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Mental Illness and Addiction: Which Came First?

by Olivia Pennelle ❘  

Understanding Mental Illness and Addiction

It’s a bit of a chicken and egg question; which came first, depression or addiction? Leading experts claim that addiction—or substance use disorder—can mask the symptoms of an underlying condition. That was certainly the case for me. I have suffered with depression and anxiety for as long as I can remember, and I developed substance use disorder in an attempt to self-medicate. It was only in recovery that I truly understood the correlation between mental illness and addiction and was able to fully recover.

Suffering From Mental Illness and Addiction

What exactly is mental illness? The American Psychiatric Association defines it as “health conditions involving changes in thinking, emotion, or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work, or family activities.” The most common types of mental illness with which people can suffer include: Depression Disorders, Anxiety Disorders, phobias, Seasonal Affective Disorder, Obsessive Compulsive Disorders, Bipolar Disorder, Dissociative Disorders, Post-Traumatic Stress Disorder (PTSD), Schizoaffective Disorder, Schizophrenia, Eating Disorders, and Dementia (this is not an exhaustive list).

Anyone can suffer with mental illness, although it is most common in those with a family history of mental illness. The onset of mental illness can occur at any time during a person’s life; symptoms can present in childhood, adolescence, adulthood, and in older age. However, the years between 18 and the late 20’s account for the greatest percentage of mental health diagnoses.

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Statistically, in any given year, nearly 1 in 5 (19 percent) US adults experience some form of mental illness; 1 in 24 (4.1 percent) has a serious mental illness, and 1 in 12 (8.5 percent) has a substance use disorder.

The parallels between mental illness and addiction are striking. Addiction affects one in three households in the US.

At my sickest, I sought help presenting with features of addiction but I wasn’t aware that those signs were masking a long-standing mental illness. It is quite common for those who suffer with addiction to display a myriad of symptoms and to self-medicate symptoms of mental illness with drugs and alcohol.

Renowned addiction expert, physician, and author Dr. Gabor Maté believes that approximately 80-90% of substance abusers have correlated mental health issues. With users self-medicating to cope with trauma, ADHD, Bipolar Disorder, depression, anxiety, and extreme stress. He says that these conditions, and their basis in trauma, all have to be addressed if we are to help addicted people overcome their problem.


The challenge for me, and many others with a dual diagnosis of addiction and mental illness, is that no program of recovery can treat mental illness. Recovery literature states that sometimes we need outside help—referring to medical experts. Difficulties arise when that literature is misinterpreted and those people see depression, anxiety, or any other mental illness as a feature of addiction that can be treated solely with a program of recovery. Contrary to that belief, medical illness cannot be treated with a spiritual solution. It is paramount that people who suffer with mental illness seek treatment from a trained medical professional.

Mental illness and addiction can be rooted in childhood development. Maté explained that the emotional atmosphere in a childhood home wires the brain and how it develops. For a healthy brain to develop, a calm, connected, attuned, non-stressed parenting environment is required. He argues this becoming less available to children in today’s world. That wiring affects all of the brains circuits that are involved in addiction—from the opiate circuits, the emotional stress and self-regulation, to incentive/motivation circuits. The greater the early stress and trauma, the less calm and supportive the early environment, the greater the risk that person is at of addiction and mental health problems because those parts of the brain have not effectively developed.

As a child, I recall feeling low in mood. I was sad all the time. I also remember feelings of isolation, with little or no motivation to do anything. I was challenging to parent as a moody, shy, and awkward child. I lacked joy in life. My teenage years were much the same, punctuated with such anxiety and depression that I was perceived as socially awkward and withdrawn. In my twenties, my depression deepened, and my social anxiety became so palpable that I felt like I had a brick in my chest. I discovered that alcohol and drugs provided temporary relief; they flooded my brain with feel good chemicals and I finally felt—albeit temporarily—okay.

The problem is that by self-medicating with drugs and alcohol I only exacerbated my mental illness. I had frequent episodes of clinical depression. During those times, I couldn’t get out of bed, and I often contemplated my existence. I took months off work at a time, and I was unable to maintain relationships. My family became so increasingly concerned about me that one of them flew from America to the UK to stay with me. I self-medicated until I was 32. By that age, my tolerance to alcohol had become so high, and my depression so low, that I sought oblivion in four bottles of wine and a handful of pills a day. I reached a point where I either ended my life or got help. I sought treatment for substance use disorder, but that was only the beginning.

As Maté believes, trauma and stress must be dealt with to deal with addiction. I found that to be my experience. I guess it doesn’t matter what came first—what matters is treating all of me. It was only once I got underneath my trauma, childhood, and stressors, was I able to recover. Together with help from an expert, I was able to treat my mental illness too. Over five years later, my mental and physical health is under control. As with addiction, mental illness is unlikely to disappear, it requires on-going management. It just so happens that the management of my recovery—a holistic approach focusing on mind and body wellness—treats both my substance use disorder and my mental illness.

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