Opioid use disorder and coexisting mental health disorders

Opioid use disorder (OUD) is a common and serious health condition that affects several million people in the United States and millions more worldwide. It is characterized by the chronic use of opioids, drugs that bind to opioid receptors found on nerve cells throughout the body. Opioids include both prescription pain medications as well as illegal drugs, and OUD can involve either.

OUD causes significant psychological distress, interferes with normal functioning, and causes physical dependence on opioids. People with OUD will become sensitized to opioids over time and will seek opioids in greater amounts. They will also experience physical and psychological withdrawal if they stop taking opioids. These and other factors lead to a loss of control over the use of opioids despite the harmful consequences of continuing to use opioids or a desire to stop using opioids.

It's important to know that OUD is treatable, and that treatment can help a person achieve remission from opioid use and regain function in the aspects of their life that have been affected by opioid use. A treatment plan for OUD can include a combination of medications, behavioral therapy, and counseling/support.

Treatment should also address coexisting health conditions, including coexisting mental health disorders.

What mental health disorders coexist with OUD?

Mental health disorders and substance use disorders like OUD often occur together. This is sometimes called a dual diagnosis. Screening and evaluation for mental health disorders is an important aspect of diagnosis and treatment for OUD.

Mental health disorders that are commonly diagnosed alongside OUD include:

• Major depressive disorder (MDD). A disorder characterized by persistent low moods, such as sadness, hopelessness, and loss of interest/pleasure in nearly all activities.
• Anxiety disorders. This includes generalized anxiety disorder, panic disorder, and social anxiety disorder, conditions characterized by intense feelings of worry, fear, and/or anxiety in non-threatening situations.
• Post-traumatic stress disorder (PTSD). A disorder that develops as a result of traumatic events, with symptoms that include intrusive memories, negative changes in thinking and mood, nightmares, and physical and emotional reactions to triggers.
• Attention-deficit/hyperactivity disorder (ADHD). A common disorder characterized by persistent and recurring inattention, hyperactivity, and impulsivity that interfere with functioning.
• Bipolar disorder. A group of disorders characterized by episodes of extreme emotional highs (mania or hypomania) and lows (depression) that interfere with functioning.

While these mental health disorders are the most common mental health disorders that coexist alongside OUD, they are not the only ones. Any mental health condition can coexist alongside OUD.

How does a coexisting mental health disorder affect OUD?

Do mental health disorders like those listed above contribute to OUD? Does OUD contribute to or exacerbate mental health disorders?

These are normal questions to ask for people affected by these conditions, or friends and loved ones of people affected by these conditions. However, there are no simple answers. While OUD and mental health disorders share common risk factors, everyone’s experience with these conditions is different.

It’s important to recognize that OUD and mental health disorders can have a cyclical or bidirectional relationship. In some cases, a person with a mental health disorder may use opioids to cope with negative emotions or distress. The stigma, social isolation, and emotional distress of living with OUD can also exacerbate the symptoms of a mental health disorder.

Chronic opioid use can also cause physical changes to the brain and nervous system, including structural changes in the brain and brain tissue composition. This includes parts of the brain that regulate moods, emotional responses, and reward-related behaviors.

How does this affect treatment?

Having OUD and a coexisting mental health condition can affect the choice of what therapies are used to treat these conditions.

For example, some medications that treat opioid use disorder can interact with certain antidepressants, putting a person at risk for complications like serotonin syndrome—excessive levels of the neurotransmitter serotonin that have a toxic effect on the body. Always tell each of your healthcare providers about all medications you are taking, including prescription medications, recreational drugs, over-the-counter medications, and supplements.

For a different example, cognitive behavioral therapy is frequently used in the treatment of OUD as well as mental health disorders, including depression, anxiety disorders, PTSD, bipolar disorder, and ADHD.

Essential to every treatment plan for OUD is working with a healthcare provider who understands your unique needs as a person living with OUD, including any coexisting medical conditions.