Behavioral Health: How Mental Illness Affects Addiction

By Adam Volker, MS, RBT on Apr 1, 2018

Patients who suffer from mental illnesses are at higher risk for addiction, particularly substance abuse. The adverse impact of substance abuse can be damaging in combination with cognitive problems related to mental disorders. 


According to a United Nation report, drug addiction takes 200,000 lives annually. To better understand how drug addiction develops, we need to look at what is happening on a cognitive level to reward this destructive behavior. From a psychological perspective, addiction is a disorder of modified understanding. Drugs can alter normal brain structure and functions, forcing cognitive movement that rewards usage through learning and prevents the accession of adaptive behaviors that enhance sobriety. Simply put, most drugs act on the reward center of the brain, leaving users chasing the next high to feel good again.

A recent study by Feltenstein and See distinguishes addiction as a multistage process. In the first stage, a person's casual drug or alcohol usage becomes uncontrollable and progressively constant. The neurological source of these symptoms is induced by drug deregulation of the brain's reward system. In this first stage, drugs typically increase dopamine, or the feel-good hormone. Outside of drug use, dopamine creates signals within the brain and produces enjoyable feelings that make people seek life-sustaining conditions such as eating food, sex and finding supportive environments. With drug use, the release of dopamine becomes the case of too much of a good thing.

In the second stage of addiction, individuals fall further, experiencing relapse, skewed decision-making and withdrawal symptoms as a physical result of their brain changing. Signals carried by neurotransmitters, or the body's chemical messengers, negatively impact the area of the brain associated with judgment, the prefrontal cortex to the nucleus accumbens. 

At this stage, many substance abusers are prone to withdrawal symptoms when they engage sobriety. Depending on the drug being abused, withdrawal symptoms range from vomiting, sleep issues, shakiness, depression and even death. The severity of symptoms often lead to users looking to minimize the negative physical and emotional effects of sobriety by using again so they can feel "normal."

In consideration of cognitive effects, extensive research focuses on drug abuse and the developing brain. The human brain continues to develop from the prenatal period through adolescence. Throughout this period, the brain is easily influenced, and drug abuse can potentially divert the normal course of development. 

According to the CDC, prenatal exposures have uncovered this concern with alcohol disorders, leading the cause of mental retardation in the United States. In addition, early exposure to alcohol in the brain can increase to later substance abuse. In conjunction with prenatal abuse, abuses in adolescent years is a high-risk pool. Most avid adult smokers formed their addictive habits to nicotine in their adolescent years. Recent studies have shown that smoking during adolescence highly affects cognitive skills. A test of working memory, verbal reasoning, and oral arithmetic showed that smokers scored worse than nonsmokers of the same age. Research has also proven that young cigarette smokers experience depression later in life. 

Modern concerns surround addiction and mental illnesses. Drug-induced cognitive deficits may be more catastrophic to individuals whose behavior already suffers from mental disabilities or illnesses. It has been estimated that more than half of users in the United States also suffer from mental illness, typically anxiety or depressive disorder.

Due to the physical changes to the brain, sobriety is often a long and difficult journey. A team of healthcare providers may need to help a user find sobriety, depending on the severity and years of abuse. If you or someone you know may be struggling with addiction, the first step to recovery is being honest with your provider who can provide resources and help.