Does Having a Mental Health Problem Lead to Substance Misuse?

Many people with mental health problems also struggle with substance misuse. But why is that? Research has shown that this link is complex and often goes both ways. There are three key theories that help explain why someone with a mental health condition might also use drugs or alcohol: self-medication, social vulnerability, and coping strategies.

1. The Self-Medication Theory

One reason people might turn to substances is to relieve symptoms of their mental illness.

For example:

• Someone with low mood from depression or psychosis might use stimulants like amphetamines to feel more energetic.

• People taking antipsychotic medication might use cannabis to ease muscle stiffness or caffeine and nicotine to feel more alert if they’re feeling overly sedated.

However, research has shown this link isn’t always clear-cut. People don’t always use specific drugs for specific symptoms. In fact, some reduce their substance use when their mental health worsens, suggesting that the relationship is more complicated.

2. Social Vulnerability

Mental illness can have indirect effects that make people more likely to use substances.

• Those with mental health problems often face social isolation. They may lose touch with family and friends.

• Feeling lonely or cut off from others can lead to seeking acceptance from people in similar situations – such as others who use drugs or alcohol.

• This sense of belonging might be one reason why substance use continues, even if it causes harm.

3. Using Substances to Cope

Drugs and alcohol can become a coping mechanism for dealing with difficult thoughts or emotions.

For example:

• Someone experiencing social anxiety or paranoia may drink alcohol to feel more relaxed in social settings.

• Others might use substances to manage stress, boredom, or painful memories from the past.

While it may bring short-term relief, this kind of coping often causes long-term harm and can make mental health symptoms worse over time.

Are There Underlying Causes for Both?

Many people with what’s known as a dual diagnosis – both a mental health disorder and a substance use disorder – also have a history of trauma.

Research shows:

• There are genetic and environmental risk factors for both mental illness and addiction.

• For example, growing up with a parent who misuses substances or experiencing stress in the womb can increase the risk.

• Past trauma, including sexual abuse, is especially common in people with dual diagnosis – particularly women. In fact, around half of women with both mental health and substance use problems report having experienced sexual abuse.

It’s important to note that just because trauma is common doesn’t mean it directly causes mental illness or substance misuse. But it’s still something that needs to be talked about and addressed in treatment.

Why This Matters in Treatment

For people with a dual diagnosis, understanding the reasons behind their substance use is crucial.

• Treatment may need to focus on trauma, sexual health, and relationships, alongside mental health and addiction support.

• Offering advice on safe sex and safer drug use, as well as emotional support for past trauma, can play a big role in recovery.

Final Thoughts

There’s no one-size-fits-all answer to why people with mental health problems might also misuse substances. It’s often a mix of emotional, social, and biological factors. What matters most is recognising the link – and making sure people get the right kind of help that addresses both their mental health and substance use challenges.