Detecting and addressing mental health and substance use disorders — the earlier the better

More than half of the people who seek help for an addiction also have a mental illness. These concurrent disorders present some of the most complicated and difficult-to-treat cases for our healthcare system. The links between mental health and substance use are complex, and causality can vary or be unclear. For example, a young person might use alcohol to cope with anxiety; on the other hand, the use of alcohol and drugs may promote or worsen the presence of psychological symptoms. Regardless of the direction, one way to approach the problem is to try to understand the common factors that can underlie both.

Research suggests there are many developmental pathways through which substance-use disorders and mental illnesses arise, but let’s look at one example: a child who tends to be socially withdrawn, displays emotions such as anxiety and depression, and is fearful of new experiences. Children with these characteristics seem to be at a greater risk of developing concurrent disorders. One study has shown that children with this temperament at age three were more likely later in life to attempt suicide, meet the criteria for depression, and experience alcohol-related problems. Another study of those showing these behaviours in early childhood revealed heightened activity in brain areas sensitive to reward during adolescence, which was later tied to higher levels of substance use in young adulthood.

At first blush, the developmental path to concurrent disorders might seem unavoidable, but with increasing knowledge of risk factors comes the capacity to address the issue from a preventive approach. Often overlooked, children who are socially withdrawn and anxious can be seen as less problematic by parents and teachers than their peers with overt behavioural problems. Because of such tendencies, the essential first step towards intervention is to inform parents, childcare professionals and teachers about how to detect concerning behaviours in children.

While drug-based education aimed at preventing or delaying substance use is often implemented in schools, earlier interventions that enhance social skills are lacking. Emerging evidence suggests that such interventions can be effective in addressing problems that can lead to concurrent disorders later in life. Interventions to enhance parenting skills can be beneficial in reducing behavioural and substance use problems. School-based programs where teachers are trained to implement curricula aimed at improving cognitive, emotional and social competencies in young students are showing promising results, but need to be further examined to ensure their effectiveness. Each child is unique and the best intervention strategy will be one tailored to meet his or her specific needs.

To improve policies, programs and practices in addiction prevention, detection and treatment, the Canadian Centre on Substance Abuse (CCSA) has partnered with organizations such as the Mental Health Commission of Canada, the Canadian Executive Council on Addictions, and the Ontario Centre of Excellence for Child and Youth Mental Health to provide evidence-based information through a number of CCSA publications:

Concurrent disorders are both preventable and treatable, with earlier detection and intervention producing better long-term results. More information is available at

A photo of Opal McInnis

Author: Opal McInnis, M.Sc., Research and Policy Analyst, Canadian Centre on Substance Abuse; PhD Candidate, Department of Neuroscience, Carleton University.

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC


University students’ perceptions of the link between substance use and mental health

Young adulthood can be a vulnerable time for young people. Young adults have the highest levels of alcohol use and related harms among all age groups. Mental health symptoms are also most likely to first present during late adolescence and early young adulthood. But what connection, if any, is there between mental health and substance use for this age group? And what does this mean for post-secondary students?

Rates of mental health concerns and psychological distress symptoms are high among Canadian university students. Data from the 2013 National College Health Assessment Survey showed that 10% of university students have been diagnosed with depression, and 11% diagnosed with anxiety in the past 12 months. Many more students report distress symptoms which can cause significant dysfunction or impairment for young people and may be precursors to later mental health problems. For example, in the last 30 days, 35% of students reported overwhelming anxiety and 40% felt very exhausted.

Research suggests that youth with mental health problems are two to three times more likely to have problems with substance use, and vice versa. Although these issues tend to co-occur, it is not always clear which comes first. Youth with mental health problems may use substances to cope with symptoms of the mental health issue that they find disruptive or uncomfortable. For example, someone suffering from social anxiety may drink to feel more comfortable in social situations.

Alternatively, substance use can create problems that trigger or exacerbate mental health symptoms. For example, alcohol use increases the chances of being a victim of sexual assault or poor-decision making, which could impact mental health. It is also possible that both substance use and mental health symptoms are caused by similar risk factors, such as environmental triggers like stress or trauma, therefore increasing the likelihood of co-occurrence.

But do young people perceive there to be a link between substance use and mental health?

In focus groups, our research lab asked university students about the link between mental health and substance use. Most students believed that mental health influenced student’s use of substances reporting that using substances to cope with stress and other negative situations or emotions, such as bad grades or break-ups, is a common and accepted practice among students. Students reported that support from friends regularly included suggestions of getting “wasted” to “forget about your problems.” However, students did not identify a bi-directional link; meaning they see few mental health consequences from substance use, although some students noted that going out and drinking sometimes prevented them from meeting their deadlines or getting their work done, which increased their levels of stress. Students appear to know that substance use is not a “healthy” way to cope with their stress and problems, but noted that it has the fastest effects and is accepted and encouraged among peers.

Students seem to underestimate the impacts of both mental health and substance use on their overall health and academic success. Would greater discussions in post-secondary settings about the links between these issues help students better understand the relationship between substance use and mental health?

Kara Thompson, CARBC

Author: Kara Thompson, Postdoctoral Fellow, Dalhousie University

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC.