What if I have depression, anxiety or trauma as well as a substance problem?

You are not unusual

NIDA's page on co-occurring disorders explains that it is common for a substance use disorder and another mental health condition to occur together. It names anxiety, depression and post-traumatic stress disorder among them, and notes that more than 30 percent of adults with a substance use disorder experienced childhood trauma.

NIAAA's treatment booklet lists depressive disorders, anxiety disorders, and trauma and stress-related disorders among the conditions that commonly occur with alcohol use disorder. It advises seeking treatment for accompanying mental health issues as well.

How the two can affect each other

NIDA describes how people who feel anxious, stressed, depressed or in pain may use substances to try to feel better. Some substances can reduce symptoms for a short time. NIDA notes they can also make those symptoms worse. A NIAAA resource written for health professionals gives an example: alcohol may seem to relieve anxiety at first, but over time heavy drinking and repeated withdrawal can make both worse.

That can make it hard to tell what came first. Sometimes low mood or anxiety eases once drinking or drug use stops. Sometimes it continues, or becomes clearer, because it was there all along. Working that out is part of a clinician's job, and it may take some time after use stops before the picture is clear.

You do not need to know which came first to ask for help. Describe what you notice, when it started and what makes it better or worse.

Why treating both together matters

NIDA says it is usually better to treat these conditions at the same time rather than separately, and that integrated treatment leads to better health outcomes. NIDA's Principles of Drug Addiction Treatment adds that someone with one condition should be assessed for the other, and that treatment should address both, including medication where appropriate.

NIDA also notes that people with both conditions often find it harder to stay in treatment. A plan that ignores anxiety or depression can leave someone struggling with the very feelings that make stopping difficult.

What to ask a program

Not every program offers the same level of mental health care. ASAM's Criteria FAQ describes an expectation, under its latest edition, that programs be able to recognize co-occurring conditions and build them into treatment plans, with at least one staff member qualified to assess them. It says programs are not expected to provide specialist mental health treatment themselves. People with more complex needs may be better served by programs described as co-occurring enhanced.

When you contact a program, ask who assesses mental health and what qualifications they have. Ask whether therapy for depression, anxiety or trauma is part of the program or arranged somewhere else, and whether there is a psychiatrist or other prescriber for mental health medication. Ask how the program coordinates with a therapist or doctor you already see.

If trauma is part of your story, ask how the program approaches it. Some people need to know they will not be pushed to talk about details in a group before they are ready. You can ask whether there are private sessions and how staff respond if something in a group brings up distress.

If you already take medication for your mental health

Tell the program about every medication you take, including antidepressants, anti-anxiety medication and sleep aids. Ask how those will be reviewed and managed during treatment.

Do not stop a mental health medication because you are entering substance use treatment, unless a prescriber advises it. If a program's rules seem to require a change, ask for the clinical reason and who made the decision.

If you are in crisis

If you are thinking about suicide or harming yourself, call or text 988 or call 911. You do not have to be sure it is an emergency to reach out. This applies whether or not you are in treatment, and whether or not you have been drinking or using.

If you are in a program, tell a staff member straight away. Mental health crises are part of what a treatment team needs to know about, not something to manage alone so that you seem to be coping.

Keeping both in view after treatment

The need for mental health care does not always end when a substance use program does. Before you leave, ask who will continue to see you for depression, anxiety or trauma, and whether that appointment is booked. Ask what to do if symptoms return between appointments.

The same NIAAA resource says the likelihood of recovering from both conditions is higher when both are treated. A plan that includes both kinds of care is worth asking for.