In the 1980s and 90s, the dominant drug use prevention educational program was D.A.R.E. This program, aimed at elementary and middle school-aged children, taught skills to resist pressure to use tobacco, drugs, and alcohol, and was ultimately noted to be ineffective. One fault of resistance-based education is it ignores the complexities that contribute to why people use substances in the first place. One major factor to consider is the connections between mental health and substance use.  The idea that substance use is related to a moral failing has long perpetuated and contributed to stigma that has affected countless people’s ability to recover. It is paramount, because of this, to explore the relationship shared between substance use and mental health. 

     When a person has both a mental health and substance use disorder it is referred to as a co-occurring disorder, and recent data showed that more than 21.5 million adults would fall into this group. This is notable as both mental health and substance use disorders are chronic but treatable. With this knowledge, it is important that both are identified and treated. While often people can be placed into specialized treatment for a specific disorder, studies have shown that exploring the relationship between mental health and substance use can lead to better outcomes. 

     So, what does a deeper look at the relationship between mental health and substance use show? Is there a direct causal relationship between the two? The answer to that can differ from one person to another. Mental health disorders have been found to lead to substance use. For example, someone with schizophrenia may self-medicate with alcohol to quiet auditory hallucinations. The inverse of this can also be the case, as substance use can contribute to developing mental health disorders. Sometimes factors independently can cause the development of co-occurring disorders, such as genetics, trauma, or environmental factors.  

     It’s also notable that many people with substance use disorder may not have a co-occurring disorder, however, often they are still experiencing increased symptoms of depression, anxiety, or paranoia. It is important that these identified symptoms of substance use can lead to increased chances of both unintentional and intentional overdose. This can also help to inform which practices in treatment can be most beneficial as there are multiple evidence based practices that have been identified to assist in both mental health and substance use treatment.  

     In northeastern Massachusetts, Co-Occurring Enhanced programs like Tower Hill Recovery Home and Solstice House treat substance use disorder and moderate to severe mental health disorders in a structured residential environment, which is an evidenced-based model shown to assist this population. Additionally, programs like the Ambulatory Clinic through Riverbend are licensed to treat both substance use disorder and mental health disorders, with councilors holding certifications for both.  

     One person whose experience working with clients with SUD and mental health concerns is Riverbend’s Chief Clinical Officer David Fillio. Fillio echoed the importance of treating co-occurring disorders sharing “I am very pleased and aligned with the shift in philosophy I have seen in the last decade or so, recognizing the importance and prevalence of co-occurring disorders in the field. It is equally as important as being person-centered and recognizing the need for individualized care for every individual served.” Fillio, however, also mentioned that there still is more work to stating “As pleased as I am on one hand, in my anecdotal experience I am equally concerned on the other hand that these concepts are still novel for some in the field. It is important to continue to spread word of this understanding to combat stigma and focus on ways to enhance care.” 

    While the decreased stigma around mental health and substance use has been a welcome change in recent years, it is crucial that we don’t ignore the relationship between the two. The more we consider the factors of mental health when helping people in substance use treatment the better the outcomes will continue to be. We need to help the whole person, and not just one aspect of them. 

References 

Aram, J. W., Spencer, M. R. T., Garnett, M. F., & Hedegaard, H. B. (2022). Psychological distress and the risk of drug overdose death. Journal of affective disorders, 318, 16–21. https://doi.org/10.1016/j.jad.2022.08.115 

Co-Occurring Disorders and Other Health Conditions. (2024, March 29). https://www.samhsa.gov/substance-use/treatment/co-occurring-disorders 

Section 6 PE Tables – Results from the 2022 National Survey on Drug Use and Health: Detailed Tables, SAMHSA, CBHSQ. (n.d.). Retrieved February 1, 2025, from https://www.samhsa.gov/data/sites/default/files/reports/rpt42728/NSDUHDetailedTabs2022/NSDUHDetailedTabs2022/NSDUHDetTabsSect6pe2022.htm 

Substance Use and Co-Occurring Mental Disorders—National Institute of Mental Health (NIMH). (n.d.). Retrieved February 1, 2025, from https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health 

West, S. L., & O’Neal, K. K. (2004). Project D.A.R.E. Outcome Effectiveness Revisited. American Journal of Public Health, 94(6), 1027–1029. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448384/