as a nightcap to help you sleep. But while it can help you to fall asleep faster, alcohol will also disrupt your sleep. It can necessitate extra trips to the bathroom, aggravate breathing problems, interfere with the restorative REM-sleep phase of your sleep, and cause you to wake up earlier than normal. All this adds up to a poor quality night’s sleep. By skipping the nightcap, it may take you longer to fall asleep but you’ll sleep better and wake up feeling more refreshed and well-rested.
Similarly, you may use alcohol to improve your mood or as a coping mechanism for anxiety. While a few drinks can have the desired effect—making you feel happier or less anxious—because alcohol is a depressant, it will ultimately make you more anxious and depressed. Regular alcohol use depresses the central nervous system and decreases the levels of the brain chemical serotonin, leaving you feeling sadder and more prone to worrying than before.
[Read: Anxiety Disorders and Anxiety Attacks]
Even when you realize how your self-medicating is only temporarily masking your problems rather than serving any helpful purpose, it can be hard to shake the misconceptions and false beliefs you’ve built up in your mind. The more you challenge your beliefs about the benefits of self-medication, though, the less hold they’ll maintain over your behavior. You can do that by replacing your substance use with more effective, healthier means of coping with your problems.
It’s easy to fall into the trap of thinking that you’re powerless against your mental health problems. But no matter what you’re facing, there are always steps you can take to change how you feel and improve your symptoms—with or without professional help. Most people with depression, anxiety, or stress, for example, respond well to self-help steps such as:
Reaching out for social support. There is nothing more calming to your nervous system than chatting face-to-face with a friend or loved one. Even in times of social distancing, you can find ways to regularly connect with family and friends to ease your stress and anxiety and boost your mood.
Getting more exercise. Exercise triggers powerful changes in the brain that can boost your mood, burn off tension, and promote feelings of calm and well-being. Exercise can also serve as a valuable distraction, enabling you to break out of the cycle of negative thoughts that often fuel mood disorders.
Adopting a relaxation practice. Practicing a relaxation technique such as meditation, deep breathing, or yoga can help ease stress and leave you feeling calmer and more positive throughout the day.
Improving your sleep. A lack of sleep can make anxiety, depression, and stress worse, just as mood disorders—and the use of certain substances—can make it harder to get a good night’s sleep. By staying clean and adopting new daytime and bedtime habits, though, you can break the cycle and improve how well you sleep at night.
Eating a healthier diet. The food you eat can strongly influence your mood. Cutting down on sugar and junk food, eating more fresh fruit and vegetables, and increasing your intake of omega-3 fatty acids can help improve your outlook and boost your energy.
When you’re depressed, it can feel like life is hopeless and helpless, with no light at the end of the tunnel. But there are many things you can do to lift and stabilize your mood—from challenging negative thinking to spending time in nature and scheduling fun activities into your day.
[Read: Coping with Depression]
Anxiety refers to a group of related disorders rather than a single condition. Some people suffer from intense panic attacks that strike without warning, while others may shudder at the thought of mingling at a party, or struggle with irrational fears, intrusive thoughts, or uncontrollable worries.
Anxiety disorders are among the most common mental health issues—and are highly treatable. Worrying, for example, is a mental habit you can learn how to break.
It may seem like there’s nothing you can do about stress. The bills keep piling up, there are never enough hours in the day, and your work and family responsibilities are never-ending. But there’s still plenty you can do to keep your stress levels in check—whether your stress tends to occur at predictable times or takes you by surprise.
If self-medicating a mental health issue has triggered a substance abuse problem (addiction or dependency), it’s known as a dual diagnosis or co-occurring disorder. To get help for a co-occurring disorder, you’ll need to simultaneously address both the substance abuse problem and the mental health issue that triggered your drug or alcohol use in the first place.
Treatment for your substance abuse may include detoxification, managing withdrawal, therapy, and/or attending peer support groups. Depending on the severity of the substance abuse problem, some people are able to achieve and maintain sobriety on their own with the support of friends and loved ones, while others need professional help.
Treatment for your mental health problem may include a combination of self-help steps, healthy lifestyle changes, individual or group therapy, and medication.
Helping a loved one who’s self-medicating can be an uphill struggle. You need to overcome any denial about their issues or substance use, help them recognize why they’re self-medicating, and then deal with both the underlying condition and the problems created by their drinking or drug use.
[Read: Helping Someone with a Drug Addiction]
It’s important to remember that you can’t do the hard work of dealing with your loved one’s problems for them. You can’t force someone to deal with their mental health condition any more than you can force them to remain sober. But you can encourage your loved one to seek help and offer your love and support.
Talk to the person. When you’re both sober and calm, talk to your loved one about the damaging behaviors and issues that you’ve noticed. Encourage them to open up to you by listening, without being judgmental or accusatory.
Learn all you can about the person’s underlying mental health issue that’s causing them to self-medicate. The more you understand what your loved one is going through, the better able you’ll be to support their recovery.
Encourage your loved one to seek help. Suggest a general check-up with a physician and even offer to go along with them on the first visit. Talking about the reasons for self-medicating with a professional may help them to see their problems more clearly.
Don’t drink or use drugs with your loved one or argue about their substance use when they’re impaired. Instead, fill the time you spend together with fun, healthy activities and hobbies that don’t involve drinking or drug use.
Encourage social interaction. When someone’s depressed, anxious, or experiencing another mental health issue, it can be tempting for them to retreat into their shell. But social contact and support from friends and relatives is vital to their recovery.
Set boundaries. Be realistic about the amount of care and time you can offer your loved one without feeling overwhelmed yourself. Set limits on disruptive behaviors and stick to them. Letting your friend or loved one’s problems take over your life isn’t healthy for either of you.
Be patient. Recovering from depression, anxiety, or any other condition that’s prompted their self-medication doesn’t happen overnight. Recovery is an ongoing process and relapse is common. Be patient, encouraging, and supportive.
Seek your own support. It’s easy to get worn down by your loved one’s problems. Talk to someone you trust about what you’re going through. It may even help to get your own therapy or join a support group for people facing similar issues.
Call the NAMI HelpLine at 1-800-950-6264 or the SAMHSA helpline at 1-800-662-4357.
Call the SANEline at 07984 967 708.
Call the Sane Helpline at 1800 187 263.
Visit Mood Disorders Society of Canada for links to provincial helplines.
Call the Vandrevala Foundation Helpline at 1860 2662 345.
Millions of readers rely on HelpGuide.org for free, evidence-based resources to understand and navigate mental health challenges. Please donate today to help us save, support, and change lives.Donate to HelpGuide.org today