Article: Understanding and Coping with Substance Use and Mental Health

Substance use problems, including alcohol and drug misuse, are much more common in people with mental health challenges than in the general population. For example, about 50% of people with serious mental health challenges experience problematic substance use at some point in their lives, compared to only about 15% of people without a mental health condition. Why are the rates of substance use problems so much higher in people with a mental health condition? There is no single answer to this question. Rather, there are multiple different reasons for why alcohol and drug challenges are so common in people with mental health difficulties. Different reasons may apply to different people. And more than one reason may be true for any particular person.

In this article we review different reasons for the high rate of substance use problems in people with mental health challenges. Understanding why you or a loved one may be prone to these problems can help you in taking steps to address them. After reviewing the different reasons for substance use problems in people with a mental health condition, we describe some strategies for coping with these problems and overcoming them.

What are some Common Reasons for Substance Use Problems in People with Mental Health Challenges?
There are several important factors that contribute to substance use problems in people with mental health challenges. Some of the most common reasons are listed below. All of these reasons have some research supporting them:

  • Super-sensitivity to the effects of alcohol and drugs
  • Self-medication
  • Social connection
  • Recreation/pleasure enhancement
  • Lack of meaningful structure
  • Family history of substance use problems

Please click here to read more about reasons why people with mental health challenges may use substances (PDF link).

How Can I Cope More Effectively with Substance Use Problems?
The COVID-19 pandemic has led to multiple challenges in people’s lives, and has been associated with an increase in substance use problems. Considering the common reasons for using substances reviewed above, these increases in substance use are easy to understand. People with mental health conditions be experiencing more severe symptoms due to the confinement and inability to participate in many of the activities that help them cope and keep grounded in their lives. The structure that many people had in their lives before the pandemic has been reduced or is gone, and people are left with a task of creating new structure for themselves.

Although these are challenging times, it is important not to give up hope! New vaccines against the coronavirus have been developed and shown to be protective, and they are being widely distributed at this moment. Brighter days are ahead, when people will be free of the constraints of social distancing, able to pursue their goals and dreams. In the meanwhile, it is important to take care of oneself and this includes putting a check on once use of substances, especially if for people who have had an increase in substance use during the pandemic. 

The SANE approach to substance use recommended in the article by John Kelly in this newsletter will undoubtedly be of help to many people (attending to Social, Activity, Nutritional, Emotional needs). Some additional strategies are listed below that may be useful in helping people cope with their substance use problems:

  • Easy does it
  • Experiment with changing your substance use habits
  • Use distraction to cope with urges to use
  • Explore new ways of getting your needs met

Please click here to read more about strategies to cope with substance use (PDF link).


Kim Muser, PhD
Professor, Boston University Department of Occupational Therapy
Center for Psychiatric Rehabilitation

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