How Does Addiction Affect You Mentally

Discover how addiction takes a toll on your mental state. Unveil the hidden impact of substance use on mental health.

Leora B.H. Staff

May 30, 2024

Understanding Substance Use Disorder

Substance use disorder (SUD) is a treatable mental disorder that significantly impacts both the brain and behavior of individuals. It refers to the inability to control the use of substances such as drugs, alcohol, or medications, leading to adverse consequences. SUD can range from mild to severe, with addiction being the most severe form [1].

Impact on Brain and Behavior

Substance use disorder has a profound impact on the brain and its functioning. Drugs and alcohol disrupt the normal communication processes within the brain, affecting areas responsible for reward, motivation, and judgment. The repeated use of addictive substances can result in changes to the brain's structure and function, leading to the compulsive and uncontrollable drug-seeking behaviors observed in individuals with SUD.

Moreover, substance use disorder can alter an individual's behavior and cognition. It can impair decision-making abilities, impulse control, and emotional regulation, making it challenging to resist the urge to use substances. These changes in brain structure and behavior contribute to the cycle of addiction and the challenges faced by individuals seeking recovery.

Co-Occurring Mental Health Disorders

It is common for individuals with substance use disorder to also experience co-occurring mental health disorders. These could include anxiety disorders, depression, attention-deficit hyperactivity disorder (ADHD), bipolar disorder, personality disorders, and schizophrenia, among others [1].

The co-occurrence of substance use disorder and mental health disorders presents unique challenges in diagnosis and treatment. When both conditions are present, it is generally more effective to address them simultaneously rather than separately. Tailored treatment approaches, including behavioral therapies and medications, should be based on an individual's specific combination of disorders, symptoms, age, the substance(s) misused, and the particular mental disorder(s) involved.

Treating co-occurring substance use disorder and mental health disorders requires an integrated approach that addresses both conditions comprehensively. Effective medications are available to treat addiction to opioids, alcohol, and nicotine, as well as to alleviate symptoms of various mental disorders. Some medications can be beneficial in treating multiple disorders, providing a holistic approach to recovery [1].

It is worth noting that the prevalence of co-occurring mental illness among individuals seeking substance use disorder treatment is significant. For example, over 60 percent of adolescents in community-based substance use disorder treatment programs have been found to meet diagnostic criteria for another mental illness, underscoring the high rate of co-occurring mental illness in this population.

Mechanisms of Addiction

Understanding the underlying mechanisms of addiction is essential in comprehending how it affects an individual's mental state. Several key factors contribute to the development and perpetuation of addiction. This section will explore three important aspects: dopamine and reward circuitry, neurotransmitter alterations, and the role of brain areas.

Dopamine and Reward Circuitry

Dopamine, a neurotransmitter, plays a central role in the reinforcement of beneficial behaviors such as eating, socializing, and sex. It contributes to the experience of pleasure and motivates individuals to engage in activities that are essential for survival and well-being. Drugs, however, can produce significantly larger surges of dopamine, reinforcing the connection between drug consumption, pleasure, and external cues linked to the experience. This reinforcement leads to the brain seeking drugs at the expense of other healthier activities.

Addiction is associated with a hypo-dopaminergic dysfunctional state within the reward circuitry of the brain. Genetic variations and environmental factors, such as stress and social defeat, can alter brain-reward mechanisms, making individuals more vulnerable to addiction. All addictive drugs enhance the dopaminergic reward synaptic function in the nucleus accumbens, a key component of the reward circuitry. The levels of dopamine in the nucleus accumbens regulate drug self-administration to maintain a desired hedonic level. Tolerance to the euphoric effects of some addictive drugs, such as opiates, can lead to post-use dysphoria.

PET studies have shown that individuals with substance dependence have reduced striatal D2/D3 receptor density, suggesting a blunted dopamine system. This supports the reward deficiency hypothesis of addiction. However, enhanced striatal dopamine release in response to drug cues has also been observed, indicating a heightened incentive motivation toward drug-related cues. This supports the incentive sensitization theory of addiction.

Neurotransmitter Alterations

The use of drugs can lead to significant alterations in various neurotransmitter systems in the brain. Different drugs affect different neurotransmitters, which can profoundly impact an individual's mental state.

For example, stimulant drugs like cocaine and amphetamines affect the levels of dopamine, norepinephrine, and serotonin in the brain. These alterations can result in increased energy, attention, and euphoria. On the other hand, drugs such as opioids can bind to opioid receptors in the brain, mimicking the effects of endogenous opioids like endorphins. This can lead to pain relief, relaxation, and a sense of well-being.

The neurotransmitter alterations caused by drug use can disrupt the delicate balance of brain chemistry, ultimately impacting an individual's mood, cognition, and overall mental state.

