Substance Abuse and Mental Health in Alabama

There are many individuals in Alabama who suffer from substance abuse issues in addition to a mental illness. When mental health issues and substance abuse are co-occurring, this is referred to as a dual diagnosis. According to The Substance Abuse and Mental Health Services Administration (SAMHSA), 19% of the adults in Alabama who utilized state mental health services reported co-occurring mental health and substance abuse issues. There is a stark difference here in children and teens who used Alabama state mental health services, with just 1% presenting with a dual diagnosis. The state provides services for these individuals to utilize in order to get treatment.

Topography of Mental Illness in Alabama

According to the Alabama Public Health department, Alabamians reported that substance abuse co-occurring with a mental illness was the second most prominent health concern in the state. In Alabama, care of mental health issues and substance abuse are key problems statewide. Unfortunately, Alabama state government allocates a huge part of its budget for incarcerating substance abusers in the state's correctional facilities. Alabama also has a shortage of mental health providers, especially in rural areas. If this issue were to be addressed, it would likely free up a portion of the state's budget connected with incarcerating the mentally ill, not to mention provide the crucial help these individuals need instead of incarceration.

The National Survey on Drug Use and Health reported that 5.2% of Alabama teens used marijuana while 8.8% of teens used alcohol in 2015. Although both of these statistics are below national average numbers, they represent a significant portion of the youth population in Alabama. Alabama also saw 11.0% of its youth and teen aged 12-17 experience a major depressive episode in 2015. Of this 11%, only 36.2% received any type of treatment for this mental illness.

In Alabama, 4.6% of the adult population experienced a serious mental illness in 2015, according to the same survey. The state saw slightly better numbers of individuals who received treatment for these serious illnesses, with 44% receiving treatment.

Why do mental health issues and substance abuse co-occur?

Often times, people with mental illness attempt to alleviate their symptoms by self-medicating. By using a drug or taking alcohol these individuals are trying to change the way they feel or numb their feelings without necessarily realizing the underlying reason they are using. Having an undiagnosed mental illness is one of the number one reasons these people turn to drugs and alcohol. This method of coping with an undiagnosed mental illness can lead to addiction and substance abuse.

On the other hand, although precise causation has yet to be determined for many psychological disorders, is has been established that certain genetic predispositions combined with environmental circumstances strongly correlate with the development of a mental illness. That is to say that if a person is genetically predisposed to developing a mental illness, unfortunately it may be that the abuse of drugs and alcohol is the catalyst which triggers the onset of such illnesses.

The relationship between mental health disorders and substance abuse is such that one exacerbates the other. Understanding this dynamic is crucial in working towards healing in a dual diagnosis case.

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What are the signs and symptoms of a dual diagnosis case?

There are challenges that come with diagnosing an individual who may be suffering from co-occurring mental illness and substance abuse issues. Specific training is required to truly tease out which behaviors are stemming from mental illness and which are likely to be caused by substance abuse. There are also symptoms and adverse effects that are inextricably connected to both diseases, making pinpointing causation next to impossible. However, there are some general signs and symptoms to watch for which may indicate a co-occurrence.

What treatments are available for a dual diagnosis?

The best treatment available for dual diagnosis is an integrated approach in which both issues are addressed simultaneously. In the past, care providers may have hesitated to treat a patient with dual diagnosis because of the potential confounding effects one condition would have on treatment for the other condition. Recently, it is widely understood that this way of thinking is antiquated and potentially harmful therefore most care providers will treat any co-occurring illnesses at the same time to ensure the best possible outcomes for patients. For instance, if a patient is presenting with depression, anxiety and alcoholism, the patient will be treated for alcoholism and also treated for the depression and anxiety. Providers will not wait until one illness is treated to start treatment for the other.

A treatment provider will design a personalized plan for each individual, however most plans follow a similar trajectory. There is no one specific path to success in dual diagnosis cases, however there are certain methods that have been found to have been successful for a variety of individuals. The common methodologies used to treat a co-occurrence include a mix of detoxification, inpatient rehabilitation, supportive/transitional housing, psychotherapy, medication and self-help support groups.


First and foremost, many drug or alcohol addicts need to undergo a detoxification process in order to move forward with any type of treatment. Detoxification deals with the acute and potentially life threatening symptoms of withdrawal from a substance. Although there are outpatient options for detoxification, this process should be done under medical supervision in an inpatient environment in order to elicit the highest effect. While a patient is undergoing inpatient detoxification, highly trained medical staff will monitor the individual on a 24 hour/7 day a week basis. This constant monitoring ensures that any possible complications with the detox are handled safely and also helps to prevent dangerous behaviors from occurring, such as attempts at suicide or attempts to harm others. In addition, these detox centers provide therapy, support and any needed medication. The staff is also authorized to administer tapering doses of the abused substance in order to bring a patient safely off a harmful drug.


Once a patient has completed detoxification, one common and effective path to further treatment is to check into an inpatient rehabilitation facility. Admission to an inpatient rehab will ensure that the 24/7 monitoring continues, providing a healthy structural framework conducive to treating mental illness and substance abuse issues. Inpatient facilities offer group therapy, individual therapy, alternative medicine options as well as medication therapies. Each of these modalities is integral in the treatment of mental health issues and substance abuse problems. Highly trained and motivated staff are on call to walk a patient through what may be one of the most difficult times in their lives.


Once an inpatient program is successfully completed, it may be wise for the patient to seek out transitional housing in order to ease reentry into normal everyday life. One's normal life is filled with the same stressors that contributed to that person's need for rehabilitation. Any action taken to strengthen healthy coping skills is paramount to continued success in sobriety and maintaining a level of good mental health. Transitional housing is also a great way to establish networks of support with like-minded individuals who are also working to maintain their newly learned coping mechanisms and healthy behaviors. Those who take advantage of all a transitional housing situation has to offer are more likely to maintain their sobriety and mental health breakthroughs obtained in an inpatient rehab.

Support Groups

Most inpatient programs use tried and true methods of maintaining abstinence which may include 12-step programs, so a patient will have already been connected with these groups which serve as safety and support network and facilitate self-help. There are a wide variety of support groups available to those who wish to stay connected. Whichever group a person chooses, it is essential for a patient with a dual diagnosis to align themselves with like-minded people on the path of maintaining sobriety and optimal mental health. Patients will be supplied with resources to locate such groups once they are ready to enter back into their everyday lives.


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