Alcohol and other drugs and mental health
This Alcohol and Other Drugs and Mental Health section provides an overview of the relationship between alcohol and other drugs and mental health problems, highlighting the need for integrated prevention, early intervention, treatment and management of these issues.
It is particularly relevant to health professionals including GPs, alcohol and other drug (AOD) workers, mental health clinicians, and community care workers. The intent is to support the need for a collaborative approach to mental health and alcohol and other drug comorbidity conditions which are prevalent and should be considered in tandem to support recovery.
The relationship between alcohol and other drugs and mental health
The relationship between alcohol and other drug (AOD) use and mental health conditions can be mutual.1
Individuals may experience co-occurring mental health and substance use problems and may present to health professionals with one, or both, at any stage.
- At least 55 per cent of people experiencing an AOD use disorder have a co-occurring mental health condition.
- 60 per cent of people with a mental health disorder are also experiencing AOD dependence.2
Co-occurring AOD and mental health conditions – both medically diagnosed (known as a ‘dual diagnosis’) and non-diagnosed - can lead to poorer outcomes for that person.1
For some conditions, including alcohol dependence and depression, co-occurring mental health and drug disorders can be bi-directional, i.e.: alcohol dependence can arise from using alcohol as a coping mechanism for anxiety and depression; while, depression can be an outcome of alcohol dependence.1
The nature of this bi-directional relationship, and how it affects people, is different from person to person – and may change over the course of their life.
A person experiencing a dependence on alcohol may start to experience alcohol-related issues in their personal and work life.3 The end of a relationship, or the loss of a job, may result in symptoms of anxiety and depression on top of the existing dependence on alcohol.4
A person’s physical health can also be affected. For example, alcohol can disrupt sleep,5 which may contribute to some symptoms increasing.6 Nutrition and exercise could also be affected, contributing to poorer health.
People with both AOD and mental health issues also face higher rates of relapse and subsequent hospital visits, imprisonment, unemployment, and family difficulties.1, 7
They are also are more likely to be a victim of violence than the general community, particularly if their mental health condition is severe, and they are more likely to experience homelessness and discrimination.8, 9
Stigma is attached to both conditions and further marginalises people who may avoid seeking help, due to the real or perceived attitudes of others.8
Alcohol and other drugs and mental health challenges are not distributed equally throughout the population.
Many people are vulnerable due to genetic, environmental, social or biological factors over which they have little control: they may experience a severe difficulty or trauma in their life or face chronic personal, social, or economic problems.
Related tags from the Drug Information Directory
- Marel C, Mills K, Kingston R, Gournay K, Deady M, Kay-Lambkin F, et al. Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings. Sydney: Centre of Research Excellence in Mental Health and Substance Use, Centre NDaAR; 2016.
- Jaffe A, Jiang D, Huang D. Drug-abusing offenders with co-morbid disorders: Problem severity, treatment participation, and recidivism. Journal of Substance Abuse Treatment. 2012;43:244-50.
- Holt M, Treloar C, McMillan K, Schultz L, Schultz M, Bath N. Barriers and incentives to treatment for illicit drug users with mental health comorbidities and complex vulnerabilities. Canberra; 2007.
- Keyes KM, Hatzenbuehler ML, Hasin DS. Stressful life experiences, alcohol consumption, and alcohol use disorders: the epidemiologic evidence for four main types of stressors. Psychopharmacology. 2011;218(1):1-17.
- Thakkar MM, Sharma R, Sahota P. Alcohol disrupts sleep homeostasis. Alcohol. 2015;49(4):299-310.
- Nutt D, Wilson S, Paterson L. Sleep disorders as core symptoms of depression. Dialogues Clin Neurosci. 2008;10(3):329-36.
- Victorian Government Department of Human Services. Dual diagnosis: key directions and priorities for service development. Melbourne: Government of Victoria; 2007.
- National Academies of Sciences E, and Medicine,. Ending discrimination against people with mental and substance use disorders: The evidence for stigma change. Washington (DC): National Academies Press; 2016.
- Latalova K, Kamaradova D, Prasko J. Violent victimization of adult patients with severe mental illness: a systematic review. Neuropsychiatric Disease and Treatment. 2014;10:1925-39.
- World Health Organization and Calouste Gulbenkian Foundation. Social determinants of mental health. Geneva: World Health Organisation; 2014.
