The Link Between Mental Health and Alcoholism / Addiction

Diagnosis and treatment of mental health disorders – the focus of psychiatry – has always been a big part of my medical practice. It’s an inevitable part of practicing psychotherapy, and it’s an area of medicine that has enticed me. How could it not? As a people-watcher the only thing I find more fascinating than normal psychology is abnormal psychology. It’s also an area of medicine where a motivated doctor can tellingly impact people’s lives.

Most of my time in practice has been in a region where psychiatrists are in scarce supply, so I had no shortage of this kind of work. Unfortunately, people with mental illness carry a label of being somewhat demanding and difficult to deal with, so many doctors don’t relish seeing them. Many of my colleagues say they will see some people with mental illness because they feel they should “do their part.” However, these patients deserve better than doctors who are seeing them just to “do their part.”


Doctors seem to love coming up with complex words to describe simple things. True to form, they use the word comorbidity to describe a mental health disorder and alcoholism-addiction present at the same time in the same person. You may also hear them referred to as concurrent disorders or dual diagnosis.

Many people have mental issues that bother them, but what makes it a mental health disorder is when the issues cause problems to the point of interfering with the ability to function in life. We have names for these disorders of mental function: depression, anxiety disorders, schizophrenia, bipolar disorder, and anorexia are some among many. The definitions of the various mental health disorders are standardized in an internationally accepted book known as the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, the fifth version of which is currently in use).

All the diagnosis terms aside, there is a lot of overlap in the symptoms, causes and treatments of mental health disorders. And that includes alcoholism/addiction.

What we know of as alcoholism and addiction are technically not proper medical terms, because they do not appear in the DSM-5. Instead, it refers to substance use disorders, and then provides a list of substances that fall into this category. This list includes alcohol and other addictive substances. However, regardless of terminology, alcoholism and addiction are considered to be a mental health disorder. I prefer just calling them “our disease.”

Mental Health and addictions overlap

The interaction of our disease with mental health disorders can have serious ramifications.* People suffering comorbidity experience:

• more severe psychiatric symptoms,
• more dramatic effects from using substances, including more blackouts,
• lower likelihood of following treatment plans,
• more physical health problems,
• increased experiences of social stigma,
• increased financial problems and homelessness,
• poorer management of personal affairs,
• more serious relationship problems, including with family,
• more verbal hostility, tendency to argue, disruptive behaviour, aggression,
• greater likelihood of ending up in jail, and
• increased suicidal thoughts and action.

As put by the National Institute on Drug Abuse: “[alcoholism/addiction] is a complex brain disease characterized by compulsive, at times uncontrollable drug craving, seeking, and use despite devastating consequences— behaviors that stem from drug-induced changes in brain structure and function.”**  These brain changes are discussed in the post "The Brain in Addiction and Alcoholism" Click Here.

These changes occur in some of the same brain areas and affect the same neurotransmitters that are responsible for other mental health disorders, such as depression, anxiety, or schizophrenia. It is therefore not surprising that there is such a high rate of comorbidity between alcoholism-addiction and other mental illnesses.


Because addictive substances disrupt our neurotransmitter levels in our brain, they counter-act the effects of medications used in treating mental health illness, which are trying to correct these levels and get us back to good health. We're pretty good at treating mental health problems now, and whenever I had a patient who was not getting any better I always knew they must be drinking or using.

Our genes and our mental health

In another post (Click Here) we discussed how our genes can have a significant impact on our vulnerability to alcoholism-addiction. We saw that the genetics of our disease are complex, with many different genes interacting to produce the factors that can lead us to becoming addicted to a substance while other people can take it or leave it.

Likewise, mental health disorders are instigated by numerous genetic factors that intermingle to make us more likely to develop these problems. Unsurprisingly, given the overlap in brain locations, neurotransmitters, and symptoms between alcoholism/addiction and mental health disorders, there are also overlapping genetic vulnerabilities. This means that the same genes that can make us more likely to become substance addicted can also make us more likely to develop a mental health disorder… and vice-versa.

While the influence of genetics is powerful, our environment (our up-bringing, our experiences, our life situation, our friends) is a major factor. Many of the things we are exposed to in life that can bring on alcoholism/addiction are also risk-factors for mental illness: growing up in an unstable household, poor education, lack of life opportunities, poor nutrition, abuse and other trauma, to name a few.

