For over 58 million Americans, mood disorders are an everyday part of life. These disorders include depression, bipolar disorder, and a wide range of other mental health disorders, which impact mood. These disorders, which are also known as affective disorders, are characterized by disturbance in mood versus disturbances in psychosis. Therefore, bipolar disorders, depression, anxiety, and substance abuse are all considered mood disorders.
For many people, these disorders are significantly and strongly linked to substance abuse – because the risk factors for substance abuse and mood disorders overlap, because mood disorders increase vulnerability to substance use disorders, and because substance abuse can trigger or even cause mood disorders.
That complex relationship means there are a significant number of ways a mood disorder can influence a substance use disorder and vice versa.
The same factors behind mood disorders increase vulnerability to substance abuse and substance use disorders. In fact, substance use disorder increases vulnerability to mood disorders and a mood disorder increases vulnerability to substance use disorder.
Further, the epigenetic, social, economic, physical illness, and trauma factors that influence mental health are also very likely to influence vulnerability to substance abuse. In the Adverse Childhood Experiences study, over 70,000 people reported data on traumatic experiences as children, which was then traced to increased likelihood of mental illness, physical illness, and substance abuse as adults.
Self-medication is the phenomenon of using non-prescription (or non-prescribed) drugs and alcohol to mitigate or relieve symptoms or stress without the oversight of a medical doctor. Self-medication is extremely high in mood disorders and is, in fact, more prevalent than in almost any other population. Here, individuals with bipolar disorder are most likely to self-medicate, with 41% of all people with bipolar I self-medicating.
Self-medication is substance abuse and can rapidly lead to tolerance, chemical dependence and addiction. Here, “self-medication” can be as small as using a glass of alcohol to unwind after a day, taking benzodiazepines to come down from mania, or using amphetamines to prolong mania. Whatever the case, it often ends up in the individual relying on drugs or alcohol to cope and to function, eventually resulting in addiction and seeking behavior.
Self-medication also results in long-term exposure, which means you build up tolerance, needing more and more of the substance to get the same effect. That can be extremely dangerous, simply because you eventually work your way into addiction by simply maintaining current results.
People with mood disorders are also extremely likely to have been given prescriptions to help manage those disorders in the past. Individuals with panic disorders, PTSD, bipolar disorder, and many forms of anxiety were previously given benzodiazepine prescriptions with very little oversight. That can very easily lead to addiction – even after just a short period of usage. That’s especially true for people who are already vulnerable to addiction like those with mood disorders.
Long-term prescription use can also lead to reliance, where you feel as though you need the drug to be okay. That can lead to taking the drug to feel better and even triggering episodes or attacks when you don’t have it. For that reason, most modern prescriptions are monitored, giving every individual with a prescription the help they need to manage their medication safely.
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Substance abuse including drug and alcohol use heavily influences neurotransmitter and hormone production in the brain and central nervous system. In long-term use, most illicit drugs reduce production of serotonin and dopamine, reduce natural production of opioids, and change GABA production. While these hormones each serve different purposes, they all influence mood and emotional regulation – leading the individual to feel more down, more unstable, and more prone to mood swings, irritability, and anger.
This process is so bad that there are entire classes of diagnosable mood disorders caused by alcohol and drug abuse. Often these disorders will recover over time but may take several years following quitting to do so.
Here alcohol and benzodiazepine abuse are significantly likely to cause depression and major mood depression in heavy users. In addition, even withdrawing from benzodiazepines can result in major depression, which can last as long as 12 months after you quit the drug.
Finally, most drugs and alcohol exacerbate the symptoms of mood disorders. Drugs and alcohol actively disrupt the neurotransmitters and hormones regulating your mood. In addition, drug and alcohol abuse actively get in the way of the habits, social engagement, and self-care that help you to manage mood disorders. Someone with a mood disorder should eat healthily, get enough sleep, and ensure they stay hydrated to maintain energy levels. A person abusing drugs or alcohol will rarely do any of those things.
Therefore, many people with low level or unnoticeable mood disorders start using drugs or alcohol and eventually have significantly worse symptoms. Those symptoms may return to pre-abuse levels after you quit but they may not.
For many people with a mood disorder, a dual diagnosis and treatment for both substance use disorder and the mood disorder is the only way to move forward. If you’re struggling with addiction, that addiction can get in the way of treating your mood disorder. At the same time, if you seek out “just” addiction treatment, your mood disorder will complicate and slow the process of addiction treatment. A dual diagnosis ensures that both are taken into consideration and treated at the same time, helping you to work through problems and symptoms as they get in the way of your primary treatment – helping you to move forward in a way that works for your mood disorder.
That’s especially true for anyone with prescription medication. Dual diagnosis will allow you to build a program around maintaining your medication and maintaining your mental health, rather than simply focusing on getting clean or sober – which allows individuals with bipolar and borderline personality disorders to seek out treatment.
Mood disorders are extremely common and make up most mental illnesses. At the same time, they greatly increase vulnerability to substance abuse and substance use disorders, with 17 million people struggling with both a mental illness and a substance use disorder. Understanding that both impact each other and in complex ways can help you to seek out the right treatment, to help with your mental health and mood disorder, substance abuse, and how the two overlap.