Written by Ryan A. Schwantes.
Do mental illnesses cause addiction?
When you poll people in the street as we have for the last 33 years, nearly everyone will say yes addictions are caused by mental illnesses (or some line stating that idea). And, if you present an alternative view that mental illness doesn’t cause addiction (or heavy substance use), many people will argue or listen in disbelief or even get angry, shouting their disapproval of your stance on the subject. This reaction is understandable; it’s can be a highly emotional conversation at times because we are discussing a topic that highlights personal beliefs, thoughts, and emotions. We are talking about real people who are seen as vulnerable beings affected negatively by their mental health issues. No one studying the problem of mental illnesses or addictions for that matter wants to be seen as being callous or uncaring while discussing any topic that involves human suffering. Being sensitive to this, we will do our best to look strictly at the data and see what relationship, if any, exists between serious mental health struggles and addictions.
Mental health and mental illness is a nebulous topic that can be difficult to nail down. The truth is addiction is as well. Both have gone through evolutions in their respective definitions for centuries. The frequency of changes in this field of study has increased dramatically in the information age, adding confusion and complication to an already complex view. There are now more mental illnesses described and defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) than ever before. And the same is true of addictions, as it seems we are being told we are “addicted to” something new each day. Consequently, pinning down the relationship between the two can be difficult. To say that one causes the other, when the very definitions of each are in constant flux, is a tough starting point.
With all that said, for the purposes of this article, we will obviously need to make some general assumptions. We will assume as most people do, that there are common mental illnesses such as depression, anxiety disorders, and trauma that are said to cause addictions to substances such as alcohol, opiates, and cocaine, among many others. This, I think, we can agree is the common view being questioned here and is what we will explore.
Let me get right to the point and provide a spoiler alert:
Based on the data, addiction is not caused by mental illnesses, but the two have a slight correlation that is essentially meaningless when looked at from a macro view. Whatever correlation exists, it is just that – a correlation, and not a causal relationship between the two. However, and this is no small point, in the micro or individual’s view, their personal belief that addictions are caused by their mental illness may be so entrenched that this view does indeed become quite believable to them; and beliefs are powerful things. They become the person’s reality and thus the individual acts in a manner that supports their ideas on the topic, no matter how factually inaccurate they may be. It is our hope that this article, and the other information we lay out in our revolutionary book, The Freedom Model for Addictions text can provide a very different perspective from the misinformed recovery society rhetoric we hear supporting the notion that addiction is caused by mental illness. If we can change the current causal view, to one based on the facts, people suffering with mental illnesses may feel more empowered to let go of their addictions should they have them, and vice versa.
The following is an excerpt from Chapter 6 of The Freedom Model for Addictions , Learned Connections that can start that road to progress:
“…there is more data that further reinforces the point that mental illnesses don’t cause heavy substance use, nor is mental illness an obstacle to ceasing heavy substance use. When both addictions and other mental illnesses are measured side-by-side, you can see that addictions are the shortest-lived problems. For example, the National Comorbidity Survey 1990-1992 showed remission rates for drug addiction were more than double the remission rates of all other mental illnesses (about 75% of those surveyed got over their addiction, while just over 30% got over their other mental illnesses.) (Heyman, p. 73-75) How could so many people recover from addiction while not recovering from the mental illnesses that supposedly caused their addiction or were believed to be tied closely to it? For the causal connection to be valid, then logic holds that people wouldn’t get over their addictions until and after they get over their other mental illnesses. Yet data consistently shows that this isn’t the case at all.
In another similar survey, National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) 2001-02, where further data was collected and addiction recovery rates were identical, it was found that those addicts with other mental illnesses were no less likely to recover from their addictions than those without mental illnesses.
The NESARC researchers also specifically analyzed the mental illnesses most common to addiction treatment patients:
“Mood disorders included DSM-IV primary major depressive disorder (MDD), dysthymia and bipolar disorders. Anxiety disorders included DSM-IV primary panic disorder (with and without agoraphobia), social anxiety disorder, specific phobias and generalized anxiety disorder.”
And they found that:
“No association was observed between mood and anxiety disorders and dependence remission for any of the substances assessed.”
So, not only was there no evidence that conditions like depression, bipolar, and anxiety (stress), cause people to “stay addicted”, there was also no correlation found. Let’s sum up what we’ve presented here:
- Only 1 out of 5 people with the mental illnesses said to “cause addiction” actually have addictions.
- The rate of remission from addiction is twice as high as the rate of remission from other mental illnesses.
- Addicts who have other mental illnesses (“co-occurring disorders”) are just as likely to recover from addiction as those without other mental illnesses.”
We then go on in the chapter to discuss the practical aspect of this data; how it relates to someone trying to move past an addiction but who also believed their addiction was caused by their mental illnesses:
“If you want to see your emotional problems as the cause of your heavy substance use, you certainly can make that choice, but you would be holding onto a belief that is false. If you accept the data presented above, the only logical conclusion is that your choice to continue heavy substance use is causally independent of the presence of other mental health issues. The question for you personally then becomes whether or not heavy substance use is a proper and useful response to your emotional problems. That is, does heavy substance use effectively help to relieve your psychological issues in a way that makes it worth the costs involved to you?
But What About My Specific Problem?
The data presented above spoke in broad strokes about mental health issues, and so some of you may still be holding onto the idea that your specific mental health issue, disorder or illness is more unique and truly forces you to use substances. Let us now give you some more specific data.
In this next portion of the book we look at Dr. Stanton Peele’s work on the subject:
In the area of trauma, our friend Dr. Stanton Peele covered this quite succinctly in a 2011 article for Psychology Today, where he examined the data commonly used to promote the trauma/addiction connection. He noted that while high trauma scores were correlated with addiction, we still shouldn’t conclude that trauma causes addiction. In particular, he noted that about 3.5% of those with high childhood trauma scores become IV drug users, and 16% become “alcoholics.” But then he asked readers to look at the other side of this; specifically that 96.5% of those with trauma don’t inject drugs, and 84% don’t become alcoholics. If the numbers were presented in the inverse like this, you’d never assume that people are forced to use substances heavily by trauma.
The Anxiety and Depression Association of America note that:
“About 20 percent of Americans with an anxiety or mood disorder such as depression have an alcohol or other substance use disorder, and about 20 percent of those with an alcohol or substance use disorder also have an anxiety or mood disorder.”
Again, this leaves us with the fact that 80% of people with anxiety and mood disorders don’t connect them to heavy substance use. The ADAA also advised that ‘those with anxiety disorders may find that alcohol or other substances can make their anxiety symptoms worse.’”
It is wonderful to know that what we believe about mental illness matters because it gives us a perspective of potential change should we choose it. We can look at the data and see that we can separate our mental health struggles from our substance use habits. This is massively empowering! It is time to change the narrative that we are beings run by genetics and biology and frankly, human struggle. Those aspects of the human experience are there, and they’re not going anywhere. But if we seek the truth, and in this case a very empowering truth, we are provided tools to change our lives for the better regardless of the sometimes difficult circumstances we find ourselves in. Certainly, knowing that addictions are not caused by mental illnesses is a powerful truth. Next is the question of how to move past your addictions now that they have been separated from your other mental challenges. For this, The Freedom Model for Addictions carries on the conversation.