Role of Brain Areas

Drugs can affect important brain areas that are necessary for life-sustaining functions and can drive the compulsive drug use that characterizes addiction. Two key brain areas affected by drug use are the basal ganglia, which is part of the reward circuit, and the brain stem.

The basal ganglia, including the nucleus accumbens, is involved in the experience of pleasure and reward. Drugs of abuse can hijack this system, leading to the intense cravings and motivation to seek and use drugs. The brain stem controls basic functions critical to life, such as heart rate, breathing, and sleeping. Drugs can interfere with these functions, leading to various physiological and behavioral changes.

Understanding the mechanisms of addiction, including the impact on dopamine and reward circuitry, neurotransmitter alterations, and the role of brain areas, is essential in comprehending the profound effects addiction has on an individual's mental state. By unraveling these mechanisms, researchers and healthcare professionals can develop targeted interventions and treatment strategies to address the complex nature of addiction and its impact on mental health.

Effects of Drugs on Mental Health

The impact of addiction on mental health is profound, leading to a range of mental health risks and potential influence on neurodegenerative disorders. Understanding these effects is crucial in comprehending the toll addiction takes on an individual's mental state.

Mental Health Risks of Substance Use

Prolonged use of alcohol or drugs can have detrimental effects on mental health, increasing the likelihood of self-harm or suicide. Substance use can exacerbate pre-existing mental health conditions or even trigger the onset of new ones. Research suggests that certain drugs, such as cannabis, may elevate the risk of developing psychosis or a psychotic disorder. It is essential to recognize the potential risks associated with substance use and seek appropriate support and treatment.

Influence on Neurodegenerative Disorders

Drug use can also impact neurodegenerative disorders, further complicating an individual's mental health. The brain is a complex organ, and prolonged substance abuse can alter important areas necessary for life-sustaining functions and drive compulsive drug use. The basal ganglia, which is responsible for the reward circuit, and the brain stem, controlling vital functions like heart rate, breathing, and sleeping, can be affected by drug use [3]. These alterations can contribute to the development or progression of neurodegenerative disorders.

It is important to note that the specific effects of substance use on mental health and neurodegenerative disorders can vary depending on various factors, including the type of substance used, duration of use, and individual susceptibility. Seeking professional guidance and support is crucial for individuals who are struggling with addiction and its impact on their mental well-being.

Understanding the effects of drugs on mental health is the first step towards addressing the hidden toll that addiction takes on an individual's mental state. By raising awareness and promoting access to appropriate treatment and support, we can help individuals navigate their journey towards recovery and improved mental well-being.

Impulsivity and Substance Use

Impulsivity plays a significant role in substance use disorders (SUDs) and can have a profound impact on decision-making. Understanding the relationship between impulsivity and substance use is crucial in comprehending the toll that addiction takes on an individual's mental state.

Impulsivity in Substance Use Disorders

Substance use disorders (SUDs) are strongly associated with impulsivity, with deficient inhibitory control being a key component. Impulsivity is often observed as a preexisting trait that can predict initial substance use, the development of SUDs, addiction risk, chronic use, relapse rates, and treatment retention.

Individuals with SUDs, involving stimulant, opiate, and alcohol use, tend to exhibit higher levels of impulsivity. They also display greater discounting of delayed rewards, which contributes to their susceptibility to substance abuse. These findings suggest that impulsivity is closely linked to the development and maintenance of SUDs.

Impact on Decision-Making

Impulsivity is associated with attentional dysfunction and the inability to follow instructions. Studies consistently demonstrate deficits in impulsivity among individuals with SUD, indicating preexisting deficiencies in the prefrontal cortex. The prefrontal cortex is responsible for executive functions, including decision-making and self-control. Consequently, the impairment of this region due to chronic substance use, such as binge drinking, leads to declined cognitive abilities and increased impulsivity.

The relationship between impulsivity and substance use is bidirectional, with impulsivity contributing to the development and maintenance of SUDs, while chronic substance use further exacerbates impulsivity. This cyclic relationship can create significant challenges for individuals seeking to overcome addiction.

Understanding the impact of impulsivity on decision-making is crucial for developing effective treatment strategies for individuals with SUDs. Promising findings in pharmacological treatments for impulsivity in SUDs include drugs like topiramate, modafinil, and aripiprazole, which have shown efficacy in reducing impulsivity and improving substance use outcomes in individuals with alcohol use disorder (AUD) [7].

By addressing impulsivity and its impact on decision-making, healthcare professionals can develop tailored approaches to assist individuals with SUDs in managing their impulsive tendencies and making healthier choices.

Co-Occurrence of AUD and Mental Health Conditions

The co-occurrence of Alcohol Use Disorder (AUD) and Mental Health Conditions (MHCs) is a significant phenomenon that has gained increasing attention over the past few decades. Research has shown that there is a high rate of co-occurring AUD and MHCs, particularly in young individuals with a history of MHCs. Adolescents with an MHC are at an increased risk of developing AUD, with the onset of alcohol use, regular alcohol use, and AUD occurring at median ages of 12.2 years, 13.8 years, and 14.3 years, respectively.

