Substance use alongside a mental health condition

When someone has both a mental health condition and a substance use disorder, the two are called co-occurring disorders. Many people with a substance use disorder also live with depression, anxiety or bipolar disorder, and people with a mental health condition are more likely to develop substance use problems. Stress, trauma and genetics can play a part in both. Some people use alcohol or drugs to cope with symptoms, and substance use can also change the brain in ways that raise the risk of other conditions.

• Drinking or using more, or for longer, than you meant to
• Wanting to cut down, or trying to, without managing it
• Using to calm anxiety, lift your mood or get to sleep
• Needing more to feel the same effect
• Feeling unwell when it wears off, such as shaky, sweaty, restless or unable to sleep
• Keeping on even though it's making you more anxious or low, or causing problems at home or work
• Taking risks while using, such as driving

These signs are a general guide, not a checklist for diagnosis. Substance use disorders range from mild to severe, and they're treatable.

Getting the diagnosis right matters, because the symptoms of substance use and of mental health conditions can overlap. Some drugs can mimic or worsen mood symptoms, so we take time to understand how they fit together.

As part of a comprehensive psychiatric evaluation, we ask about:

• What you use, how much and how often (honest answers help us keep you safe, and there's no judgment)
• How your mood, anxiety and sleep change with use, and which seemed to come first
• Past attempts to cut back, and any withdrawal symptoms you've had
• Your physical health and every medication you take
• What you want to change, and what would make change feel possible

Together we look at whether outpatient care is the right fit, or whether you'd be safer with more support first. Your first evaluation is up to 90 minutes in length. Some people need more time, some less, and we take the time you need. Follow-up visits are typically 20 to 30 minutes, and extended follow-ups are available.

Treating the psychiatric condition. When anxiety, depression, bipolar disorder or sleep problems are part of the picture, we treat them, with medication when it's appropriate. We explain every choice, including how a medication may interact with alcohol or other substances.

Real conversation in every visit. Visits include motivational interviewing, CBT-informed strategies for triggers and stress, and practical work on sleep. You set the goals; we help you get there.

Help finding more support. We don't offer standalone weekly therapy, but we're happy to help you find a therapist and, with your permission, we'll coordinate with them. We can also point you toward substance use counseling and support groups.

Regular follow-ups. Change rarely happens in a straight line. Regular visits let us check in, adjust carefully and keep you on track.

If alcohol is part of the picture, your provider can talk with you about options, which may include non-controlled medications such as naltrexone tablets or acamprosate when appropriate. We don't offer injectable naltrexone (Vivitrol) or detox.

Some situations need more support than outpatient visits can safely give. We don't provide detox (medically supervised withdrawal), crisis care, inpatient care, day programs (PHP), intensive outpatient programs (IOP), or medication treatment for opioid use disorder. That isn't a judgment about you. It's about getting you the care that fits, and we'll help you find it.

• If you drink heavily and want to stop: please talk with a medical provider before you stop. Alcohol withdrawal can become life-threatening, and moderate to severe withdrawal may need care in a hospital or treatment facility. Go to the nearest emergency room or call 911 for seizures, fever, severe confusion, hallucinations or an irregular heartbeat.
• To find a program near you: call SAMHSA's National Helpline at 1-800-662-HELP (4357). It's free, confidential and open 24 hours a day, every day, in English and Spanish, and it refers callers to local treatment, support groups and community organizations. You can also search FindTreatment.gov.

If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), any time, day or night. In an emergency, call 911 or go to the nearest emergency room.