One of the most common — and emotionally charged — questions in mental health is whether mental illness or substance abuse comes first. Families want clarity. Clinicians want accuracy. Individuals want relief from blame. The truth is more nuanced than a simple cause-and-effect answer. Mental illness and substance use disorders often develop together, feeding into one another in a complex, self-reinforcing cycle. For some, emotional distress or psychiatric symptoms precede substance use. For others, drugs or alcohol initiate changes in the brain that lead to mental illness. And for many, both emerge from shared underlying roots.
In many cases, mental illness comes first. Anxiety, depression, PTSD, bipolar disorder, and ADHD can leave people feeling dysregulated, overwhelmed, or desperate for relief. Substances may initially appear to offer comfort, control, or escape — a phenomenon often called self-medication. Alcohol may quiet anxiety, opioids may numb emotional pain, and stimulants may temporarily improve focus or energy. Over time, however, tolerance develops, symptoms intensify, and what once felt like a solution becomes another source of suffering layered onto the original illness.
In other situations, substance use comes first. Certain drugs — especially alcohol, stimulants, and cannabis can trigger anxiety, depression, paranoia, or even psychosis. For some individuals, these symptoms fade with sustained sobriety. For others, substance use acts as a catalyst, activating an underlying vulnerability to serious mental illness that may have remained dormant otherwise. Genetics, age of first use, frequency, and potency all influence how substances interact with the brain and mental health over time.
Often, however, the question of “which came first” misses the larger picture. Mental illness and substance use frequently share common origins: trauma, chronic stress, loss, poverty, isolation, or adverse childhood experiences. Rather than viewing them as separate problems, research increasingly supports integrated, trauma-informed treatment that addresses both simultaneously. Healing happens not by assigning blame or sequencing symptoms, but by restoring safety, connection, coping skills, and hope. When we treat the whole person — not just the diagnosis — both mental health and substance use outcomes improve.
In my workplace, I am the Recreational Activity Coordinator in an Acute Geriatric Behavioral Unit of a hospital. These patients are ages 55 and older, with an acute variety of symptoms where they are a danger to themselves or others, or gravely disabled to the point where they cannot take care of their basic needs of food, shelter, clothing, or personal hygiene. They cannot contract for their own safety. My role is to holistically care for the patients in an activity-based manner. Through mind-body-spirit-intellect-emotion-creative activities, I teach and encourage patients to be partners with their health treatment plans. We practice different styles of coping techniques through everyday fun activities which build their abilities to take care of themselves better after the acute period of care.
Holistic and whole-patient-centered care is important for our most vulnerable folks in the community. My mentor keeps stating that activities are medicine. We have more leisure time when we retire. We definitely need purposeful and passionate pursuits as we age. Otherwise, there is a higher chance of abusing drugs and alcohol, committing crimes, and participating in unsafe sexual practices. I add that throughout one's whole life, we need purposeful and passionate pursuits.
In the recovery practices and in the mental illness world, the medication and meditation work together. The movement practices and the nutrition work together. Seeking out community and connection with a tribe of like-minded individuals serve both populations well, and, the populations can have the similar symptoms when in an acute state. At any age, trauma can trigger more intense symptoms in both populations.
We need to care more. We need to help more. We need to support more. Sometimes the lines between the two populations are blurred, and all of us in society can improve as a result of treating the whole person. Do you know somebody in your circle of love who is suffering with addictions or mental illness? What types of care are they receiving for their symptoms? I want to hear from you.
Sincerely,
KJ Landis
@superiorself on Instagram and X
@SuperiorSelf channel on YouTube
@superiorselfwithkjlandis on TikTok
[email protected]
Books available everywhere!
Bibliography:
~American Psychiatric Association. (2022). DSM-5-TR: Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). American Psychiatric Publishing.
~National Institute on Drug Abuse. (2023). Comorbidity: Substance Use Disorders and Other Mental Illnesses. NIDA. https://nida.nih.gov
~Substance Abuse and Mental Health Services Administration. (2023). Substance Use and Mental Health Issues. SAMHSA. https://www.samhsa.gov
~Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231–244.
