According to the CDC, substance use disorders affect more than 20 million Americans 12 and older. Additionally, up to 50% of individuals with a mental health illness also have a substance use disorder. There’s no question that the pandemic and ensuing crises have complicated the issue even further.

Misty Tu, M.D., medical director at Seattle Anxiety Specialists, explains that substance abuse disorders are a part of mental health. Traditionally, people have thought about mental health as issues with mood, anxiety or thinking (psychosis). “Individuals can have issues with mood, anxiety or thinking and not have substance use disorders,” she explains. “Some individuals with substance use disorders don’t have many problems with mood, anxiety or thinking, but many individuals can have both.”

Kate Willman, MA, LMHCA, HCA, is an associate psychotherapist who agrees there are many observable correlations between mental health issues and substance abuse. “First, the most common mental health issues such as depression, anxiety, etc. can lead to use or abuse of substances as a form of neutralizing discomfort (sometimes colloquially known as ‘self-medicating’),” she says. “Second, substance use itself can contribute to the experience of one or more symptoms of mental health issues — including depression, anxiety, suicidal ideation, psychosis, obsessive thoughts …”

There is also substantial evidence that neurological changes can occur as a result of substance use, depending on frequency, duration and severity, in addition to what substances are involved and when the usage begins. “Finally, there are often correlations between substance use and mental health symptomology that are etiologically indistinguishable,” Willman says. This means there’s often a reciprocity between mental health issues and substance use issues that can make it difficult to discern the specific dynamics between them, let alone causation or source of either or both.

Tu believes that the pandemic has affected mental health treatment in both positive and negative ways. On the positive side, in some cases, there is less stigma and this is something society is more open to speaking about. “We also see many more telehealth options for mental health care. This can expand and open access, especially to rural areas,” she says.

Of course, the pandemic has caused grave issues, too, like exacerbating existing problems and introducing new anxieties — at a time when coping outlets decreased as isolation, already a challenge among individuals with substance use disorders, increased. “Many of our best, most natural coping mechanisms were unavailable to us,” Willman says, “including the live support of family and friends, the release, productivity and enjoyment of the workplace and various hobbies enjoyed both socially or alone.” She adds, “The already easy access to legalized substances like alcohol and cannabis became even easier via delivery programs in many areas, and so some people came to rely on substance use as a primary coping mechanism in the absence of others.”


Tu explains that getting the right diagnosis is the main complication, since this is where treatment begins — and illicit substances can cause symptoms that mimic many mental health illnesses.  “Amphetamines, cocaine and some high-potency and synthetic cannabis can make individuals paranoid, irritable and have insomnia,” she says. “This can look like schizophrenia or a manic episode of bipolar disorder. Alcohol can affect people differently causing mood swings, bizarre behavior, anxiety, depression, etc. Some cannabis and opioid use can cause mimic depression symptoms as well, and then anxiety during withdrawals.”

In light of the many recovery options available, Willman genuinely believes each person must try many forms to see what fits. “What’s ‘best,’ in the end, is what works, right?” she says. “And in terms of recovery, no person can understand what works until they’ve tried it.”

Some of the most common avenues include online and in-person mutual support groups (Willman co-chairs a Ben’s Friends meeting in Seattle that supports members of the hospitality industry); mental health counseling; inpatient treatment facilities; and intensive outpatient services. Willman also highly suggests medical detoxification — or at least medical assistance — for those whose physical dependence is severe.

Tu shares that treatment has to be tailored to the individual, and it often takes a team approach of physicians monitoring physical and emotional health, possibly medications to assist in treatment and therapy with recovery groups for coping skills and social connectedness. She adds, “There are medications that can help with cravings and decrease use in alcohol use disorder as well as opioid use disorder. Some symptomatic treatment is also appropriate but must be done with thoughtfulness.”

“Substance use issues do not develop overnight, thus they are unlikely to be treated overnight,” Willman says. “If one avenue or resource leads to a dead end, try again. And always, remember you are not alone!”

Willman believes that at present there is less stigma and more information surrounding the prevalence of substance use issues and the insidious nature of the disease of addiction. As someone who has been in long-term recovery since 30 January, 2013, Willman’s personal experience in getting sober led directly to her role as a therapist. She says, “I believe each person already has what they need to be free of these shackles [of untreated mental health problems and/or substance use issues], and it is perpetually an honor to work with them and remind them of their potential.”

Both experts recommend resources like The Substance Abuse and Mental Health Services Administration (SAMHSA, 800-662-HELP [4357]). Tu also calls out recovery groups like Alcoholics Anonymous, SMART recovery, Celebrate recovery and Narcotics Anonymous. Individuals can talk to their doctors, and a PCP can usually do a screening assessment and make referrals.

“For those readers who don’t, themselves, identify as struggling with either mental health or substance use issues,” Willman says, “I urge you to become informed anyway, because the likelihood that you or someone you know will at some point face one or more of these issues is essentially guaranteed.”

“Support, accountability, empathy, and inclusion are paramount in treating the very real — and, too often, fatal — diseases of substance abuse and mental illness,” Willman says. “We can all help by informing ourselves and others about the perils of addiction, the resources available for recovery, the universality of mental health issues and the reality that love and understanding are key in facing these successfully.”

Seattle Anxiety Specialists, PLLC is a private psychiatry and psychotherapy practice in downtown Seattle, providing evidence-based treatments and in-depth self-exploration for anxiety and conditions that create anxiety including phobias, depression, GAD, OCD, PTSD, ADHD, OCPD and bipolar.