Is Addiction Really a Mental Health Issue?

September 11th, 2023

By P. Casey Arrillaga, LCSW, LCDC

For most of modern medical history, addiction and other mental health issues have been classified and treated as two separate problems. More recently, it’s become increasingly clear that this is a false distinction that can interfere with someone getting all the help they need. In this post, we’ll look at how this separated view came to be, why it’s time to let it go, and how to get appropriate treatment that takes a more holistic view of the issues at hand.

How They Came to be Separated

The simplest reason that addiction (officially known as Substance Use Disorder) and other mental health disorders have been treated separately is that for most of our history, neither one was well-understood but both needed some kind of help. For a few hundred years, mental health help often looked like institutionalizing patients without much hope that they would get better. Many treatments were tried, but getting better was more a matter of luck than science.

Medicine had even less to offer those plagued with addiction, which was most often seen as a lack of willpower. People were advised to moderate alcohol intake even when it was clear that this was not working. Sober houses and treatment centers were founded in the 19th Century and some people undoubtedly walked out free, but the science behind this was a mystery to all involved.

This is largely because until the 20th Century, the functions of the human brain were almost completely unknown, at least in any way that would help addiction or any other mental health issue. Psychology was also a primitive art that focused on dream interpretation and letting people talk with as little input as possible from the psychiatrist.

Thus, the institutions that were put into place to address addiction offered moral and religious instruction, while other mental illness were treated with anything from ice water baths to a lifetime of being warehoused in a psychiatric hospital. If the two worlds met each other, it was when the person with the addiction was so far gone that they were put into a mental ward with no intention of ever letting them go.

Why They Do Better Treated as One Problem

All this started to change in the mid to late 20th Century, as psychiatric medications became more effective and brought with them hope of many mental illnesses finding stabilization to the point that those who had them could rejoin society. No “magic pill” appeared to address addiction, but some success came from more modern treatment centers that focused on addiction alone. These mostly used the 12 Step model combined with group therapy and education. For people who clearly fit both into mental health and addiction treatment centers, there was professional debate about “which one should be treated first.” People might be sent away from an addiction treatment center to “get their mental illness in order” and then return for addiction treatment or vice-versa.

As the 21st Century dawned, the thinking started to shift toward the idea of “co-occurring disorders,” which encompassed treating both that which was categorized as mental illness and the addiction at the same time. There was precious little talk about thinking of them as one big family, though. “Treat both together” became the prevailing wisdom. The worlds of treatment for addiction and other mental conditions were like siblings that had grown up in different families. The approaches felt very different even if an objective view could see similarities in the underlying conditions.

Addiction and any other mental condition center in the brain, both rely on the workings of chemical messengers known as neurotransmitters, and each can be treated using many of the same methods as the other. The main reason to think of them separately now is tradition, not any scientific finding.

Experiential evidence for this includes how much addiction treatment has relied on some of the techniques used to help other mental health disorders, such as medication management, therapeutic techniques including CBT and deeper trauma processing methods, and a recognition that healing involves seeing the client as a whole person worthy of compassion, not a moral failing who needs to be browbeaten into better behavior. Similarly, other mental health disorders have benefitted greatly from some of the discoveries of addiction treatment, such as harnessing the power of community through mutual self-help fellowships and having those who are in recovery from a given mental illness help others who are new to treatment for it.

The most powerful evidence is how often addiction and other mental health disorders appear together. In fact, it is now recognized that it is vanishingly rare to find someone who has an addiction and no other mental health issues. Similarly, a very high percentage of those with another mental health problem become addicted as they use alcohol and/or other drugs in an attempt to control their symptoms.

How to Find Effective Treatment for the Whole Picture

If you or a loved one are looking for treatment for addiction and any other mental health disorder, it is not enough to find place that advertises itself as giving “co-occurring treatment,” because almost every treatment center says this today. Instead, look at the depth of experience of the staff, check to see if the center take clients who are primarily focused on other mental issues or do they say “co-occurring” but really shoehorn everyone into an addiction treatment model, see how well they deal with trauma, and ask about what kind of treatment outcomes they commonly see.

At Windmill Wellness Ranch, we are proud to offer treatment that takes the whole person into account. We have some of the best staff in the nation, as verified through both outside observers and our clients, and we have been rated as having the best outcomes in the United States by Trac9 assessment systems. Most importantly, we have the testimony of the many people who have recovered from addiction and other mental health conditions together at our facility.

The Bottom Line

Addiction belongs in the same category as other mental health condition rather than being treated as a separate class of disorder. Recognizing this allows the most effective treatment to be found and implemented. When seeking help for yourself or a loved one, insist on treatment that takes the whole person into account and addresses everything at the same time to get the best outcomes possible.

About The Author

P. Casey Arrillaga is the Team Leader for Education at Windmill Wellness Ranch, and he is the author of books including “Realistic Hope: The Family Survival Guide for Facing Alcoholism and Other Addictions”. His books, podcast, videos, etc. can be found at

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