Last Updated on November 13, 2021 by Morris Green

The National Bureau of Economic Research (NBER) reports a “definite connection between mental illness and the use of addictive substances.” Most will not dispute that untreated mental illness can (and does) lead to self-medication. When people self-medicate, they often turn to addictive substances – like alcohol, cigarettes, and illicit drugs. But there is another side to this subject. A side heavily debated and surrounded by stigma. It is the fact that substance abuse and addiction, no matter how they started, are ultimately mental illnesses.

Understanding Mental Illnesses

Mental illness is a tough topic. It’s an uncomfortable subject. Opinions run rampant, and there is a great divide separating opposing views.

As a leading addictive substance expert in Charlotte and Concord, North Carolina, we work with substance abuse and addiction daily. We find that many are unaware of how and why addiction is classified as a mental illness. Many get too caught up in the argument over choice versus disease without understanding what addiction, once developed, really is. As a result, addiction is seen as either the product of choice or a disease when it is, in fact, commonly both.

In what follows, we will present facts about substance abuse, addiction, and mental illness. It will be up to you to come to your own conclusion based on these facts.

What Is Mental Illness?

Any part of the body can get sick.

When a person is “sick,” they have a series of symptoms. These symptoms may decrease their ability to function. For example, when you get a cold, you are sick. Cold symptoms can lower your ability to perform at work or school. If the symptoms are severe, you might take a sick day to rest and recover.

Mental illness is when the mind falls sick, and the symptoms decrease a person’s ability to function.

According to the Mayo Clinic, the term mental illness includes “a wide range of mental health conditions.” These include “disorders that affect your mood, thinking and behavior.” Just as there are multiple strains of viruses that cause a range of sicknesses, there are different kinds of mental illnesses. There are, in fact, five major categories:

1. Anxiety disorders
2. Dementia
3. Eating disorders
4. Mood disorders
5. Schizophrenia and psychotic disorders

Where Does Mental Illness Come From?

For many, mental illness develops due to their environment. Stress is the leading cause. Stress takes on many forms ranging from common life stressors (finances, family, major life events) to trauma (victimization, war, crime).

For some, mental illness is a condition they are born with. For example, a person born with diabetes or a heart defect is not unlike a person born with attention deficit disorder (ADD) or bipolar. These conditions or sicknesses – mental illnesses – are the product of genetics and no person’s direct fault.

Fault. It’s an important word in the mental health and illness discussion. To indicate or assign fault – to blame – implies that someone is responsible for a wrongful act. All too often, people who have a genetic combination that causes a mental illness are blamed for their illness. But in these cases, they are no more at fault than a person born with a defect.

Diabetes, a heart defect, and many other conditions can be found by tests – blood work, imaging, etc. Mental illness isn’t so easy to find. There is no blood test or imaging that can definitively show a person has an anxiety or mood disorder. Diagnosis centers around careful assessment of an individual’s symptoms.

Enter Substance Use

Due to mental illnesses being difficult to diagnose, many go undiscovered and untreated. For some, they live much of their life undiagnosed.

The indicators of mental illness vary per person, but there are some mainstream symptoms. Common signs include:

• Alcohol or drug abuse
• Confusion
• Detachment
• Excessive fears or worries
• An extreme feeling of guilty
• Extreme mood changes
• Reduced concentration
• Severe sadness
• Suicidal thoughts
• Unusual tiredness, low energy, or trouble sleeping
• Withdrawing from friends and family
• Degrading performance at work and school

Mental illnesses can even produce physical symptoms, such as unexplainable aches and pains. But it mostly affects emotions, thoughts, and behaviors.

When a mental illness goes untreated, the risk for substance use and abuse increases.

Alcohol and drugs provide temporary relief from the thoughts and emotions that come with mental illness. For example:

• Anxiety: Someone with an anxiety disorder might use alcohol to temporarily control or lessen their anxious feelings.
• Depression: Someone suffering from depression might use alcohol or marijuana as a temporary escape from sadness and guilt.
• ADD/ADHD: Someone with ADD/ADHD might use stimulants to increase focus and concentration because of how their brain chemistry reacts to stimulants.

Easily obtainable substances like alcohol, cigarettes, and marijuana relieve the emotional pain of mental illness. When the source of that pain is not diagnosed and properly treated, a substance use disorder can develop over time.

In contrast, people with diagnosed and treated mental illnesses can also develop a substance use disorder. For example:

• Anxiety and Depression: Someone taking medication for anxiety and/or depression might misuse their meds. Misusing a prescription medication increases the risk of substance abuse and addiction.
• ADD/ADHD: The stimulants used to treat attention deficit disorders are dangerous if taken by someone who does not have ADD/ADHD. These drugs are especially risky when misused.

What Is Drug Misuse?

Since misuse of medication increases the risk of a substance use disorder, what exactly is drug misuse? And what constitutes drug abuse?

In its most basic form, drug misuse is the use of a substance for a purpose not consistent with legal or medical guidelines. In general, this use results in negative consequences that affect the user’s health. It includes:

• Taking a prescription medication without a prescription
• Taking a prescription medication without qualified medical supervision
• Failing to follow the directions for taking or using a prescription drug
• Taking a higher dose and/or more frequently than prescribed

Drug abuse is no different. The two terms are used interchangeably. Misuse of a drug is abuse, and both can lead to two major symptoms of addiction: dependence and tolerance.

