Untreated Mental Illness May Repeatedly Trigger Relapse to Substance Use

By Raafea Malik, MD

struggling woman upset and crying

It’s not uncommon to find that individuals suffering with substance addictions also often have other mental health problems, such as depression or anxiety. It’s not always clear which came first, but both need to be treated in order to provide the best scenario for recovery. It’s vital to treat both issues simultaneously and to educate individuals about their mental health and their addiction. Untreated, mental illness may repeatedly trigger relapse to substance use.” 

Our team has the tools to diagnose and treat patients for both their addiction and the underlying and interwoven mental health issues that often accompany addiction. This is called dual disorder treatment.  

The good news is that dual disorders are treatable.

About 80% of patients with addictions have psychiatric symptoms in addition to their addiction which makes them use drugs to treat their psychiatric symptoms.  Common mental health disorders coupled with substance use disorders include: anxiety disorders, depressive symptoms, bipolar spectrum disorders, attention-deficit disorder, psychotic disorders such as schizophrenia and schizoaffective disorder, PTSD associated with traumas, and chronic pain conditions.

Some individuals use drugs to numb psychological pain, such as depression, anxiety and trauma. Drugs create a sense of happiness, euphoria and calmness as well as a sense of numbness. Drugs also relieve actual physical pain due to their effect on the peripheral pain pathways.

People also use drugs because they want to maintain the artificial sense of happiness and also because the withdrawal symptoms from the drugs can be very uncomfortable and they have to keep using the drug(s) to prevent the withdrawal symptoms.

Untreated symptoms of mental illness may repeatedly trigger relapse to substance use. Relapse indicates a return to prior, old behavior. Relapse is often part of a learning curve for individuals who are trying to learn new, healthier behaviors and skills, to take care of themselves differently and maintain sobriety.

Post-treatment withdrawal symptoms may also de-stabilize individuals in sobriety, causing increased stress and may trigger cravings/thoughts about drinking/drugging to reduce temporary discomfort. 

Treating addiction and mental health is not a one-size-fits-all solution. In treatment, clients find a range of care, as well as the understanding and nonjudgmental care to help them develop coping skills and alternative behaviors and find a new path to a healthier future. When a patient is able to recognize warning signs and help themselves, they can more successfully avoid relapsing.

It takes courage to seek help for addiction. 

Lifelong sobriety can be maintained by using effective coping and relapse prevention skills and also with the support of a 12-step recovery model.  Also, as patients begin their recovery process, they learn about addiction as a disease and the ways it affects, not only their own lives, but the lives of their families. Traditional 12-step meetings, AA or NA meetings, SMART Recovery, NAMI, DBSA, other support groups and peer support groups provide the help individuals need to maintain lifelong sobriety and wellness.  

Medication-assisted treatment reduces the symptoms of withdrawal and cravings, and frees the client from thinking about drugs and alcohol, so they can focus on their recovery.  Post-treatment withdrawal symptoms may de-stabilize individuals in sobriety, causing increased stress, and may trigger cravings/thoughts about drinking/drugging to reduce temporary discomfort. 

Medication-assisted treatment such as Suboxone and Vivitrol can stop the cravings for drugs and alcohol, allowing the individual to stay focused on their recovery plan. 

Verbal therapy counseling (psychotherapy) is also necessary to help individuals learn new, healthier behaviors and skills, and to take care of themselves differently, and also to learn coping skills to deal with underlying depression, anxiety, trauma and other mental health problems, instead of turning to drugs and alcohol to numb their psychological pain. 

One client told Dr.Malik: “Treatment has taught me how recognize my symptoms of depression early on, and not turn to drugs when I was feeling upset or down.  Instead, I learned some practical skills to use that helped me change my thoughts and to view my situation in a more positive light.  My positive thoughts created positive feelings, and also prevented my drug behaviors.  Now I’m living a drug-free and happy life – the life I deserve.” 

Raafea F. Malik, MD is the Medical Director for The Changing Pointe Addiction Treatment Center at CenterPointe Hospital. The Changing Pointe provides medication-assisted treatment at every level of care, including detox, residential treatment and outpatient therapy.  Dr. Malik is board certified in psychiatry and addiction psychiatry. She utilizes best practices from both psychiatric and addiction treatment methods, delivering an effective dual diagnosis treatment approach for patients at The Changing Pointe.  Dr. Malik is an Assistant Clinical Professor for the Department of Psychiatry and Human Behavior at Saint Louis University Health Sciences Center where she also supervises psychiatry residents.