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Mental Illness & Addiction

According to *SAMHSA, many people with mental illness abuse drugs or alcohol. There are many reasons for this, but primarily, people with mental illness are likely to use substances to self-medicate their uncomfortable symptoms such as depression and anxiety.

“Coexistence of both a mental health and a substance use disorder is referred to as co-occurring disorders. According to SAMHSA’s 2014 National Survey on Drug Use and Health, approximately 7.9 million adults had co-occurring disorders in 2014. During the past year, for those adults surveyed who experienced substance use disorders and any mental illness, rates were highest among adults ages 26 to 49 (42.7%). For adults with past-year serious mental illness and co-occurring substance use disorders, rates were highest among those ages 18 to 25 (35.3%) in 2014.” Source: SAMHSA

A Dangerous Combination

It’s important to realize that there are many additional and compounding effects someone with mental illness might have if he uses drugs or alcohol.

For example, if he’s on psychiatric medication and he drinks or drugs, his prescribed medication might become ineffective. The alcohol or drugs, in effect, might deactivate what may be very necessary medical treatment.

If he’s using addictive psychiatric medications like a benzodiazapines such as Klonopin or Xanax which are used to treat anxiety and other disorders, illicit drugs or alcohol can potentiate (increase) the effects of the medication and could lead to overdose and/or death.

Another example of problems that can arise for someone with mental illness when taking alcohol or drugs is that the substances can exacerbate a person’s symptoms. For example, alcohol can make depression worse. Some drugs increase anxiety. Others cause hallucinations. They can intensify existing symptoms and even lead to new symptoms, sometimes quite serious ones.

If a co-occurring disorder is untreated, it can lead to a homelessness, illness, criminal activity and arrest, suicide, or even death. Of course the same can be true of either mental illness or addiction alone, however the combination can exponentially increase these chances.

A Treatment Case

Co-occurring disorders are best treated by a multi-disciplinary team. Both medical doctors and addiction counselors are necessary and they must communicate with each other.

Years ago my team and I worked with someone who had an anxiety disorder, and was prescribed benzodiazapines for anxiety symptoms, and was also drinking alcohol and using cocaine. She was using the alcohol to calm down and relax, and the cocaine to stimulate and perk up.

Meanwhile, the benzos were circulating her body more intensively due to her illicit drug and alcohol use. What happens in these cases is the liver selectively metabolizes the alcohol. While it’s doing its job with the alcohol, it the metabolization of the benzos slows down. Therefore, the benzos were circulating her body at nearly full-strength when they should have already been metabolized by the liver.

This put her in crisis–she was in danger of overdose or death. Her symptoms included extreme lethargy, shallow breathing, sweating, nodding out, confusion, and so on. In order to treat her, we had no choice but to call Emergency Medical Services and bring her to the hospital for life-saving treatment.

What the hospital then did was to detox her from alcohol and the benzos, and while there, she went off the cocaine by default. Detox took her 10 days, then he had to go into rehab where she stayed for three weeks. After they detoxed her, they introduced a non-narcotic anti-anxiety medication.

Unfortunately, this client went in and out of detox and rehab numerous times. The overwhelming symptoms of her mental illness lead her to attempt to medicate herself with alcohol or drugs despite all the treatment she was receiving. Eventually though, with intensive outpatient treatment (IOP) and aggressive medication assisted treatment (MAT) she’s been able to maintain abstinence.

If you or someone you know has a mental illness and/or an addiction, please encourage them to seek treatment. It might save their life.


Mental Illness & Addiction

Richard Zwolinski, LMHC, CASAC & C.R. Zwolinski

Richard Zwolinski, LMHC, CASAC is the author of Therapy Revolution: Find Help, Get Better, and Move On Without Wasting Time or Money and is licensed in addiction and psychotherapy with over 25 years experience as well as a consultant to organizations and companies in the fields of mental health and addiction. He is the executive director of an outpatient behavioral health program. Learn more about Richard here.

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APA Reference
& C.R. Zwolinski, R. (2018). Mental Illness & Addiction. Psych Central. Retrieved on July 11, 2020, from


Last updated: 18 May 2018
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