Blog: Intersection of Mental Health and Substance Use

Mental health and substance use often co-occur and are complications that require trauma-informed and person-centred care. Destigmatization and harm reduction approaches are important in these circumstances.   

By Amethyst Zapisocky, ESPC Volunteer

Substance use and mental unwellness can be interlinked. When they are co-occurring they typically reinforce each other which has many adverse effects on well-being and life functioning. (1)  It is indeterminable if mental health complications or substance use comes first for many reasons: drugs may be used for self-medication purposes, they have common risk factors (such as genetic predisposition, stress, and/or trauma), and the substance(s) may heighten/awaken preexisting mental illness or even cause them by altering brain structure. (1) (2) Nonetheless, substance use and its interaction with mental health is a grave and serious reality in Canada, as reflected by the ongoing opioid crisis. (3)  

There have been 1443 deaths from drug poisoning (any substance) in Alberta between January and November 2022, with 556 occurring in Edmonton. (4) Furthermore, more than 1 in 4 adults living with a mental health diagnosis also struggle with substance misuse, (5) and people with mental illness are twice as likely as other Canadians to engage with substances. (6) Common susceptible mental disorders include ADHD, depression, anxiety, schizophrenia, bipolar disorder, and personality disorders. (2) (5) For example, those with major depressive disorder (MDD) are twice as likely to use alcohol harmfully, with drug dependence being four times as likely. (7) Those with both substance dependence and MDD are less likely to seek treatment while more likely to have heightened suicidal thoughts and psychological distress. (7)  

Stigmatization 

Despite a need for respectful and effective intervention, mental unwellness and substance use are frequently marginalized and stigmatized – much to the detriment of impacted individuals. (3) (8) This negatively affects how the (opioid) crisis is perceived, hinders the establishment of necessary help-giving services, perpetuates misinformation on mental and substance use disorders, and poses a barrier to accessing treatment. (3) These negative effects are further complicated when judgment comes from medical professionals, which can result in inadequate care and system mistrust. (3) Destigmatization is paramount. It involves challenging the misconceptions that people who struggle with mental health and/or substance misuse are morally corrupt or unworthy. (3) (8) It also requires addressing systemic gaps, training for trauma-informed care in healthcare (and other front-line services), establishing contact, and educating on substance use and recovery. (3) (8)  

Because abstinence from substance use is not always possible, harm reduction is a beneficial approach to addressing the use of substances. (8) (9) Harm reduction aims to minimize harm from substance use by providing care that is inclusive, trauma-informed and person-centred. (8) (9) Rather than focusing on abstinence, this approach meets individuals where they are, listens to them, and recognizes the person’s particular circumstances and needs. (8) (9) It serves those who use substances by providing them with information on the potential risks along with informing them on safe use. (8)  

A substantial percentage of people who experience mental and/or substance use difficulties do not seek treatment or services, which is heightened in street-involved populations. (10) Studies conducted in Edmonton have found that such populations have complex circumstances, enduring trauma and facing both social and care exclusion. (10) (11) According to a study published in 2022, Edmontonians in this situation often perceive a need for health services (89%) and do pursue them (73%). (10) However, only 8% of respondents who sought help had their needs met. (10) This percentage of unmet care is much higher than what is reported in the general population, indicating a care system in need of improvement for this underserved community. (10)  The reported reasons for not accessing care were wanting to manage care by oneself (most common), not wanting help at the time, not knowing where to find help, and being allowed a limited amount of time (least common); this could reflect mistrust in the system, based on intersectional negative biases/discrimination that persons who are unhoused experience. (10) 

Finding Help and Responding to Drug Poisoning 

Challenging misconceptions about mental illness and substance dependence is important in minimizing harm and destigmatizing these serious (and often co-existing) conditions. Further, recognizing and knowing the signs and symptoms of mental unwellness and substance misuse can be the first step in initiating healing (HelpGuide lists some indicators). (1) If a mental or substance use disorder is suspected, professional advice should be sought.  

