I trained as an addiction counsellor and worked in a rehab programme. Even back then almost 30 years ago it was blindingly obvious that some of our patients had more going on than addiction.
In today’s world, where the importance of mental health is increasingly recognised, we continue to categorise addiction and mental health as separate entities. This division is not only outdated, but it limits the effectiveness of care and stigmatises those struggling with both. The growing body of research reveals that addiction and mental health are deeply intertwined and should be addressed as part of the same continuum of care.
Today at Portobello Behavioural Health it is pretty hard to categorise what our clients look like when we are asked. Most of our clients show up with a mix of different issues. We very much see it as our role to help identify and treat them alongside our client in a holistic and comprehensive way which requires a MDT approach and collaboration with many partners. We also make sure our staff (regardless of their own lived experience) have as extensive a knowledge and understanding as it is possible for us to provide them with.
The Historical Divide: A Product of Misunderstanding
Historically, mental health and addiction have been treated separately due to distinct approaches to diagnosis and care. Mental health disorders—such as depression, anxiety, and schizophrenia—have long been viewed through a psychological or psychiatric lens. In contrast, addiction was often seen as a moral failure or a criminal behaviour, leading to treatment through rehabilitation centres, legal interventions, or detox programs.
This separation is rooted in the past, not in the realities of today. We now know that addiction is not simply a behavioural issue but a complex condition involving neurological, genetic, and psychological factors. Substance Use Disorders (SUDs), like mental health conditions, alter the brain's chemistry, impacting cognitive function, mood regulation, and behaviour.
There has also, in my opinion, been a sort of hierarchy of stigma and it has not always been linear. In general addiction has been incredibly stigmatised. Seen as a moral failure and not worthy of concern or pity. Conversely, when I first got into recovery and went to 12 step meetings, there was a sort of pride or dogma which laid all one's troubles firmly in the lap of addiction with the 12 steps being the solution. Admitting that one had a separate but connected diagnosis was somehow a cop out. Both these things have changed in the public consciousness and in the suffering communities. It is time that the public bodies and professionals caught up.
The Evidence: Addiction and Mental Health Are Inseparable
1. High Rates of Co-Occurrence (Comorbidity):
According to the National Institute on Drug Abuse (NIDA), approximately 50% of people with a substance use disorder also experience a mental health disorder at some point in their lives. According to Public Health England around 70% of people using drug services and 86% of people engaging in alcohol services have experienced mental health problems. According to the Royal College of Psychiatrists report of 2017, 40% of people with mental health issues have experienced problematic substance use.The co-occurrence of these disorders makes it nearly impossible to effectively treat one without addressing the other. For example, individuals with anxiety or depression may turn to substances like alcohol or drugs as a form of self-medication. Conversely, substance use can exacerbate underlying mental health conditions, creating a vicious cycle of dependence and emotional instability.
2. Shared Neurobiological Pathways:
Both addiction and mental health disorders involve changes in the brain’s reward, stress, and self-control circuits. Studies show that the same neurotransmitters and brain regions implicated in mood regulation are also involved in the development of addiction. Dopamine, for example, plays a critical role in both depression and substance use disorders, underlining how interconnected these issues are on a neurochemical level.
3. Overlapping Risk Factors:
Addiction and mental health disorders share many risk factors, including genetic predisposition, trauma, environmental stress, and early life adversity. A person exposed to trauma, such as abuse or neglect, is not only more likely to develop conditions like PTSD or depression but also has an elevated risk of developing substance use disorders. This overlap in risk factors further supports the argument that separating the two categories is counterproductive.
We need to end Siloed Care
When addiction and mental health are treated as separate issues, people seeking help often fall through the cracks. Imagine a person with depression who self-medicates with alcohol being treated for one condition but not the other. The failure to treat both the mental health disorder and the addiction simultaneously increases the likelihood of relapse and worsens overall health outcomes.
Unfortunately, many treatment programs still operate in silos, with separate facilities and professionals addressing mental health and addiction. This fragmented care model neglects the complexity of co-occurring disorders, creating barriers to recovery. A report from the Substance Abuse and Mental Health Services Administration (SAMHSA) found that individuals with co-occurring disorders are more likely to experience chronic health problems, homelessness, and incarceration due to the lack of integrated care. I am a firm believer in specialisation both by facilities and professionals, but that is very different from separate treatment. All of this is not helped by governmental or regulatory bodies also separating them off and thereby requiring separate licences and increasing the cost of delivery and risk of poor inspections where a facility is doing a great job but doesn’t tick the right box.
The Path Forward: Integrated Care as the Solution
The solution to this disconnect is clear: integrated care that addresses both mental health and addiction simultaneously. Integrated treatment approaches are evidence-based and have been shown to improve outcomes for individuals with co-occurring disorders. Programmes that combine psychotherapy, psychiatric care, medication-assisted treatment, and peer support offer a more comprehensive path to recovery.
In fact, a 2019 study published in The Journal of Substance Abuse Treatment found that individuals receiving integrated treatment for co-occurring disorders had significantly better long-term outcomes, including higher rates of sustained abstinence, improved mental health, and a lower risk of relapse. This research highlights the need for a holistic approach to care that recognises the intrinsic connection between addiction and mental health.
Changing the Narrative: Reducing Stigma and Improving Care
Keeping addiction and mental health in separate categories perpetuates stigma. It reinforces the false idea that addiction is a moral failing, while mental health conditions are medical issues deserving of empathy and care. By integrating these categories, we not only improve treatment outcomes but also help to break down the harmful stigma that surrounds addiction.
Moreover, addressing these issues together aligns with the movement toward a more compassionate, science-based understanding of mental health. As we recognise addiction as a chronic condition like depression or anxiety, we can advocate for more equitable, accessible, and effective treatments.
Conclusion: Bridging the Gap
As the conversation around mental health evolves, it’s time to bring addiction into the fold. The research is clear: addiction and mental health are inextricably linked. By breaking down the walls between these two categories, we can improve care, reduce stigma, and offer individuals a better chance at recovery. The future of mental health care depends on a unified approach, one that treats the person as a whole and recognises the deep connection between their emotional, psychological, and substance-related struggles.
Together, we can create a more inclusive, effective healthcare system—one that acknowledges the true complexity of the human experience. As for neurodiversity, eating disorders, behavioural compulsions, the role of trauma, cultural sensitivity, familial or community integration and the many other things we need to keep working on in terms of learning and integration into models of care, I will leave that for another time.
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References:
- National Institute on Drug Abuse (NIDA). “Common Comorbidities with Substance Use Disorders.”
- Substance Abuse and Mental Health Services Administration (SAMHSA). “Behavioral Health Barometer, United States.”
- *The Journal of Substance Abuse Treatment.* "Long-Term Outcomes of Integrated Treatment for Co-Occurring Disorders."