- Hawkins D. Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: implications for substance abuse prevention. Psychological Bulletin. 1992.
- Hall W, Degenhardt L, Teesson M. Reprint of “Understanding comorbidity between substance use, anxiety and affective disorders: Broadening the research base”. Addictive Behaviors. 2009;34(10):795-9.
- Trewin D, Madden R. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. Canberra, Australian Bureau of Statistics. 2005.
- Demant D, Hides L, Kavanagh DJ, White KM, Winstock AR, Ferris J. Differences in substance use between sexual orientations in a multi-country sample: Findings from the Global Drug Survey 2015. Journal of Public Health. 2017;39(3):532-41.
- Baker A, Baker A, Ivers RG, Baker A, Ivers RG, Bowman J, et al. Where there's smoke, there's fire: high prevalence of smoking among some sub-populations and recommendations for intervention. Drug and alcohol review. 2006;25(1):85-96.
- Irving HM, Samokhvalov AV, Rehm J. Alcohol as a risk factor for pancreatitis. A systematic review and meta-analysis. Jop. 2009;10(4):387.
- Stenbacka M, Leifman A, ROMELSJÖ A. Mortality and cause of death among 1705 illicit drug users: a 37 year follow up. Drug and alcohol review. 2010;29(1):21-7.
- Brown S, Birtwistle J, Roe L, Thompson C. The unhealthy lifestyle of people with schizophrenia. Psychological medicine. 1999;29(3):697-701.
- Taylor D, McAskill R. Atypical antipsychotics and weightgain—a systematic review. Acta Psychiatrica Scandinavica. 2000;101(6):416-32.
- Beebe LH, Tian L, Morris N, Goodwin A, Allen SS, Kuldau J. Effects of exercise on mental and physical health parameters of persons with schizophrenia. Issues in mental health nursing. 2005;26(6):661-76.
- Greenhalgh E, Scollo M, Winstanley M. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2020.
- Kenny A, Kidd S, Tuena J, Jarvis M, Roberston A. Falling through the cracks: Supporting young people with dual diagnosis in rural and regional Victoria. Australian Journal of Primary Health. 2006;12(3):12-9.
- Mortlock KS, Deane FP, Crowe TP. Screening for mental disorder comorbidity in Australian alcohol and other drug residential treatment settings. Journal of Substance Abuse Treatment. 2011;40(4):397-404.
- Hinton M, Edwards J, Elkins K, Wade D. Problematic drug use in young people with first episode psychosis. Drug Use and Mental Health. 2009:165-78.
- Siegfried N. A review of comorbidity: major mental illness and problematic substance use. Australian and New Zealand Journal of Psychiatry. 1998;32(5):707-17.
- Kay-Lambkin F, Baker A, Lewin T. The'co-morbidity roundabout': a framework to guide assessment and intervention strategies and engineer change among people with co-morbid problems. Drug and Alcohol Review. 2004;23(4):407-23.
- Kingston R, Marel C, Mills K. A systematic review of the prevalence of comorbid mental health disorders in people presenting for substance use treatment in Australia. Drug and Alcohol review. 2016;36(4):527-39.
- Proudfoot H, Teesson M. Challenges posed by co-occurring disorders in the clinical and service systems. Drug Use and Mental Health: Effective Responses to Co-Occurring Drug and Mental Health Problems Melbourne: IP Communications. 2008:65-77.
- Kavanagh D. Treatment of comorbidity. In: Teesson M, Burns L, editors. National Comorbidity Project. Canberra: Commonwealth Department of Health and Ageing; 2001.
- Deady M, Barrett E, Mills K, Kay-Lambkin F, Haber P, Shand F, et al. Effective models of care for comorbid mental illness and illicit substance use: An Evidence Check review brokered by the Sax Institute for the NSW Mental Health and Drug and Alcohol Office. 2014.
- De Ruysscher C, Vandevelde S, Vandersplasschen W, De Maeyer J, Vanheule S. The concept of recovery as experienced by persons with dual diagnosis: a systematic review of qualitative research from a first-person perspective. Journal of Dual Diagnosis. 2017;13(4).
- Adlaf EM, Hamilton HA, Wu F, Noh S. Adolescent stigma towards drug addiction: Effects of age and drug use behaviour. Addictive behaviors. 2009;34(4):360-4.