Preventing overdose and minimizing harm from substance use is crucial. If you suspect an overdose is occurring call 911 immediately. (12) Signs of drug poisoning, as outlined by Alberta Health Services (AHS) are (12): 

For opioid overdose, Naloxone Kits are vital and are available here. (13) For other drug poisonings, stay with the person and call 911. (13) Placing the individual in the recovery position may also be helpful–especially for alcohol poisoning. (13) Avoiding overdose can also occur by not using substances alone, and by utilizing supervised consumption sites. (14) (15) AHS educational tools are available here, along with their information on drug safety available here. Further supports available are as follows: 

• AHS offers a 24/7 line for Addiction & Mental Health available at 780-424-2424  
• Indigenous-specific substance use and wellness support can be found through The Thunderbird Partnership Foundation or from the Government of Canada’s website 
• Edmonton services for mental health and addiction for adults, youth, and seniors 

• The Edmonton Housing Directory lists places and services for those in need of housing (PDF for the latest 2022 version) 

Amethyst Zapisocky is working towards a BA in psychology at the University of Alberta. A fourth-year undergraduate student, her career focus is on research and social development. She values equity, learning, and philanthropy. Personally, Amethyst enjoys statistics, mindfulness and jazz music. 

References 

1. Robinson, L., Smith, M., & Segal, J. (2023, January 4). Dual diagnosis: Substance abuse and mental health. HelpGuide. https://www.helpguide.org/articles/addictions/substance-abuse-and-mental-health.htm  
2. National Institute of Mental Health. (2021, March). Substance use and co-occurring mental disorders. https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health  
3. Mental Health Commission of Canada. (2020, October 14). Stigma and the opioid crisis: Summary. https://mentalhealthcommission.ca/resource/stigma-and-the-opioid-crisis-summary/  
4. Government of Alberta. (2023, January). Acute substance deaths overview. Alberta Substance Use Surveillance System. Retrieved January 24, 2023, from https://healthanalytics.alberta.ca/SASVisualAnalytics/?reportUri=%2Freports%2Freports%2F1bbb695d-14b1-4346-b66e-d401a40f53e6&sectionIndex=0&sso_guest=true&reportViewOnly=true&reportContextBar=false&sas-welcome=false  
5. MentalHealth. (2022, March 10). Mental Health and substance use co-occurring disorders. https://www.mentalhealth.gov/what-to-look-for/mental-health-substance-use-disorders  
6. Mental Health Commission of Canada. (n.d.). Mental health and substance use. https://mentalhealthcommission.ca/what-we-do/mental-health-and-substance-use/  
7. Currie, S. R., Patten, S. B., Williams, J. V., Wang, J., Beck, C. A., El-Guebaly, N., & Maxwell, C. (2005). Comorbidity of major depression with substance use disorders. The Canadian Journal of Psychiatry, 50(10), 660-666. https://doi.org/10.1177/070674370505001013  
8. Danda, Michelle. (2022). Meeting substance use patients where they are. American Journal of Nursing, 122(4), 11. https://doi.org/10.1097/01.NAJ.0000827256.97267.59  
9. Alberta Health Services. (n.d.). Harm reduction: Harm reduction services. https://www.albertahealthservices.ca/info/Page15432.aspx  
10. Hyshka, E., Anderson, J. T., & Wild, T. C. (2017). Perceived unmet need and barriers to care amongst street-involved people who use illicit drugs. Drug & Alcohol Review, 36(3), 295–304. https://doi.org/10.1111/dar.12427  
11. Addorisio, S., Kamel, M. M., Westenberg, J. N., Heyd, A., Maragha, T., Abusamak, M., … & Krausz, R. M. (2022). Unmet service needs and barriers to care of individuals experiencing absolute homelessness in Edmonton, Canada: a cross-sectional survey. Social Psychiatry and Psychiatric Epidemiology, 57(2), 387-395. https://doi.org/10.1007/s00127-021-02080-2  
12. Alberta Health Services. How to spot an overdose. https://www.albertahealthservices.ca/info/Page16025.aspx#symptoms  
13. FraserHealth. (n.d.). Information, resources and tips on how to respond to an overdose. https://www.fraserhealth.ca/health-topics-a-to-z/mental-health-and-substance-use/overdose-prevention-and-response/responding-to-an-overdose  
14. Alberta Health Services. (n.d.) Supervised consumption services. https://www.albertahealthservices.ca/info/Page15434.aspx 
15. Alberta Health Services. (n.d.). DrugSafe. https://www.albertahealthservices.ca/info/Page12491.aspx