~Felitti, V. J., et al. (1998). Relationship of childhood abuse and household dysfunction to many leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245–258.
In many cases, mental illness comes first. Anxiety, depression, PTSD, bipolar disorder, and ADHD can leave people feeling dysregulated, overwhelmed, or desperate for relief. Substances may initially appear to offer comfort, control, or escape — a phenomenon often called self-medication. Alcohol may quiet anxiety, opioids may numb emotional pain, and stimulants may temporarily improve focus or energy. Over time, however, tolerance develops, symptoms intensify, and what once felt like a solution becomes another source of suffering layered onto the original illness.
In other situations, substance use comes first. Certain drugs — especially alcohol, stimulants, and cannabis can trigger anxiety, depression, paranoia, or even psychosis. For some individuals, these symptoms fade with sustained sobriety. For others, substance use acts as a catalyst, activating an underlying vulnerability to serious mental illness that may have remained dormant otherwise. Genetics, age of first use, frequency, and potency all influence how substances interact with the brain and mental health over time.
Often, however, the question of “which came first” misses the larger picture. Mental illness and substance use frequently share common origins: trauma, chronic stress, loss, poverty, isolation, or adverse childhood experiences. Rather than viewing them as separate problems, research increasingly supports integrated, trauma-informed treatment that addresses both simultaneously. Healing happens not by assigning blame or sequencing symptoms, but by restoring safety, connection, coping skills, and hope. When we treat the whole person — not just the diagnosis — both mental health and substance use outcomes improve.
In my workplace, I am the Recreational Activity Coordinator in an Acute Geriatric Behavioral Unit of a hospital. These patients are ages 55 and older, with an acute variety of symptoms where they are a danger to themselves or others, or gravely disabled to the point where they cannot take care of their basic needs of food, shelter, clothing, or personal hygiene. They cannot contract for their own safety. My role is to holistically care for the patients in an activity-based manner. Through mind-body-spirit-intellect-emotion-creative activities, I teach and encourage patients to be partners with their health treatment plans. We practice different styles of coping techniques through everyday fun activities which build their abilities to take care of themselves better after the acute period of care.
Holistic and whole-patient-centered care is important for our most vulnerable folks in the community. My mentor keeps stating that activities are medicine. We have more leisure time when we retire. We definitely need purposeful and passionate pursuits as we age. Otherwise, there is a higher chance of abusing drugs and alcohol, committing crimes, and participating in unsafe sexual practices. I add that throughout one's whole life, we need purposeful and passionate pursuits.
In the recovery practices and in the mental illness world, the medication and meditation work together. The movement practices and the nutrition work together. Seeking out community and connection with a tribe of like-minded individuals serve both populations well, and, the populations can have the similar symptoms when in an acute state. At any age, trauma can trigger more intense symptoms in both populations.
We need to care more. We need to help more. We need to support more. Sometimes the lines between the two populations are blurred, and all of us in society can improve as a result of treating the whole person. Do you know somebody in your circle of love who is suffering with addictions or mental illness? What types of care are they receiving for their symptoms? I want to hear from you.
Sincerely,
KJ Landis
@superiorself on Instagram and X
@SuperiorSelf channel on YouTube
@superiorselfwithkjlandis on TikTok
[email protected]
Books available everywhere!
Bibliography:
~American Psychiatric Association. (2022). DSM-5-TR: Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). American Psychiatric Publishing.
~National Institute on Drug Abuse. (2023). Comorbidity: Substance Use Disorders and Other Mental Illnesses. NIDA. https://nida.nih.gov
~Substance Abuse and Mental Health Services Administration. (2023). Substance Use and Mental Health Issues. SAMHSA. https://www.samhsa.gov
~Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231–244.
~Felitti, V. J., et al. (1998). Relationship of childhood abuse and household dysfunction to many leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245–258.
RSS Feed