ConditionMental health & sleep
Substance-Related Mental Disorders
Substance-related mental disorders are conditions in which alcohol, drugs or medicines affect mental health. They include substance use disorders (problematic, compulsive use, often called addiction) and substance-induced mental disorders, in which intoxication or withdrawal causes symptoms such as psychosis, depression, anxiety, mania, delirium or sleep problems. They often occur alongside other mental illnesses. Treatment combines safe withdrawal, therapy, medicines for addiction, and care for the co-occurring condition.
Also called: Substance-induced mental disorder, drug-related psychiatric disorder, dual diagnosis (when with another mental illness), co-occurring disorders
At a glance
- What it covers
- Substance use disorders and mental symptoms caused by intoxication or withdrawal.
- Common substances
- Alcohol, cannabis, opioids, stimulants (cocaine, methamphetamine), sedatives, hallucinogens, tobacco.
- Substance-induced conditions
- Psychosis, depression, anxiety, mania, delirium, sleep and sexual problems, neurocognitive disorders.
- Dual diagnosis
- About half of people with a substance use disorder also have another mental illness.
- Treatment
- Medically supervised withdrawal, medicines for addiction, therapy and integrated mental health care.
- Help line
- SAMHSA National Helpline, 1-800-662-4357, free and confidential.
When to get help
Call 911 or go to the ER
- Thoughts of suicide or self-harm. Call or text 988 (US) or call 911
- Hallucinations, severe paranoia, agitation or violent behavior after using a substance
- Seizures, high fever, confusion or severe shaking during alcohol or sedative withdrawal
- Signs of overdose: unresponsiveness, slow or stopped breathing, blue lips, pinpoint pupils. Call 911 and give naloxone if available
- Chest pain, very high temperature or extreme agitation after stimulant use
See a doctor within a day or two
- Planning to stop daily heavy drinking or sedative use: get medical advice first, as withdrawal can be dangerous
- Psychotic symptoms that continue for days after stopping a drug
- Severe depression or anxiety during withdrawal
Book a routine appointment
- Struggling to cut down or control alcohol or drug use
- Using substances to cope with anxiety, depression, trauma or sleep problems
- Mood or anxiety symptoms that seem linked to drinking or drug use
Two main groups
Substance use disorders
A substance use disorder is a pattern of use leading to significant problems, diagnosed using 11 criteria grouped into impaired control, social problems, risky use and physical dependence (tolerance and withdrawal). Severity is mild (2 to 3 criteria), moderate (4 to 5) or severe (6 or more). See substance use disorder and opioid use disorder.
Substance-induced mental disorders
These are mental health conditions caused directly by a substance during intoxication, withdrawal or after medicine exposure. They usually improve within days to weeks of stopping, but some persist.
| Disorder | Common substances |
|---|---|
| Substance-induced psychosis (hallucinations, paranoia) | Methamphetamine, cocaine, cannabis (especially high-potency), hallucinogens, alcohol withdrawal |
| Depressive disorder | Alcohol, sedatives, stimulant withdrawal, opioids |
| Anxiety and panic | Stimulants, caffeine, cannabis, alcohol and sedative withdrawal |
| Bipolar-like (manic) symptoms | Stimulants, steroids |
| Delirium | Alcohol withdrawal (delirium tremens), sedatives, anticholinergic drugs, intoxication |
| Sleep disorders | Alcohol, stimulants, caffeine, sedative withdrawal |
| Neurocognitive disorder | Long-term alcohol (including Wernicke-Korsakoff), inhalants, sedatives |
| Sexual dysfunction | Opioids, alcohol, antidepressants |
Co-occurring disorders (dual diagnosis)
Substance use and mental illness often occur together and worsen each other:
- Depression and anxiety disorders
- Bipolar disorder
- PTSD
- ADHD
- Schizophrenia, in which cannabis use is linked with earlier onset and relapse
- Personality disorders
A key clinical question is whether symptoms are substance-induced (improving after a period of abstinence, often 1 month) or an independent disorder that needs its own treatment.
