Substance Use and Mental Health: Understanding the Cycle of Dependence
When the thing we use to run away from starts taking over our lives like think of a person who has a bad day. They might feel anxious or overwhelmed, lonely or emotionally drained. One thing helps them through the day, something that takes away the pressure and tension. It helps them sleep better, relieves some stress. The person starts thinking that maybe this thing helps them more than it harms. And that thought can be enough to start a downwards spiral.
Using substances like alcohol to cope is not always a deliberate choice, sometimes a person might not even perceive it as such. In many cases, the use of a substance is soothing, energizing, calming, numbing, or even empowering. However, when the positive effects begin to fade and disappear, a person may experience an uncomfortable withdrawal and will do anything to return to that state. This creates an association of a substance with stress relief, anxiety relief, and other positive feelings.
The Temporary Escape
Alcohol, nicotine, cannabis, opioids, and other psychoactive substances can alter the brain’s reward system and create associations between the substance and certain emotions.
Depending on the type of substance, they may have different effects on a person. But the general idea remains the same there is a trigger (a stressful event, anxiety, insomnia, etc.), a person uses a substance, which temporarily relieves some of the uncomfortable feelings. As a result, a brain learns that this particular substance can help take away the stress or anxiety or insomnia. This lesson is often painful to unlearn. Especially when a person continues to use drugs because they believe that without it, they cannot function.
The vicious cycle may look like this:
Psychological distress
↓
Use of a substance to alleviate some of the uncomfortable feelings
↓
Relief and decrease of the distress symptoms
↓
Development of tolerance and psychological dependence
↓
Side effects and withdrawal symptoms
↓
Increased stress levels
↓
Psychological distress
↓
And so on….
Hence, a thing that was supposed to help a person cope with their problems started to interfere with their daily life.
The Vicious Cycle of Substances and Mental Health
Substances and mental health exist in a vicious cycle. Treating one without treating the other will only lead to more issues in the long run.
A person with depression, anxiety, post-traumatic stress, or other disorders often turns to substances as a coping mechanism. On the other hand, substance abuse can induce episodes of depression or anxiety and other mental problems. That is why asking “Why don’t they just stop?”, while understandable, misses the point.
Perhaps a more interesting question would be “What does the substance help them with?”, and “How can we treat this issue without recurring to substances?”
This is a far cry from the simplistic “Bad things > Good things > Bad things > Stop”. Real people have real issues that often require real treatment. But this is a complex topic that deserves a separate discussion.
I’m sure we all heard the labels “Addict”, and similar terms that imply that the person is bad or weak, and as such, the blame for their substance abuse lies in them. But there are often multiple reasons why a person resorts to substance abuse:
- Unprocessed trauma
- Stress or Loneliness
- Anxiety or depression
- Lack of emotional stability
- Social pressure or Environmental influences
- Grief
- Biological factors
- And many, many others
Recovery Is More Than Removing the Substance
Stopping substance use is an important part of recovery, but recovery often requires more than simply taking the substance away.
If the substance was being used to manage anxiety, treatment needs to provide healthier ways of managing anxiety. If it was being used to numb traumatic memories, those experiences may need therapeutic attention. If it was providing social belonging, recovery may involve rebuilding supportive relationships. If it was filling a sense of emptiness, therapy may explore identity, meaning, relationships, and emotional needs.
In other words:
Remove the coping strategy → replace it with healthier coping → address the underlying distress.
Evidence-based treatment can include psychological therapies, motivational approaches, relapse-prevention strategies, peer or family support, and when appropriate medication and medical care.
Compassion Is Part of Treatment
Substance dependence is often surrounded by shame.
Family members may ask, “Why are you doing this to yourself?”
The individual may ask, “Why can’t I control myself?”
But shame can increase isolation, and isolation can make recovery more difficult.
A compassionate approach does not mean ignoring consequences. It means recognising that accountability and compassion can coexist.
A person can be responsible for their recovery while also deserving understanding and appropriate support.
Breaking the Cycle
The cycle of dependence can feel repetitive:
Pain → use → relief → consequences → more pain → use again.
Breaking it may begin with something which can look like –
Pause. Notice. Understand. Seek help.
What emotion comes before the craving?
What situation triggers the urge?
What does the substance provide relief, confidence, sleep, numbness, escape?
And what healthier strategies could provide some of those needs?
Recovery is rarely a straight line. It is a process of understanding patterns, developing alternative coping skills, repairing relationships, managing triggers, and learning to tolerate difficult emotions without automatically escaping them.
The substance may be the visible part of the problem. The pain underneath may be the part that needs to be heard.
And sometimes, healing begins not with asking “How do I make them stop?” but with asking:
“What are they trying so hard to escape from?”