What Families Overlook: Addiction Is Often a Symptom, Not the Whole Story

When someone you care about is struggling with addiction, it can be incredibly difficult not to focus solely on their substance use. You can physically see the drinking and the drug use. It can look like a choice. But what we often don’t see are the underlying challenges that are leading to those actions. For many people who struggle with addiction, there’s a mental illness for which alcohol or drug use is a misguided attempt to cope. 

Addiction and mental health disorders present frequently together; they’re almost like thunder and lightning. Of course they exist apart from one another, but they’re a classic combination. About half of all adults in the U.S. with a serious mental illness also have a substance use disorder. Even that estimate might be low, as many people living with addiction do not receive mental health evaluations and may have disorders that go unrecognized or undiagnosed. 

As a clinical director who treats patients struggling with addiction, I see the pattern all the time: mental illness goes untreated, and substance use becomes a way to manage. Our patients’ friends and loved ones often see them as prioritizing their substance of choice over everything else, when really they’re trying the best they can to survive, using poor coping tools. 

If your loved one is living with addiction, they aren’t “weak-willed” and they don’t love drugs more than you. They need support. They need a mental health evaluation. And they need the right kind of treatment. 

Co-Occurring Addiction and Mental Illness: the Rule, not the Exception

It can be easy to assume that if your loved one doesn’t open up to us about their mental health, that they aren’t struggling mentally. But that’s often not the case. With more than 21.2 million adults in the U.S. struggling with co-occurring mental illness and addiction, there is a high likelihood your loved one has experienced at least one mental health concern.

Addiction and mental illness frequently occur together for numerous reasons. For starters, they share many risk factors, which include trauma, adverse childhood experiences (ACEs), genetic vulnerabilities, and early substance use.

Trauma, specifically, is a major factor for many of the patients we see in our facility. A majority of our patients have come to us with some form of trauma, many having experienced multiple traumatic events throughout their lives. 

Research demonstrates a strong link between exposure to traumatic events and substance use. Nearly 45% of people with lifetime PTSD meet criteria for a substance use disorder (SUD). Not only does trauma increase the risk of developing an SUD, but having an SUD increases the risk of trauma. Individuals living in active addiction are more likely to experience traumatic events than those without. Many individuals find themselves in a vicious cycle in which exposure to traumatic events produces increased alcohol and drug use, which then produces new traumatic experiences. 

There is also the issue of self-medication. It’s not uncommon for individuals experiencing distressing symptoms of a mental health disorder to “medicate” those symptoms with drugs and/or alcohol. This tends to work in the short term to some extent, alleviating the immediate distress. However, over the long term it tends to worsen the same symptoms the person was trying to treat and may cause many other stressors that can worsen the severity of the disorder. 

Substance use may also contribute to the development of mental health issues by causing long-term changes in the areas of the brain typically impacted by mental health disorders. 

The Impact of Mental Illness on Early Recovery

Mental illness complicates recovery, and the right kind of care is necessary. It’s not just about abstinence; it’s about learning how to live without drinking or using drugs. 

Early recovery is a period that is already intensely challenging, and it’s made even more so by psychiatric disorders. Getting sober brings emotional difficulties that are amplified when mental health issues are untreated. Anxiety, depression, trauma, or mood instability can trigger cravings, increase relapse risk, reduce therapy engagement, and make coping with withdrawal and stress harder. 

Untreated symptoms can also heighten social and interpersonal stress, creating a cycle where mental health concerns and substance use reinforce each other.

Because alcohol and drug use is often adopted as a coping strategy for managing symptoms of mental illness, leaving those symptoms unaddressed leaves the patient vulnerable. They are given little support in dealing with their distress and may find recovery unattainable. This may lead them to return to the substances quickly to alleviate their suffering. 

Studies suggest that an integrated approach to co-occurring disorders offers the best outcomes for individuals facing both substance use and mental health issues. When exploring treatment options for a loved one, families should prioritize programs that treat both conditions together and can explain clearly how they are doing so. Families can, and should, ask questions like 

• “What therapies do you use?”
• “Do you offer medication management for mental health disorders?”
• “Do you offer trauma-informed care, and what does that look like?” 

Don’t be afraid to ask as many questions you need. A reputable provider will be happy to answer any of your questions so you feel comfortable knowing your loved one is in their care. 

Addiction Shouldn’t Be Treated in a Vacuum 

A person’s whole health, not just their substance use, must be addressed for lasting recovery. I think about it like this: treating a patient who struggles with a disorder like depression for their drinking or drug use only is like prescribing medication for chest pain without evaluating the reason for the pain. This would leave the patient at risk for a heart attack or other serious cardiac events. 

It’s the same for a patient experiencing addiction and a mental health disorder. While a person may be able to white-knuckle abstinence for a while, they are ill-equipped to sustain long-term recovery when their care plan doesn’t include treatment for their mental health concerns. 

Asking individuals to stop using substances without giving them proper alternative coping skills can lead to the adoption of other maladaptive or dangerous coping behaviors. Equipping individuals with effective coping strategies is essential to help them manage intense withdrawal, severe psychological distress, and the high risk of relapse.

Mental Health is the Foundation of Sustained Recovery 

Mental health stabilization helps individuals manage mood, anxiety, trauma, or other psychiatric symptoms, thus allowing them to engage more fully in therapy, build positive coping skills, and make healthier decisions. It reduces emotional lability, improves adherence to treatment and medication, and strengthens resilience against stressors. Addressing mental health early and consistently doesn’t just support recovery, it makes it possible.

If siloed treatment harms a patient’s recovery efforts, integrated treatment does the opposite. It bolsters a patient’s ability to thrive. Truly integrated treatment addresses both substance use and mental health disorders together through a coordinated, patient-centered approach. 

We wouldn’t expect someone to recover from a physical illness while ignoring a major underlying condition, and recovery from addiction should be no different. For loved ones, this means seeking out care that treats both at the same time, giving your loved one the support they need for a more stable and lasting recovery.