Substance abuse and addiction to alcohol and/or drugs change perceptions of normal desires and priorities; often negatively impacting behavior and interfering with an individual’s ability to maintain healthy relationships. There is a strong correlation between mental health and substance abuse, though it would be wrong to assume a causal relationship between the two. The relationship is multi-fold: 1) substance abuse may be an attempt to escape the symptoms of mental illnesses; 2) substance abuse may contribute to symptoms of mental illnesses; and 3) substance abuse and mental health illnesses may maintain one another.

Last year, approximately 8 million adults had a co-occuring mental illness and substance abuse disorder. Research indicates that at least 60 per cent of people battling one of these conditions are battling both. However, the impact that substance abuse has on mental illness and vice versa is dependent on the individual’s mental (and physical) state, as well as the nature and intensity of any existing levels of mental distress.

Those struggling with mental health disorders and illnesses are twice as likely to turn to substances such as alcohol and drugs. Looking at them separately, alcohol increases the risk of (and is related to a higher rate of) depression and anxiety. In the short-term, alcohol can be a major catalyst for violence, self-harm and suicidal behaviour for those with existing mental health conditions. In the long-term, it can reduce the effectiveness of antidepressant medication, and effectively act as a depressant in itself. On the other hand, drug-induced effects are seen to lessen symptoms of mental distress in the short-term. Thus, those with mental illnesses experience drug use and abuse at a far greater rate than others. In some individuals, the abuse of drugs may trigger the first symptoms of mental illness. Depression is a common side effect of certain drugs and alcohol as they begin to wear off: this is a symptom that has the potential to develop into a mental disorder over time.

The most common mental illnesses that co-occur with substance abuse (apart from depression) are anxiety, bi-polar disorder, eating disorders and post-traumatic stress disorder. In some cases, it is difficult to identify which comes first – the substance abuse or the mental health disorder. It is also difficult to establish a causal relationship, as the symptoms of one condition appearing first doesn’t necessarily mean it caused symptoms for the second. People commonly abuse alcohol and drugs to ease the symptoms of an undiagnosed mental disorder, to cope with varying emotions or to temporarily change their mood. It is therefore common for individuals to self-medicate mental health symptoms by turning to substances. However, the effects of alcohol and drug abuse may in turn bring about or worsen the symptoms and severity of mental illness.

The most difficult aspect of the relationship between mental health and substance abuse deals with diagnosis and treatment. Both can stem from suffering through a traumatic event, like physical or sexual abuse. They could both also have adverse effects on day-to-day functioning. In most cases, the two have similar (or at times almost identical) symptoms: for example, the negative effects of marijuana can cause an individual to experience paranoia, anxiety and panic attacks. And more importantly, both substance abuse and mental health illnesses often fall prey to denial, which significantly hinders effective diagnosis and treatment. The same way it is difficult for those struggling with mental health issues to come forward, it is also difficult for individuals to admit how dependent they may be to substances such as alcohol and drugs. A few questions to ask yourself are: do you feel depressed when you indulge in alcohol? do you use alcohol or drugs to cope with unpleasant feelings, intense emotions, or to ‘feel better’? do you turn to substances to help you face situations that you may be uncomfortable in? do you feel pressurized to indulge in substance use to feel ‘accepted’ by those around you?

In cases where mental illnesses and substance abuse occur at the same time, it is very important for treatment to address both problems concurrently. The existence of one makes you more vulnerable to the other. The untreated symptoms of a mental health disorders can make an individual more prone to substance abuse; and the untreated issues surround substance abuse can make mental health treatments ineffective. In a country like Pakistan, where alcohol and drugs are illegal yet rampant, unregulated and readily available, we must be even more cautious of the effects that substance abuse can have on our mental health and wellbeing.

Published in the Daily Times on 7 October 2018