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Mental Health & Opioid Use Disorder

Elena Hill, MD, MPH profile image
Medically Reviewed By Elena Hill, MD, MPH • Updated Aug 11, 2023 • 14 cited sources

An opioid use disorder (OUD) can be thought of as a mental health condition. Ongoing drug use alters brain chemistry, moving your drug use from voluntary to compulsive.

But your OUD can be complicated by other mental health issues, including depression and anxiety. And a mental health problem can increase your risk of developing OUD.

Understanding how these two issues overlap is critical to your ongoing health and well-being. Here’s what you need to know. 

Key Facts About Mental Health & Opioid Use Disorder 

In 2020, over 1.5 million people had opioid use disorder (OUD).[1] 

One in five adults in the United States experiences some form of mental illness.[2]

Mental illness and drug addiction commonly co-occur. About half of individuals with mental illness will also develop a substance use disorder, and half of those with a substance use disorder will also have a mental illness.[3]

The Connection Between Mental Health & Opioid Use

Mental health conditions increase the risk of developing OUD and vice versa.

When two disorders, such as OUD and a mental health disorder, occur in the same individual, it is called a dual diagnosis.

The following mental health disorders commonly co-occur with OUD:

Depression & OUD

Depression is a mood disorder of the brain, causing feelings of sadness and poor motivation that interfere with daily life.[5]

Depression and OUD commonly co-occur. Studies have shown as many as 41% of people with OUD also have a mood disorder.[6] The connection can be caused by the following:

  • Poor mental health: People with depression often turn to drugs as a form of self-medication to feel better, which raises the risk of developing a substance use disorder.
  • Addiction: Opioid use can lead to extreme mood swings and crashes when the drug wears off, which can cause depression.

Anxiety & OUD

Anxiety disorders also co-occur with OUD. Similar to depression, anxiety is a disorder that can involve multiple genetic, environmental, and biochemical factors that can increase the risk for substance misuse and, therefore, a substance use disorder. Close to one in three people with an OUD also report symptoms of anxiety.[7]


OCD, or obsessive-compulsive disorder, includes obsessions (uncontrollable and recurring thoughts) and compulsions (repetitive behaviors).[8] The disorder’s risk factors often overlap with substance misuse. 

Personality Disorders & OUD

Among the various types of personality disorders, the most common to co-occur with SUDs are antisocial personality disorder and borderline personality disorder. It is estimated that somewhere between 34.8% to 73% of people being treated for addiction may also have a personality disorder.[9]

Bipolar & OUD

Bipolar disorder is defined as having periods of both depression and mania. It is estimated that approximately 56% of people with bipolar disorder also have a substance use disorder at some point in their lifetime.[10] Bipolar disorder can include significant and extreme mood swings, which can be made more extreme by the concurrent use of substances such as opioids.

Effect of Mental Health on Opioid Use

We do not often think of opioids as psychiatric drugs, but we probably should.

Opioids work in these ways:

  • Binding: Opioids bind to opioid receptors in the brain and cause a euphoric “high.”
  • Releasing chemicals: Mood enhancers (such as dopamine) are responsible for feelings of pleasure.
  • Altering need: Long-term use can change a person’s behavior and personality.

In someone with an underlying mental health disorder, opioids can either ameliorate or exacerbate the symptoms of various psychiatric conditions. It is no wonder that mental health conditions and OUD are often seen together. Effective treatment of one requires effective treatment of the other.[11]

The Effect of Opioid Use on Mental Health

Opioids change brain chemistry and interact with pleasure receptors, causing extreme highs and significant lows. Because opioids create a false sense of happiness, depression and anxiety are common withdrawal side effects.

Prescription opioid use has been frequently associated with an elevated risk of major depression.[12] The more regularly opioids are taken, the more they change cellular function over time, meaning a person can no longer easily feel pleasure without the opioid drug. Repetitive opioid use and the development of OUD can result.

Factors Affecting OUD & Mental Health 

OUD and mental health conditions are closely connected through a variety of factors, including the following:


Both substance use disorders and mental health disorders are heritable conditions, meaning risk for them can be passed down through families. 

Genetic factors can also contribute to how a drug affects a person and how the body and brain will respond.

Genetics alone don’t cause either addiction or mental health conditions. However, they can predispose a person to both.

Brain Regions & Composition

Similar parts of the brain can be involved in both the onset of a mental health condition and the likelihood of developing an OUD.

For example, reward circuitry and pathways may not function correctly in someone with a mental health disorder, contributing to a desire to use substances and continued substance misuse.

Environmental Factors

Multiple environmental factors can contribute to the onset of a mental health disorder and the likelihood of misusing opioids and developing an OUD.

For example, living in an environment where drugs are made and sold can make it easier to experiment and develop an addiction. 

Early Life Adversity

Adverse childhood events are a major risk factor for both OUD and comorbid mental health disorders.[13] Trauma at a young age can disrupt the natural formation and development of the brain and reward processing. This disruption of brain circuitry increases the risk for OUD and co-occurring mental health conditions.

How to Avoid Addiction & Mental Health Issues 

You can’t change your genes, your upbringing, or your brain function. But you can change some decisions and habits and increase your risk of avoiding both addictions and mental health issues. 