Tolerance and Drug Dependence

Highly addictive drugs are frequently prescribed for many common illnesses and pain. Misusing or abusing a drug – especially an addictive one – can lead to drug tolerance and dependence. But intentional drug abuse isn’t the only catalyst behind tolerance and dependence.

Dependency is the product of either taking a drug for an extended period of time or abusing it. When a person becomes dependent on a drug – physically or psychologically – they need it. Without it, they experience withdrawal.

Drug dependency is a sign of addiction.

Tolerance is when the body needs more and more of a drug (higher or more frequent doses) for it to be effective. Anyone who takes a drug for a long time period can develop a tolerance.

Drug tolerance can be a sign of substance abuse or addiction but not always.

Mental Illness and Substance Use Disorder

The misuse or abuse of drugs and addiction to an addictive substance fall under the umbrella of substance use disorders. Remember, earlier “alcohol or drug abuse” was identified as a mainstream symptom of mental illness. Substance use disorders fall beneath the bigger umbrella of mental illness, and mental illness rests under the even bigger umbrella of disease. Therefore, addiction is a mental illness by fact.

Here enters the heated debate.

One side claims addiction – whether to a prescription or illicit drug or alcohol – is a choice. They believe that if an addict chose to use a drug like marijuana, heroin, or cocaine, the resulting addiction problem is their fault.

The other side claims addiction is a disease. They believe that an addict – regardless of how they started using an addictive substance – suffers from mental illness.

What are the facts?

Conscious Choice

The most dangerous addictive substance – the real gateway drug – is alcohol. It’s the most readily available and often the first substance an addict abuses.

It is true that some make a conscious choice to drink too much alcohol or use dangerous, addictive (and illegal) drugs. But does this choice make their addiction their fault versus an illness?

Actions do have consequences – this is a fact that cannot be overlooked.

When a person purposely uses an addictive substance frequently, and in large volume, it can be said that their choices led to their developed substance abuse and addiction. However, this does not detract from the fact that addiction is a mental illness.

Addiction is characterized by compulsive behavior. It is a brain disease that distorts thinking, behavior, and body functions. It is scientifically recognized and categorized as a disease in both the general medical and mental health fields.

While actions do have consequences, the person who chooses to engage in substance abuse and develops addiction still suffers from mental illness.

When a person uses – and/or abuses – a substance, the development of dependency and addiction involve visible changes to the brain. Over time, the brain “rewires,” which is why cognitive behavioral therapy (CBT) is highly effective for treating substance use disorders. CBT works by retraining the brain through the influence of thoughts and beliefs that impact actions and behavior.

Byproduct

The use of prescription drugs is fast becoming a significant cause of substance use disorders, including drug dependency, drug abuse, and addiction. For the vast majority who find themselves suffering from a substance disorder while or after taking a prescription drug, its development was never a choice.

Consider the patient who undergoes surgery and is prescribed a standard (but potentially addictive) drug for pain. They never misuse the drug. They take it exactly as prescribed. When it’s time to stop taking it, they suddenly experience symptoms of drug withdrawal. By definition, this is drug dependency, and in this case, it’s a byproduct of doing nothing wrong.

Genetics can increase the risk (and development) of a substance use disorder.

If a dependency isn’t properly addressed, it can spiral into full-blown addiction. Why? Because dependency is essentially a stage in a progressive disease – a stage in the mental illness known as substance abuse and addiction.

Substance Abuse, Dependence, Addiction, and Mental Health

Substance abuse is the misuse or abuse of a drug. It includes using a drug for something other than its purpose. It also includes not following medication use instructions and taking a prescription that is not yours (meaning prescribed to you by a doctor). Drug abuse can range from mild to severe. In most cases, misuse of a substance becomes the first stage of a substance use disorder.

Drug dependence is the development of a need for a drug. It is usually the second stage of a substance use disorder. Dependence involves the brain’s neurons adapting to repeated drug exposure. The brain “rewires” and a physical and/or psychological dependence is the result; a person needs the drug to function normally. Without it, they suffer withdrawal. The rate at which dependency on a drug develops varies per person, and genetics play a major role.

Addiction is the third and most serious stage of a substance use disorder. When a person reaches this stage, their body has suffered biochemical, cellular, and molecular changes. Their brain has been “rewired,” and their compulsive need for a drug will triumph over everything else. Negative consequences mean nothing.

Read more about the stages of addiction in Substance Abuse vs Dependence vs Addiction.

Addressing Substance Use Disorders

Substance use disorders are one of the most preventable and treatable mental illnesses.

At the heart of prevention is education. It is vital to understand what addictive substances are and how substance use disorders develop. It is also critical to be aware of what substances are addictive and present the most risk.

Substance use disorders are very treatable, but these disorders are one of the least treated mental illnesses. Why? Stigma. The heated argument focused on choice versus disease leaves many feeling they can’t admit their problem and ask for help. Feelings of judgment and failure stop people from seeking help every day.

Perhaps one of the most detrimental results of the debate is the lack of empathy people with opposing views develop. Instead of agreeing to disagree, a climate of malice has developed. Many who suffer from a substance use disorder don’t seek help because they fear punishment, regardless of how their disorder developed.

The seemingly black and white debate of choice versus disease isn’t so black and white after considering proven facts and real-world scenarios. How will you define substance abuse, dependence, and addiction?