Mental Health and Substance Use = Chicken or the Egg?

By: Julia Geigle, M.S.W., LICSW
YSB Chemical Health Program Supervisor, Specialist D834

Mental Health Disorders (MD) and Substance Use Disorders (SUD)…   

  • are real
  • are public health conditions
  • affect anyone: regardless of age, race, IQ, religion, income
  • can often overlap

Unfortunately, there continues to be stigma and misunderstanding about these disorders. May is Mental Health Awareness Month so it is a great time to educate ourselves and work to eliminate the discrimination that exists around it.

When it comes to mental health and substance use issues, for instance, it is quite common for a person to be battling both of these challenges at the same time.

About 80% of adolescents who are abusing substances also show symptoms of mental health disorders, such as Depression or Anxiety.

AND: approximately 80% of adolescents who struggle with a mental health disorder have turned to substance use as a way to manage their emotional pain.

So, what does this tell us?  That youth don’t typically abuse substances, or frequently get intoxicated, because their life is going ‘great.’

At YSB, our Youth-Focused Therapists and School-Based Chemical Health Specialists know that the best way to help someone who is struggling to make healthy choices – is to explore factors that may be contributing to, or hindering, that person’s overall well-being.

Sometimes the mental disorder comes first and leads to substance abuse, and other times, the substance use disorder comes first, leading to emotional and mental health problems.

It’s the ‘Chicken or the Egg’ conundrum.

Take for instance, an adolescent female who is consuming alcohol every weekend to the point of intoxication, and indicates she is experiencing depressive symptoms. It is hard to know whether she started drinking as a way to deal with her depression, or if the alcohol use lead to depression due to consequences from the use and changes in the brain that can occur from repeated use.
(see below: Co-Occurring Disorder Continuum)

What can also happen is an individual may not disclose his/her substance use to others. It is not uncommon for, especially an adolescent, to hide their substance use and not feel ready to talk about it, yet alone address it. This person may feel that their substance use is actually helping their mental health so they are reluctant to talk about it for fear of being told to quit, being given a punishment by their parents, or getting in trouble with the law.

As substance use is particularly harmful to the developing brain, adolescents do need to be held accountable with reasonable consequences to deter continued use.

At the end of the day, it is about helping that young person become open to addressing possible factors that may contribute to quality of life – and work on those issues in an integrated way to maximize their potential for health and well-being!

Youth Service Bureau’s programs, and district partnerships to provide School-Based Services, help foster this youth-adult relationship – focusing on guiding youth through important conversations, self-reflection and understanding outcomes of continued use.

I stopped smoking and actually looked at my future and asked myself…    
 do I really need this? No
Youth Participant, YSB Chemical Health Services  

YSB staff can give education on substance use and the developing brain, signs and symptoms of substance use disorder, and the overlapping nature of MD and SUD.

YSB Therapists’ or Chemical Health Specialists’ role is not to implement consequences, but rather provide a confidential space for the individual to openly and honestly discuss their use.

The staff member supports the individual to evaluate his/her use by helping them identify the needs their substance use is ‘meeting’ for them that isn’t getting met elsewhere in life. They also discuss finding healthier ways to get these needs met.

*If you know a young person who is struggling with either mental health concerns, substance use issues – or both – confidential services from YSB are only a call or click away.

651.439.8800 |


Mental Disorders (MD)/ Substance Use Disorders (SUD) – Co-Occurring Disorder Continuum:


MD ——————– DD/Co-occurring ——————– SUD

In attempts to understand mental and substance use disorders, we try to put these issues in a cause and effect, linear equation. However, SUD and MD are more like a rubric cube that are entangled in one another. With the advances in medical science, we are realizing more than ever that mental and substance use disorders are legitimate health conditions.

Another way to look at this is envision a continuum with one end of being mental disorders (MD) and the other end being substance use disorders (SUD). Some may fall on the ends of the continuum, while others may fall somewhere along with continuum. An individual that falls right in the middle might meet the criteria for both a MD and SUD. In the medical community, this is referred to as co-occurring disorders or dual diagnosis (DD).
To further illustrate the complexity of these issues, someone may meet the criteria for a severe SUD and a mild generalized anxiety disorder, thus would be on the SUD end of the continuum but not on the end.

Just like other health conditions, a person may be experiencing two separate, but related medical conditions. For instance, a person may have diabetes and heart disease. Thus, for maximum healing to occur, the two need to be treated simultaneously. This is true of those with SUD and MD as well.

There are often barriers to addressing both substance use and mental health issues in an integrated fashion. An example of a barrier to addressing both is this concept of ‘self-medicating.’ For instance, a person may be ‘self-medicating’ their Anxiety with marijuana. The problem with this concept is that it leads people to believe that if that person solely dealt with their anxiety, their ‘need’ for marijuana would disappear.

What we need to keep in mind is that there are people with anxiety who do not use marijuana or perhaps any substance, for that matter. Consequently, it is important to look at the biological, social, and psychological components of the marijuana use as well. It’s like saying, if we focused only on the diabetes, the heart disease will go away. This approach may help minimize the severity of the heart disease, but it’s not a remedy for it. 

Regardless of one’s ‘place’ on the continuum, the most important thing to know is that no one has to face these challenges alone.

YSB’s confidential, life-changing services are available. We welcome your call. 651.439.8800


Better Choices. Brighter Futures. |

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