These are good steps to take: 

Use Opioid Medications Carefully

Chronic pain is often associated with depression, and many people with mental health disorders have a medical need to take prescription opioids. It is important to be aware of the risks and to understand the elevated risks for OUD with mental health conditions. 

If you require opioid medications, follow these steps:

  • Take them exactly as directed and under the supervision and direction of a trained medical professional. 
  • Use them for as short a time as possible.
  • Stay in touch with your doctor throughout your treatment
  • Ask for alternative, non-addictive medications if available

Benefits of Dual Diagnosis Treatment for Co-Occurring Conditions 

Dual diagnosis treatment involves treating both disorders simultaneously. Treatment can improve quality of life and lead to better treatment outcomes, including these:

  • Decreased hospitalization
  • Increased stability
  • Less potential for medication interactions
  • Improved psychiatric functioning
  • Higher rates of successful treatment
  • Reduced substance use

With dual diagnosis treatment, a patient should receive care for their mental health condition either from a primary care doctor or a mental health professional as well as care for their substance use disorder. Ideally, multiple providers involved in the patient’s care will communicate with each other to come up with the best treatment plan for the individual patient.

Therapies for dual diagnosis treatment of co-occurring disorders can help to teach coping, interpersonal, and management skills to improve treatment outcomes and elevate daily life functioning.[14]

Medications could also be part of your treatment plan. Tools like Suboxone could lower your relapse risks if you have OUD and ease your drug cravings. Psychiatric medications could ease mental health symptoms too. 

Mental Health & Opioid Use Disorder FAQs

How does opioid use affect mental health?

Opioid misuse can increase the risk of developing a mental health condition due to changes in brain chemistry and functioning.

Can opioids cause mental illness?

Opioids do not cause mental illness when used as medically directed. Opioid use disorder and opioid misuse on a long-term basis can potentially lead to the development of anxiety or mood disorders.

What is the connection between mental health and substance use?

Mental health conditions and substance use share overlapping risks and contributing factors that can raise the risk of developing one if the other is present. A mental health disorder increases the risk for substance misuse and vice versa.

Can I safely take opioids if I have a mental health condition?

Yes, opioids can be taken when medically directed and under strict directions from a professional. It is important to use these medications exactly as directed.

Which comes first: mental health conditions or opioid use disorder?

Either condition can precede the other and raise the odds of developing the other.

Can both mental health disorders and opioid use disorder be treated together?

Ideally, both of these disorders are treated with dual diagnosis treatment, which involves treatment of the opioid use disorder as well as treatment for the mental health condition.

What is the best treatment for co-occurring disorders?

The optimal treatment method for co-occurring mental health disorders and opioid use disorder involves dual diagnosis treatment. This involves several professional providers working in tandem as a team as well as medications and behavioral therapy techniques.

Will long-term Medication for Addiction Treatment work with a mental health disorder?

Yes, medications like Suboxone, which contains a long-acting partial opioid agonist, can be used safely when medically directed to treat co-occurring disorders. Medications will need to be managed to avoid potential medication interactions. This should be overseen by a trained professional, and all medications need to be taken as directed.


Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More

  1. What Is the U.S. Opioid Epidemic? U.S. Department of Health and Human Services. October 2021. Accessed December 2022.
  2. Mental Health by the Numbers. National Alliance on Mental Illness. March 2021. Accessed December 2022.
  3. Substance Use and Co-Occurring Mental Disorders. National Institute of Mental Health. Accessed December 2022.
  4. Prescription Opioid Use Among Adults with Mental Health Disorders in the United States. Journal of the American Board of Family Medicine. July-August 2017. Accessed December 2022.
  5. Depression. Mental August 2017. Accessed December 2022.
  6. Sensitivity and Specificity of Self-Reported Psychiatric Diagnoses Among Patients Treated for Opioid Use Disorder. BMC Psychiatry. October 2021. Accessed December 2022.
  7. Benzodiazepine Raise Overdose Risk – And Prolong Life-Saving Treatment for Opioid Use Disorder. Health City. January 2020. Accessed December 2022.
  8. Obsessive-Compulsive Disorder. National Institute of Mental Health. October 2019. Accessed December 2022.
  9. Comorbidity of Personality Disorder Among Substance Use Disorder Patients: A Narrative Review. Indian Journal of Psychological Medicine. November-December 2018. Accessed December 2022.
  10. Mood Disorders and Substance Use Disorder: A Complex Comorbidity. Addiction Science and Clinical Practice. December 2005. Accessed December 2022.
  11. Comorbidity: Substance Use Disorders and Other Mental Illnesses DrugFacts. National Institute on Drug Abuse. August 2018. Accessed December 2022.
  12. Prescription Opioid Use and Risk for Major Depressive Disorder and Anxiety and Stress-Related Disorders. JAMA Psychiatry. November 2020. Accessed December 2022.
  13. The Development Origins of Opioid Use Disorder and Its Comorbidities. Frontiers in Human Neuroscience. February 2021. Accessed December 2022.
  14. Common Comorbidities With Substance Use Disorder Research Report. National Institute on Drug Abuse. April 2020. Accessed December 2022.

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