Substance Abuse and Comorbidity

Hard wired for madness or an innocent child gone wrong?

There are so many stories surrounding addiction, alcoholism and how to recover. What do we believe? How can you stop using or drinking? Where did the problem start? Does this matter? How can you help an addict or an alcoholic? How do other mental health issues tie in with addiction and alcoholism? These, as with many things associated with addiction and recovery, bounce between extremes, oxymoron’s and paradoxes. Often, this means that the whole idea of recovery can become shrouded in an intellectual minefield of opposing views chucking bombs at each other.

Was I born to use?

A particular favourite of these is: ‘I was born to use drugs and drink alcohol’ versus ‘the wonky trajectory of life catapulted me innocently forward in some pretty unfortunate ways’. So, are addicts and alcoholics hardwired for madness or just innocent children that have taken some wrong turns?

The addict ego and the addict victim

The first of these ideas hints at a quasi- romantic belief in one’s own tragic destiny and the second has connotations of a low level victim mentality. Arguably, one stems from pride and ego while the other is a manifestation of insidious self-pity. Many people in the rooms of 12 step fellowships espouse both versions of this pseudo intellectual clap trap. Do either of these points of view help someone struggling with addiction who just wants to know how to stop? Do these concepts assist the level of self-discovery that is required for long term recovery?

Black and white and grey

Addicts do generally prefer the truth to be to be either black or white. It’s much easier with no conflicting thoughts and feelings surrounding an issue (or a person for that matter). There is a sense of safety and security in there being no grey area. 12 step recovery is built on an  extreme and that is one of the reasons recovery works for many. It meant going from mixing up any narcotic relief going to taking nothing at all. That appeals to addicts and alcoholics  monochrome fantasies of the world.

However, life is never simple, often different shades of grey and rarely fits into a neatly checkered pattern. Recovery on the other hand should be as simple as possible. Long term recovery grows into a more a personal affair but early recovery needs to lay those simple formulaic foundations. And they need to be made strong.

What makes addiction a mental illness? – Some simple concepts

Addiction and alcoholism – whichever term is more applicable to you, is actually a mental illness in the same way as depression or bipolar. The disease of addiction alters the brain in some very fundamental ways as does other mental health conditions and mood disorders. Addiction disturbs a person’s normal hierarchy of needs and desires which ultimately means substituting new priorities connected with procuring and using the substance. The resulting compulsive behaviours override the ability to control impulses despite the often wholly negative consequences. This criteria is actually hugely similar to that of many other forms of mental illness.

Diagnostic criteria for addiction and alcoholism

The medical community has a diagnostic criteria for all mental disorders including drug related disorders. They say that there are two definitive types. Drug dependence is tantamount with to addiction as opposed to drug abuse which means the harmful use of substances but without the physical tolerance and withdrawal. Frequently, abuse warms up full blown dependence.


Many people who regularly abuse drugs and/or alcohol are also diagnosed with other mental disorders and vice versa. Suffering from two or more medical conditions at once is known as comorbidity, dual diagnosis or a co-occurring disorder. These fancy terms essentially all mean the same thing (in terms of drug and alcohol addiction): that the client suffers from addiction and another mental health condition.

The high incidence of comorbidity has been well documented in multiple national population surveys since the 1980s. Research shows people diagnosed with mood or anxiety disorders are about twice as likely to suffer from a drug or alcohol misuse disorder (abuse or dependence). It’s also true for those diagnosed with an antisocial syndrome, such as antisocial personality or conduct disorder. Similarly, persons diagnosed with drug disorders are roughly twice as likely to suffer also from mood and anxiety disorders.

Treating comorbidity successfully

Treating any addiction and a mental health condition at the same time is a highly specialised business. In the most extreme cases the patient can present with more than one mental health condition and multiple addictions. The key to helping people find long term recovery is accurate diagnosis and this can be difficult for the following reasons:

• Substance use masks an underlying mental health condition

• Drugs and alcohol exacerbate a mental health condition

• Other people find that once they stop using and drinking the symptoms of their mental health issue vanish. Often, the negative effects of addiction commonly mimic the symptoms of disorders like depression, anxiety and psychosis.

A residential treatment centre provides the best place to treat comorbid conditions, both conditions can be monitored by the same team. Often when people treated in the community have different care providers looking after separate elements of their needs. Residential rehab means a fully integrated approach and 24 hour care and support.

Call the Hader Clinic today!

If you or somebody you know is addicted to drugs and has mental health condition call our addiction experts at the Hader Clinic today. It doesn’t matter if you think you were born to use or if you have just taken some wrong turns – the solution remains the same.