Causes and risk factors
- Genetics and family history
- Trauma and adverse childhood experiences
- Early age of first use
- Pre-existing mental health conditions
- Social and environmental factors: peer use, availability, stress, poverty
- High-potency substances, such as strong cannabis products, fentanyl and methamphetamine
Warning signs
- Using more than intended, or being unable to cut down
- Cravings
- Neglecting work, school or family
- Withdrawal symptoms
- Mood swings, irritability or hostile behavior
- Paranoia, hearing voices or unusual beliefs after use
- Changes in sleep, appetite and appearance
- Secrecy, financial or legal problems
Diagnosis
A doctor or mental health professional will take a detailed history of substance use, timing of symptoms and family history, examine physical health, and may use urine or blood drug screens. Observing symptoms during a period of abstinence helps separate substance-induced from independent mental disorders. Screening for infections such as hepatitis C and HIV may be recommended.
Treatment
Integrated care
The best outcomes come from treating substance use and mental health together, by the same team where possible.
Withdrawal management
Medically supervised detox for alcohol, sedatives and opioids, with medicines to ease withdrawal and prevent complications such as seizures.
Medicines
- Alcohol use disorder: naltrexone, acamprosate, disulfiram
- Opioid use disorder: buprenorphine, methadone, extended-release naltrexone. These reduce overdose deaths significantly
- Tobacco: nicotine replacement, varenicline, bupropion
- Antipsychotics for substance-induced psychosis, and antidepressants or mood stabilizers for co-occurring disorders
Psychological therapies
- Cognitive behavioral therapy
- Motivational interviewing
- Contingency management, especially effective for stimulant use
- Trauma-focused therapy
- Family therapy
Support and harm reduction
- Mutual support groups (AA, NA, SMART Recovery)
- Naloxone for anyone at risk of opioid overdose
- Fentanyl test strips and never using alone
- Housing, employment and social support
Outlook
Substance-induced symptoms often resolve after stopping use, though psychosis and cognitive problems can persist in some people. Recovery from substance use disorders is common, and relapse is part of a chronic condition rather than failure. Integrated treatment improves both mental health and substance outcomes.
Frequently asked questions
What is a substance-related mental disorder?
It is a mental health condition linked to alcohol, drugs or medicines. It includes substance use disorders (addiction) and substance-induced disorders, where intoxication or withdrawal causes symptoms such as psychosis, depression, anxiety or delirium.
Can drugs cause psychosis?
Yes. Methamphetamine, cocaine, high-potency cannabis, hallucinogens and alcohol withdrawal can cause hallucinations and paranoia. Most substance-induced psychosis improves within days to weeks of stopping, but some people go on to develop a lasting psychotic disorder.
What is dual diagnosis?
Dual diagnosis, or co-occurring disorders, means having both a substance use disorder and another mental illness, such as depression, anxiety, PTSD or bipolar disorder. About half of people with one also have the other, and both need treatment.
How do you know if depression is caused by alcohol or drugs?
Doctors look at timing. If depression began after heavy use and improves within about a month of stopping, it is likely substance-induced. If it started before use or persists after abstinence, it is likely an independent disorder needing its own treatment.
Where can I get help for substance use?
In the US, call the SAMHSA National Helpline at 1-800-662-4357 for free, confidential referrals, 24/7. A primary care doctor can also help. In a crisis or with suicidal thoughts, call or text 988; in an emergency, call 911.
Sources
This guide was written from current patient and clinical guidance, including:
- American Psychiatric Association: DSM-5-TR, Substance-Related and Addictive Disorders
- National Institute on Drug Abuse: Common Comorbidities with Substance Use Disorders
- SAMHSA: Co-occurring disorders; National Helpline
- NIAAA: Alcohol use disorder treatment
- 988 Suicide and Crisis Lifeline: About 988
- MedlinePlus: Drug use and addiction