Prevalence and Risk Factors

In the United States alone, an estimated 14.1 million adults had AUD in 2017, while 46.6 million had an MHC. Among these individuals, 5.9 million adults had current, co-occurring AUD and MHCs, representing 41.8% of individuals with current AUD and 12.7% of individuals with a current MHC. It is important to note that individuals with AUD have a higher prevalence of co-occurring disorders compared to individuals with MHCs. AUD has been associated with an increased lifetime risk for major depressive disorder, anxiety disorder, bipolar I disorder, antisocial, and borderline personality disorders.

Treatment Strategies

Co-occurring AUD and MHCs have been linked to poorer treatment outcomes, including an increased rate of relapse, use of psychiatric services, and use of emergency services when compared to each disorder individually. Therefore, it is crucial to develop treatment interventions specifically tailored for individuals with co-occurring AUD and MHCs.

Behavioral therapies, such as motivational enhancement therapy and cognitive-behavioral therapy, are standard care for individuals with AUD and are key components of treatment plans for those with co-occurring AUD and MHCs. These therapies aim to address both the substance use and mental health aspects, providing comprehensive support and strategies for managing both disorders.

Pharmacotherapy trials have shown modest improvements in MHCs with limited improvement in AUD, and vice versa. While medication alone may not be sufficient, it can be a valuable adjunct to psychotherapy in the treatment of co-occurring AUD and MHCs.

It is worth noting that screening for the presence of AUD and other MHCs may be lacking in certain practice settings, particularly among specific subgroups such as adolescents, individuals from low socioeconomic backgrounds, and racial/ethnic minorities. However, screening for alcohol and substance use in medical settings has become the standard of care, and the efficacy of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in reducing problematic alcohol use has been well-established.

In conclusion, the co-occurrence of AUD and MHCs requires specialized attention and treatment. Implementing comprehensive approaches that address both disorders, including behavioral therapies, pharmacotherapy when appropriate, and supportive community resources, can improve outcomes and provide individuals with the necessary tools for recovery.

Therapeutic Approaches for CODs

When it comes to addressing substance use disorders (SUDs) and co-occurring mental health conditions, therapeutic approaches play a vital role in promoting recovery and improving overall well-being. Two important therapeutic approaches in the treatment of co-occurring disorders (CODs) are the establishment of a strong therapeutic alliance and the implementation of relapse prevention strategies using motivational interviewing.

Importance of Therapeutic Alliance

A therapeutic alliance, characterized by a collaborative and trusting relationship between the individual and their healthcare provider, is a cornerstone of the COD recovery process. It supports recovery from mental disorders and SUDs by improving symptoms, functioning, treatment engagement, satisfaction, and quality of life.

Research has shown that a strong therapeutic alliance is a significant predictor of treatment retention, symptom reduction, enhanced abstinence-related self-efficacy, and more days of abstinence for individuals with SUDs or CODs. By fostering a safe and non-judgmental environment, healthcare providers can engage individuals in their treatment, increase their motivation for change, and promote positive outcomes.

To establish a robust therapeutic alliance, healthcare providers should actively listen to the individual's concerns, provide empathy and support, collaborate on treatment goals, and involve them in the decision-making process. Cultivating a strong therapeutic alliance helps build a foundation for effective treatment and long-term recovery.

Relapse Prevention and Motivational Interviewing

Relapse prevention therapy (RPT) is an effective approach in the treatment of SUDs. It helps individuals maintain health behavior changes by teaching them to anticipate and cope with relapse situations. RPT strategies include assessment procedures, insight/awareness-raising techniques, coping-skills training, cognitive strategies, and lifestyle modifications to prevent relapse and maintain abstinence.

Motivational interviewing (MI) is another valuable therapeutic approach for individuals with CODs. It is a client-centered approach that enhances clients' internal motivation to change by exploring and resolving ambivalence. MI has been shown to be effective in improving behavior change, enhancing motivation, and confidence in people with mental or substance misuse problems, including comorbid conditions.

In the context of CODs, motivational interviewing can help individuals explore their readiness for change, resolve ambivalence, and increase motivation to engage in treatment. By using empathic listening and reflective techniques, healthcare providers can elicit and reinforce the individual's own motivations for change, ultimately enhancing treatment outcomes.

Relapse prevention strategies and motivational interviewing can complement each other in the treatment of CODs. Through relapse prevention therapy, individuals develop the skills and strategies to cope with high-risk situations and prevent relapse. Motivational interviewing helps enhance their internal motivation to make positive changes and engage in the recovery process.

By integrating these therapeutic approaches into the treatment of CODs, healthcare providers can support individuals in their recovery journey, promote long-term abstinence, improve mental health outcomes, and enhance overall well-being.