Is Addiction a Mental Illness?

When a family member or individual suffering from addiction calls our admissions specialists, we may be asked if patients being treated for addiction will be grouped with our mental health patients, or vice versa. These callers are concerned that they or their loved ones will be “lumped into” a diagnosis that may not apply to them. However, what they don’t understand is that addiction is a diagnosed mental illness, and the various types of addictions and dependencies are found in the DSM-V, the text that classifies all mental health diagnoses.

Often occurring together, mental health and addiction have several similarities, however, there are also relevant differences in treatment approaches. Despite addiction being a mental illness, it is treated uniquely from other mental illnesses, including the common need for detox; though many important treatment modalities, like talk therapy, overlap and are applicable to both mental health and addiction disorders.

Let’s get deeper…with some definitions.

Substance abuse involves using illegal drugs, alcohol, prescription drugs, or over-the-counter substances in a way that they were not intended. In this narrow definition, and not considering the potential consequences of substance abuse, this is not in and of itself a mental illness.

A substance use disorder (SUD), on the other hand, is a mental illness. SUDs affect the brain and limit the patient’s ability to stop using the substance. It is important to understand that the patient is affected psychologically by a substance use disorder, and the brain may be altered structurally.

Addiction is the most severe form of a substance use disorder, defined as a chronic condition including patterns of relapsing and significant consequences for the afflicted individual. Individuals addicted to a substance typically seek it compulsively and continue using it even when faced with obviously detrimental consequences. Look no further than methamphetamines and the physical and personal hygiene deteriorations that have become synonymous with its use (think meth mouth). Clearly, there is a physical component, but the mental health concern is real too.

As you can see, addiction is a mental health and physical concern and has consequences, much like other medical problems. Substance use disorders and addiction, like other physical diseases, can structurally affect the organs, last a lifetime, and lead to death.

Co-occurring Disorders (Dual Diagnosis) – Chicken or the Egg?

If you or a loved one has been struggling with a substance use disorder or mental health concern, your research will likely turn up the term co-occurring disorder or dual diagnosis. These terms are used to describe the occurrence of more than one disease. For example, some patients may have mental health and physical problems. Most commonly, however, these terms are used to describe patients with both mental health and substance use issues. This necessitates a unique approach and a treatment facility that has expertise in both realms.

But which came first? Does addiction lead to other mental health issues, or do mental health issues lead to addiction? The complex and related interplay between addiction and mental health shows us that one is likely to exacerbate the other because, ultimately, they are simply different sides of the same coin. This is not to say that all people with addiction have other mental health concerns, nor does it mean that all mental health patients have addiction problems. What it does mean is that individuals struggling with both will need to receive care that can address both issues in tandem.

What Do Others Say?

Over the past few decades, most governments and advocacy organizations have largely agreed on the relationship between mental health and addiction. Indeed, the US government passed The Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008, an amalgamation of years of laws targeting insurance coverage for mental health and addiction issues. This legislation further reinforces the importance of addressing both and gives mental health and addiction their deserved spots in the continuum of medical care.

The National Institute on Drug Abuse defines addiction as “…a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences.”

The American Society of Addiction Medicine says: “Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.”

The American Psychological Association defines addiction as: “a state of psychological or physical dependence (or both) on the use of alcohol or other drugs.”

Ultimately, each modern definition of addiction has been built upon decades of research that have shown addiction to be, in many cases, both a physical and mental concern.

A Case of Willpower?

Both the mind and structure of the brain are unbelievably complex, and as such, we have yet to fully understand the causes and effects of most diseases that affect them. When addiction was first studied with modern scientific knowledge, in the early part of the 20th century, there was comparatively little understanding of the workings of the brain, especially without the technological resources we have now. As a result, it was posited that addiction was a moral failing and that with willpower, patients could “get over it.” However, incredible advances in technology applied to the study of the brain have allowed us to see how abusing substances can change the brain’s reward circuitry and even the brain’s structure.

Let’s take depression, for example. Many patients suffering from depression are told to “snap out of it.” However, we know from magnetic resonance imaging (MRI) that structural alterations to patients’ brains occur, including in the frontal lobe, hippocampus, thalamus, and amygdala, amongst other areas. While these changes vary between individuals, there is enough overlap to conclude that depression does indeed cause physical changes to the brain.

Addictive drugs work much in the same way. We have reward pathways in the brain that exist to provide us with pleasure and satisfaction by activating a chemical known as dopamine. Without dopamine, we would not have the drive to perform activities that ultimately keep us alive, like eating. However, the abuse of substances can overwhelm this circuitry and create permanent changes to our reward system, with the resulting expectation of far more dopamine than can be had by natural non-substance-related activity causing alterations in the brain. This pleasure response from illicit (or even legal) drugs can be many times greater than the most potent natural rewards.

How We Treat Addiction and Mental Illness is Similar

Further reinforcing the similarities between addiction and mental illness is how they are treated. The most significant difference, of course, is in the physical withdrawal from the substance. Individuals with substance use disorders will often start with medical detoxification at a licensed facility to ensure their safety as they taper off the substance(s) they were abusing. Several of these substances, including alcohol and Benzodiazepines, can have significant or even deadly withdrawal symptoms, and as such, there should always be a qualified medical team to supervise the process.

That said after the physical withdrawal, addiction and mental health disorders are treated similarly. Medication Assisted Therapy is common in both the mental health and addiction treatment continuum, though different illnesses will have unique therapeutics. Although the specific pharmaceutical therapies will differ between the two, all the medications target the brain. Talk-based therapeutic interventions like Cognitive Behavioral Therapy / CBT and Active Listening treat both concerns.

But How These Concerns Form is Very Different

Possibly the most significant difference between addiction and other mental health disorders is that substance abuse is preventable. That first hit is a choice and not a compulsion, but the underlying decision to take that leap, and the need to keep using the substances, even in the face of negative consequences, is often a result of or worsened by, mental illness.

Understanding this reality is the foundation of the therapeutic program at The Sylvia Brafman Mental Health Center. As a mental health primary facility with a strong dual diagnosis program, we give mental health its due diligence while also understanding the unique needs of those with co-occurring addictions. We encourage you to contact us to learn more about our program and how it can help you or a loved one.