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substance use and mental health

substance use and mental health

substance use and mental health are deeply interconnected, with each influencing the other in significant ways

Substance use and mental health conditions often co-occur, complicating diagnosis and treatment. Substance use can worsen or even trigger mental health issues, leading to a vicious cycle that is difficult to break. Understanding this connection is crucial for effective treatment and support within communities. 

People dealing with both substance use and mental health issues, such as anxiety, depression and Post Traumatic Stress Disorder (PTSD), face unique challenges. The co-occurrence of these conditions, known as dual diagnosis or co-occurring conditions, requires treatment approaches that address both issues simultaneously.

The stigma surrounding both mental health and substance use can also create additional barriers to seeking help, highlighting the importance and need for supportive environments and accessible resources. In Scotland, this issue is particularly relevant due to the high rates of alcohol and drug use. People with mental health conditions may turn to substances like alcohol, drugs or nicotine as a form of self-medication to cope with their symptoms. In 2022, there were more than 1,000 deaths due to drug use in Scotland. 

Myths about substances
and mental health

substance use is always a choice and a sign of moral weakness 

Substance use can often stem from underlying mental health conditions, genetics or traumatic experiences. It is a complex issue that goes beyond willpower or morality.

mental health problems caused by substance use are temporary and will resolve once the person stops using it

While stopping can improve mental health, many individuals may need ongoing treatment for underlying mental health conditions that predate or were exacerbated by substance use. 

people with mental health conditions should never use medication for their issues because it’s just another form of substance use

Medications prescribed for mental health conditions are scientifically validated treatments that can be crucial for managing symptoms and improving quality of life.


The relationship between substance use and mental health is influenced by a variety of factors, many of which are relevant to Scotland’s unique social and economic context. Some of these causes include:

Biological factors

Genetics play a significant role in both substance use and mental health conditions. If a person has a family history of these issues, they may be more likely to develop them. Additionally, imbalances in brain chemistry can make individuals more susceptible to both substance use and mental health issues.

Environmental factors

Traumatic experiences, such as abuse, grief or significant life changes, can contribute to the development of both substance use and mental health issues. In Scotland, socioeconomic factors such as poverty, unemployment and housing instability are significant contributors to substance use. Stressful environments and limited access to mental health services in rural areas can also increase risk.


Stigma surrounding substance use and mental health conditions remains a significant barrier to seeking help and receiving effective treatment in Scotland. 

People with co-occurring disorders often face dual stigma, being judged both for their substance use and their mental health issues. This can lead to feelings of shame and isolation, making it more difficult to reach out for support. Misunderstanding and prejudice from society, family and even healthcare providers can further exacerbate these challenges, discouraging individuals from pursuing the help they need. 

How does substance use affect my mental health? 

Substance use can negatively impact mental health, often leading to lowered mental health outcomes. Here are some of the ways substance use can affect your mental health:

Development of serious mental health issues: Substance use can trigger or worsen mental health conditions such as depression and anxiety. Some substances, particularly stimulants and hallucinogens, can induce psychosis, a condition characterised by a loss of contact with reality.

Increased risk of self-harm and suicidal thoughts: Individuals who use substances are at a higher risk of experiencing self-harm and suicidal thoughts. Substance use can lead to impulsive behaviours and a sense of hopelessness, increasing the likelihood of self-injurious actions.

Strains on relationships: Substance use often strains personal relationships. It can lead to conflicts, misunderstandings and a breakdown in communication. Loved ones may find it challenging to cope with the behaviour changes associated with substance use.

Loneliness and social isolation: Substance use can lead to social isolation as individuals may withdraw from social activities and relationships. The stigma and shame associated with substance use can make it difficult to seek support, resulting in increased feelings of loneliness.

How do I know if I am using substances? 

Recognising substance use can be challenging, especially if you are using substances to cope with mental health issues. Here are some signs that you may be using substances: 

Increased tolerance: Needing more of the substance to achieve the same effect.

Withdrawal symptoms: Experiencing physical or psychological symptoms when not using the substance. These can include sleeping problems, nausea, sweating, dissociation, shaking or sensory disturbances.

Neglecting responsibilities: Failing to fulfil obligations at work, school or home due to substance use.

Loss of control: Consuming more of the substance than intended or being unable to cut down despite wanting to.

Social problems: Facing issues in relationships or social activities because of substance use.

Addiction: Feeling a persistent desire or craving for the substance, spending a significant amount of time obtaining, using or recovering from its effects.

How to help yourself

If you are struggling with both substance use and mental health issues, it is essential to take proactive steps towards recovery: 

  • Seek professional help: Contact a healthcare provider to discuss your symptoms and receive a proper diagnosis. In Scotland, integrated treatment programmes that address both mental health and substance use simultaneously are highly recommended. You can read more about this on the NHS inform website. 
  • Practise self-care: Engage in activities that promote physical and mental well-being, such as regular exercise, a healthy diet and sufficient sleep. Mindfulness practices like meditation or yoga can also be beneficial. 
  • Build a support network: Surround yourself with supportive friends and family who understand your struggles and can offer encouragement. Try to integrate with different social circles that might not revolve around substance use. Support groups specifically for substance use and mental health like those listed at the bottom of this page can provide additional communal support. 

How to help others 

Supporting someone with co-occurring substance use and mental health issues requires empathy, patience and understanding:

Gain a deeper understanding

Learn about their conditions to better understand what they are going through and how you can help.

Offer non-judgmental support

Listen to them without judgement and offer a safe space for them to express their feelings. Avoid giving unsolicited advice and instead offer to help them in finding professional support.

Encourage treatment

Recommend that they seek professional help and support them in attending appointments or following treatment plans. Be patient and understand that recovery is a process that takes time.


Our Advice and Support Service is open Monday to Friday, 10am to 4pm, where advisers can signpost you to local support that most fits your needs, including our Change Mental Health services. We offer initial advice on money worries and help to deal with emergencies. 

Contact 0808 8010 515, email us at or fill out the enquiry form on the Advice and Support Service page. 

Other Support

Turning Point Scotland: Provides specialised support for people with complex needs, including those with co-occurring substance use and mental health disorders. Visit Turning Point Scotland to learn more.

Scottish Families Affected by Alcohol & Drugs (SFAD): Offers support to families affected by substance use, including counselling and support groups. Visit SFAD for resources and assistance.

Breathing Space: A confidential helpline for people in Scotland feeling low, anxious, or depressed. Call 0800 83 85 87 or visit Breathing Space.

Alcohol Focus Scotland: Provides resources and support for those affected by alcohol use. Visit Alcohol Focus Scotland for more information.

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