top of page
  • Writer's pictureJon Sommers

Chicken or Egg

What came first, the chicken or the egg? Yeah, this argument has been around for quite a while. So in our context, what comes first: substance use issues or mental health issues? Which one begets the other? How should they be treated? And in what priority?

What are Co-Occurring Disorders (COD)

(I know, I don’t like the term disorder, but in this context it’s a medical term.) In a nutshell, this is when you have both a diagnosed mental health disorder (MHD) and a substance use disorder (SUD). The prevalence of this varies depending on the study cited. If we use the running average of approx. 20M people with SUD, and 9.2M with COD we’re at around 44% of us have both. The other interesting part in this which we won’t get to on this rant is that different MHD tend to skew to different SUD. For example, there’s a strong correlation between bipolar/mood disorder and alcohol use disorder – myself as a prime example here.

NAMI has a great page on this definition: Click to read more.

What’s in a Diagnosis

Here’s the thing, in order to be diagnosed, you have to see a doctor to undergo the mental evaluation in sufficient detail to make the determination. That being said, how many people in our country (which incidentally, fails to provide standardized medical care) have had that opportunity to spend that quality time with a psychologist or psychiatrist? And in regard to studies, keep in mind that they are completely reliant on volunteered information. So the numbers will skew to one direction or the other based on the data population and their willingness to participate. My opinion is that the vast majority of those like me that developed SUD have a COD of some type – formally diagnosed or not. There is a self-destructive nature to severe addiction that is unarguably a mental health issue – the substance being the external manifestation of the internal darkness.

I Vote Mental Health

I just had a friend see a psychologist that was adamant that SUD was the reason for the MHD. That’s stupid. Of course an individual will have signs of MHD while in the depths of substance abuse – they are jacked out of their ever loving minds! So I agree completely on the need for detox and cleansing to re-baseline the brain’s chemistry so we can really get to what the issue is. The problem is that the medical and insurance communities think that treatment consists of a 28-day inpatient (or longer intensive outpatient) for SUD followed by “congratulations, we’re done spending money on you.” Hint, when someone is on their 3rd, 4th, or more SUD “treatment”, their problem isn’t substances. Their problem is they don’t want to live.


At some point, we have to realize that substances are a form of self-medication for the individual. Yes, drugs and alcohol are fun when you start, but that’s not the reason people keep using to harmful levels. Does alcohol help with anxiety? Absolutely. Adderall and Xanax? Of course – so why not take more? All these substances do what they’re intended to do, they just come with a whole lot of side-effects and baggage.

It’s all the Brain

The best bet for tackling these issues is to treat them as if they are the same. Because they are. An addled brain has a mental health issue caused by substance – and a brain that wants to get addled has mental health issue using substance as a medication. SUD is a mental health issue masked by substance-invoked behaviors. Every single relapse that I have been privy to has been because of an underlying mental health issue – the individual just turned to the closest medication they could find.

It’s so much simpler to just lump substance issues into their own neat box with defined treatment parameters and pseudo-guaranteed outcomes. The SUD treatment industry is a multi-billion-dollar machine with giant revolving doors. Go on a bender for a weekend and back you go into the machine. You call that successful? Or cost effective? I have an idea: start treating the underlying mental health issues as soon as you get a person sober. That’s why they got there in the first place. You can get over 150 psychiatric and therapy outpatient visits, with medications, for the same price as a typical 28-day substance treatment stint.

The ultimate goal is to better mental health to a point you no longer need substances.


bottom of page