October 9, 2020

World Mental Health Day: The impact of alcohol and other drugs

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Every year, World Mental Health Day is recognised on October 10 to raise awareness and build support for mental health issues around the world.

When considering mental health, it’s important we keep in mind the relationship it often shares with alcohol and other drug (AOD) use.

This is not to say that every person with a mental health condition has an AOD issue, or that every person using AOD has issues with their mental health.

However, Australian research does suggest that over half of the people accessing treatment for AOD use are also currently experiencing a mental health condition, or have experienced one in the past year.1

What is a dual diagnosis?

When someone is experiencing AOD and mental health issues simultaneously, it is often referred to as a ‘dual diagnosis’.

A dual diagnosis usually includes a range of mental health conditions that can overlap with a range of drug-related issues. The type of diagnosis and its severity can vary from person to person, as can the impact it has on an individual’s life.

There is no single factor that will guarantee a person does - or does not - experience a dual diagnosis. Rather, it is the result of a combination of highly personal and complex experiences.2, 3

Learn more about the social determinants of mental health from the World Health Organization website.

The mutual influence between mental health and AOD use

In many cases, AOD use can directly affect a person’s mental health symptoms; and a person’s mental health symptoms can directly affect their AOD use. This is often referred to as ‘mutual influence’.2, 4

For example:

  • Someone could be experiencing symptoms of depression and anxiety and may use alcohol to help cope with those feelings. However over time, alcohol consumption can contribute to making those symptoms worse, and the person may also develop a dependence on alcohol.4, 5
  • Alternately, a person might experience a dependence on alcohol that causes issues in their personal and work life, which could result in the end of a relationship or loss of a job.5 Negative life events may then lead to symptoms of anxiety and depression alongside the existing alcohol dependence.6

Dual diagnosis and other complex needs

Many people who experience a dual diagnosis may also have a number of overlapping needs relating to their physical health and social, financial, or legal situations.2 While each individual’s experiences and needs will be different, most people will likely need support from a number of different services.

For example, a person with a dual diagnosis is more likely to:

  • experience poorer overall physical health
  • experience homelessness or insecure housing
  • be the victim of violence
  • experience trauma
  • experience poverty or limited income, or have issues with debt
  • be in contact with the criminal justice system
  • experience family issues
  • be at risk of self-harm, including suicide.2-5

The impact of stigma

Stigma is the disapproval of a person based on ‘undesirable’ characteristics or traits that serve to distinguish them from other members of a society.

People experiencing an AOD dependence or a mental health condition are often stereotyped as being dangerous and unpredictable, and may be considered ‘to blame’ for their condition/s.7

When a person internalises stigma and starts to believe negative things about themselves, they can experience shame, low self-esteem, and feel unable to succeed or accomplish goals. This can ultimately stop them from wanting to ask for help.7

The stigma associated with both AOD use and mental health can lead to people denying their symptoms, or feeling as if they cannot seek treatment – resulting in worse health outcomes.7

Treatment and care

There is no single definition of success for AOD treatment or the treatment of a mental health condition.

Each individual is the expert of their own goals and can determine what recovery means for them.8

For example, someone who uses alcohol or drugs may decide that abstinence from AOD use is not desirable and may, instead, seek to only reduce their use or find a way to feel in control of it.

Others may seek professional help and require the support of multiple organisations.

When this occurs, services that adopt a ‘no wrong door’ approach to treatment can help people navigate the network of services and get the support they want.

‘No wrong door’ means that no matter how a person comes into the health care system, they are guided to treatment that is appropriate for their situation and provided with further support for other needs they may have.

Learn more on the No Wrong Door website.

Getting help and support

  1. Kingston REF, Marel C, Mills KL. A systematic review of the prevalence of comorbid mental health disorders in people presenting for substance use treatment in Australia. Drug and Alcohol Review. 2017;36(4):527-39.
  2. Marel C, Mills KL, Kingston R, Gournay K, Deady M, Kay-Lambkin F, et al. Co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings: Illustrations; 2016.
  3. World Health Organization and Calouste Gulbenkian Foundation. Social Determinants of Mental Health. Geneva: World Health Organisation; 2014.
  4. Department of Health and Human Services. Dual diagnosis: key directions and priorities for service development. Melbourne: Victorian Government 2007.
  5. Holt M, Treloar C, McMillan K, Schultz L, Bath N. Barriers and incentives to treatment for illicit drug users with mental health comorbidities and complex vulnerabilities. Canberra: Commonwealth of Australia, Department of Health; 2007.
  6. 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.
  7. National Academies of Sciences EaM. Ending Discrimination Against People With Mental and Substance Use Disorders: The Evidence for Stigma Change. Washington (DC): National Academies Press; 2016.
  8. De Ruysscher C, Vandevelde S, Vanderplasschen 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):264-79.

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