Mental health disorders and alcoholism-addiction share more than causes. Because the same brain areas and neurotransmitters are affected, there are overlapping symptoms, making diagnosis and treatment challenging. Correct diagnosis is critical to ensuring appropriate and effective treatment, and failure to identify and treat a comorbid mental health disorder can jeopardize an alcoholic/addict’s chance of recovery. There is, however, one area where the overlap is, sadly, missing.

Barriers to getting well

Within healthcare systems different professionals and clinics address substance use disorders and other mental illnesses separately. Each is treated in assorted venues by a mix of health care professionals with different backgrounds. While each has an understanding of the other, neither system may have sufficiently broad expertise to address the full range of problems presented by patients.

As well, there is almost always a physical separation between the two systems, and a resulting bias against close communication between treating professionals. Baffling to me is the bias that exists in some substance use treatment centers against using any medications, including those necessary to treat serious mental illness. This is counter-productive, as many of us do not stand a chance against their alcoholism-addiction unless our mental health problem is treated.

Many of those with undiagnosed or untreated alcoholism/addiction or mental health illness end up in the criminal justice system, brought there by their disease-induced behavior. It is undeniable that alcoholism/addiction and some mental health disorders make a person much more likely to end up on the wrong side of the law, especially when comorbidity exists. However, adequate treatment services for both substance use disorders and other mental illnesses are greatly lacking within the criminal justice system. These people end up being treated as disciplinary problems. Our jails and prisons are filled with people whose presence there is a simply symptom of a treatable disease.

Also heartbreaking is that people of unfortunate circumstances – such as the socio-economically disadvantaged – tend to have markedly reduced access to healthcare, rehab facilities, and medications. Meanwhile, this population is disproportionately represented in the ranks of those who suffer alcoholism/addiction and other mental health disorders. Those most affected are those with the least access to help.

Yet another barrier to effective diagnosis and treatment of these often comorbid problems is the social stigma carried by both. The stigma contributes to many people living in denial of their conditions, or with difficulty in finding the courage to come forward for help. They are understandably psychologically resistant to taking on these new identities – labels – that are viewed as negative, even by friends, family, lovers, and employers.

Yet another challenge to diagnosing mental health problems is that we may not realize we are suffering from one. We may have lived with the condition for so long that we have long forgotten what it is like to feel “normal”.

As well, many mental health disorders are characterized by what is referred to as a “lack of insight”. The medical profession, true to form, has chosen the simple name anosognosia for this symptom. (If you’ve somehow managed to make it this far through life without knowing that word, you’re probably safe to continue on without it). This means that affected people are unaware of the symptoms they are experiencing, sometimes incapable of being aware. This is seen in bipolar disorder – where they are unaware of symptoms but able to accept the truth when confronted with enough evidence – and schizophrenia, where they remain completely oblivious to the symptoms, no matter how much they are told otherwise.

This is a baffling thing to see in real-life, because their psychiatric symptoms are so obvious that it’s hard to believe they are not aware they are ill. For the uninitiated, this impaired awareness of illness is difficult to comprehend. It may cause conflict because people will think those with anosognosia are faking or trying to pull one over on them, and the affected people are defensive about the suggestion there is something wrong with them.

The main concern about people lacking insight into their illness is that they will not seek help, will resist help when offered, and be unlikely to take their medications. They don’t believe there is anything wrong, so why would they? (Sounds a lot like another disease we know, doesn’t it?).

The data suggests that 56% of people with addiction to alcohol or drugs suffer from a comorbid mental health problem. I personally believe that to be a low estimate, because it is underdiagnosed. I suggest that anyone seeking sobriety see a doctor with a view to ruling out comorbidity early in the process.



To learn more about the science and psychology of addiction and recovery, and to understand why alcoholics and addicts behave the way they do, see the author's book The Alcoholic / Addict Within.
Available for sample or purchase in paperback and ebook editions at amazon.com (Click Here).

Article references:
* Concurrent Disorders: A Resource for Families. Centre for Addiction and Mental Health, Toronto. 2006. pg. 15
** United States National Institute on Drug Abuse. Research report Series. Comorbidity: Addiction and Other Mental Illnesses. NIH Publication Number 10-5771 Printed December 2008, Revised September 2010.