Mental Health and Substance Use/Abuse: Strands of a Rope

Mental Health Matters

Dr. Shirley Huisman, MSW, LISW-CP/S, PhD

Owner/Therapist at Oasis Therapy Services

January 26th, 2026

Some human experiences are pretty much universal. We all share some basic similarities, such as the need for food, rest, and connections with other humans, for instance. My friends in the 12-step community have a helpful acronym.  The acronym is HALT. Don’t let yourself get too hungry, angry, lonely, or tired. Any one of these is a threat to one’s recovery from whatever the addiction may be. In any combination of the four, the power of the threat is magnified exponentially.

We also share the experience of pain with perhaps one exception. I recently learned through one of my clients about a genetic condition called Congenital Insensitivity to Pain (CIP), or Congenital Analgesia. It is a rare and life-threatening condition. If we think for a minute about the value of feeling pain, we can recognize that it has a really important role to play in our day-to-day safety, particularly for children. If we touch a hot burner on the stove, the pain immediately alerts us to the danger, and we pull our hand away from the burner. Or we might sprain an ankle, and the pain keeps us from putting more strain and stress on it. If we feel no pain from the sprain, we are at high risk of a more serious injury to that same joint. When a person has CIP, they do not experience any of those warning signals, leading to potentially life-altering/threatening outcomes.

Most of us do not have CIP. Most of us feel pain when we encounter it.  Several years ago, I experienced some of the most intense pain in my life due to a gallbladder condition. And I have birthed four children. I learned very quickly that this pain was not going to go away permanently until my gallbladder was removed. In general, we quickly learn to address the pain in some way. We look for ways to understand it and make it stop or go away. One of the least talked about forms of pain comes through mental health.

Mental health pain has its own complications. It is largely invisible and often misunderstood. It is not like a broken limb where we have a cast. That cast communicates a real story to anyone who sees it. Conditions such as depression and/or anxiety, two common mental health conditions, are hard to detect unless one knows what to look for and what questions to ask.  For a wide variety of reasons, we tend to carry mental health pain for a very long time before we can access treatment of some kind to alleviate that pain.

So, what do we do in the meantime?

Most human beings find, or rather, stumble upon some sort of solution to the problems that depression and anxiety visit upon us. For many of us, that stumble involves trying a substance or alcohol and discovering that it just happens to provide us with some relief from mental health pain. Or perhaps it is not a substance, but rather a behavior such as shopping, gambling, internet usage, just to name a few. When we find that relief, it can become one of the only things that brings about relief, albeit temporary and with its own painful consequences.

Perhaps you have heard of certain conditions that tend to occur hand in hand with one another, or what we call co-occurring conditions. Where we find one, we often find the second. Mental health conditions and substance use disorders are often found to be co-occurring conditions. Is this accidental, or just happenstance? Likely not.

We often find these conditions co-occurring because they share some common roots in brain changes, trauma, and genetics. These roots also often trigger or worsen the other through self-medication or through direct impact. This, in turn, can create a never-ending loop where mental health creates the need for some sort of substance self-treatment, and in turn, the use of the substance or behavior makes worse the mental health condition or vice versa. Often, these co-occurring conditions create other social problems that seem to impact both mental health and substance use even further.

This can look like problems in our personal relationships, our employment, our ability to parent, or our ability to live within the guidelines of legal behavior. Each of these alone can become life-shattering on its own, and often they happen in tandem with each other. Our relationships become riddled with unkept or broken promises, or we might become violent and abusive to those we love the most. We might lose our jobs, leaving us unable to support ourselves and our families. We are at high risk for making poor decisions, such as driving while impaired, taking money to feed our habits, or putting the lives of others at risk. There are those in recovery who can relay stories of having lost pretty much everything important to them before they found help for the dual afflictions of mental health and substance use disorders.

Both conditions share certain risk factors or are affected by and reinforced by shared brain circuitry related to rewards, stress responses, and impulse control behaviors. One of the most powerful reinforcements, of course, is that one often provides temporary relief from the pain of the other. Untreated mental health conditions can create torturous experiences, for which we seek even temporary help. Because, as humans, we seek relief from pain.

Not only are there similar brain structures and circuitry involved in the origins of both conditions, but both conditions also tend to change brain structure and function. They not only exacerbate existing conditions but can also lead to additional conditions. Both will affect mood, cognition, and behavior, making them closely linked and intertwined brain diseases.

So, the cycle can look like this: Mental health issues can lead to substance use problems. Substance use tends to worsen existing mental health conditions and create new ones. Both conditions tend to worsen in relation to one another. The substance use deepens the mental health problems, and the worsening mental health condition tends to increase the amount of substance needed to relieve these symptoms.

While both conditions share biological risk factors, or predispositions, both are also greatly impacted by life circumstances and experiences such as trauma or difficult childhoods. Others include life stressors such as divorce, being laid off from a job, the loss of a loved one, or the common experience of depression after pregnancy. While they are co-occurring brain diseases, they can carry significant social and legal consequences not found with other diseases. For instance, the disease and diagnosis of cancer or diabetes rarely result in the loss of relationships or behaviors that put us at risk of legal consequences.

The very good news is that we have evidence-based, research-backed treatments for both conditions, found separately or co-occurring. We have come to understand that both conditions need to be treated simultaneously for the best outcomes. Substance use treatment without mental health care often fails, and mental health care rarely succeeds if substance use is not also addressed.

What do you do if you are struggling with either or both conditions? If you or a loved one is experiencing either one or both conditions, please reach out to your medical provider as a starting place to seek help. You can also seek out mental health care through either state, local, or individual mental health and addiction specialists as a place to begin. 

The human pain that leads to both these conditions can be profound and life-altering. However, neither one needs to have a permanent hold on your life, as both are treatable. There is recovery. There is hope. There is a community of others who know your story through their own experiences, who are waiting to welcome you into a life where mental health and addiction pain do not have to control you any longer.