There is a clear connection between substance abuse and mental health. Substance use and mental health disorders affect very similar areas of the brain, disrupting our ways of thinking and behaving. They cause altered mental states that are difficult for a person to control, and these disorders often co-occur. It’s reported that more than 17 million adults in the United States are battling both substance addiction and a mental health disorder. This statistic causes many people to wonder: Which comes first? Does mental illness lead to substance abuse, or does substance abuse trigger mental health problems?
The answer is both. However, for the purpose of this article, we will be discussing the latter: Substance-induced mental disorders—In other words, mental health disorders that are caused by substance abuse.
When most people drink alcohol or use drugs, there is a temporary feeling of euphoria or relief (a “high” or “drunk”) that fades over a period of time. They then return to baseline, until the next time they drink or use. People who use drugs or drink regularly, however, might be more dependent on these substances to function. They may require more of a drug to feel its effects, and may experience a “low” period following their high. Low periods, also known as periods of withdrawal, can involve difficult emotions, feelings of anxiety, low energy levels, aggressive behaviors, and physical pains like body aches. Typically, withdrawal is experienced by people who are struggling with a substance use disorder (SUD), also known as addiction. These symptoms can often be relieved with continued use of a drug.
However, there is a number of people out there who experience a different type of disorder after using drugs and alcohol. They might face the anxiety, depression, and/or mood changes that come with withdrawal—However, they typically experience these symptoms for longer periods of time (sometimes, even when they are using). This is known as a substance-induced disorder or SID.
What is a Substance-Induced Disorder (SID)?
According to the American Psychological Association (APA), a substance-induced disorder is a significant and persistent emotional disturbance caused directly by the physiological effects of a substance. Substances can include alcohol, drugs of abuse, medicinal drugs, or even heavy metals or toxins (such as gasoline). When exposed to these substances, a person with an SID will experience changes in the way they think, feel, or act. These mood changes may happen right after exposure, or after stopping use of the drug, but can last between days and weeks.
When caused by a drug of abuse – whether legal, like alcohol and prescription medicine, or illegal, like cocaine and heroin – the mood disturbances experienced with an SID must be more severe than what’s normally experienced by a person who is intoxicated or in withdrawal. In the DSM–5, the diagnostic term for this severe disturbance is a substance/medication-induced disorder.
According to the National Library of Medicine, substance-induced mental disorders may occur during active use of a drug, intoxication (directly after drug use), or withdrawal (the “let down” period following drug use).
There are several types of substance-induced mental disorders. Some medications and substances will cause a person to feel depressed and unmotivated. Others will cause a person to have an overload of energy, or manic episodes. Some will trigger severe anxiety. Below are examples of specific conditions that fall under the umbrella of a substance-induced disorder:
- Substance- / medication-induced depressive disorder
- Substance – / medication-induced psychotic disorder
- Substance – / medication-induced bipolar or related disorder
- Substance – / medication-induced anxiety disorder
- Substance – / medication-induced obsessive-compulsive or related disorder
What are the Symptoms of a Substance-Induced Mental Disorder?
The symptoms of a substance-induced mental disorder will mirror the symptoms of an independent mental health disorder or problem being faced. For example, substance-induced depression may be characterized by feelings of sadness and hopelessness. Substance-induced anxiety disorder may manifest as insomnia, persistent fear or worry, or avoidance of certain situations. Substance-induced bipolar disorder might exhibit itself as irritability, periods of increased energy, and periods of depression. You can learn more about common mental health disorder symptoms here.
However, it is important to note that if a person had these symptoms at all before starting to use drugs or alcohol, their condition would not be considered a “substance-induced disorder.” Instead, it would likely be classified as an independent mental health disorder.
The symptoms of a substance-induced disorder generally resolve following the intoxication of a substance and the withdrawal from that substance, lasting up to one month. This is how a substance-induced disorder is typically diagnosed as a separate entity from an independent mental disorder.
The specific diagnostic criteria of substance-induced disorders, according to the DSM-5, includes:
- Symptoms appear within one month of intoxication or withdrawal.
- Symptoms cause significant distress and/or impaired functioning.
- Symptoms did not exist before using the substance.
- Symptoms did not occur solely during intoxication caused by the substance (i.e. while drunk or high).
- Typically, symptoms do not persist for a substantial period of time (i.e. they go away after detox and minor treatment).
What Causes Substance-Induced Mental Disorders?
The cause of substance-induced disorders may sound relatively obvious: substances of abuse. Drugs, alcohol, medications, and toxins can all trigger symptoms of a mental health disorder. However, there is more to it than that. Why do these substances have the power to cause such profound effects on the brain?
When a person uses or is exposed to certain drugs, the drugs disrupt the chemistry of the brain. They cause an imbalance in the natural chemicals needed to control thoughts, emotions, and behaviors. Because of this, drugs can trigger mood problems while they are being taken. Some can cause mood problems that extend for several weeks after stopping drug use. For example, drugs and medications that commonly cause substance-induced mental symptoms include alcohol, illegal drugs, prescription medications, over-the-counter medications, and chemical toxins like paint and gasoline.
How Common Are Substance-Induced Disorders?
The lifetime prevalence of substance-induced mood disorders is relatively low. Research shows that substance-induced depressive disorders, for example, only affect up to one percent of the population. However, those with clinical substance use disorders are at increased risk for SIDs. For example, among those with alcohol use disorder, between 40 and 60 percent of individuals experience substance-induced depression. 55 percent of people with an opioid use disorder also reported substance-induced depression. This data is cited by the National Library of Medicine.
How are Substance-Induced Disorders Treated?
Substance-induced mental disorders, as noted above, typically resolve within one month of exposure to the drug or “irritant.” However, during this period, medication or therapy may be needed to help manage difficult symptoms, particularly if one is at risk of putting themselves (or others) in danger. A clinical assessment and judgement from a qualified professional is needed to determine a proper course of treatment for those with a substance-induced disorder.
Treatment for substance-induced disorders must emphasize safety and methods for reinforcing positive mental health. Further, treatment must reinforce abstinence from the substance that induced the negative symptoms. Maintenance of abstinence is the most important factor in mitigating episodes in the future, and sobriety will offer a person’s best chance of recovery. As noted by national sources, “Familial support, psychotherapy, financial stability, and medication compliance are all factors that promote sobriety.” These are similar principles that are mirrored in a mental health or dual diagnosis treatment setting.
Substance-induced disorders are a reality for many people, ranging from adolescents to adults. If you are concerned about mental health symptoms after exposure to a drug or alcohol, it is important to speak with a professional. You may always contact Turnbridge for support. As a mental health and substance use treatment provider, we are here for you. Call 877-581-1793 to learn more.