Is Addiction Like Any Other Mental Illness?

September 4, 2012 Natasha Tracy

Recently a friend queried me on addiction. Specifically, would I consider addiction to be like any other serious mental illness? After all, it harms people. It helps people end up on the street. It destroys people’s lives. It sure sounds serious.

But, on the other hand, addicts are a special bunch in that their behavior caused their illness. No one made them take that first drink. No one made them snort that first line. No one made them take that first hit. They did that all on their own, and eventually, that decision spiralled into an illness. But people with mental illness like schizophrenia or bipolar disorder get there without any hitting, drinking or snorting of any kind. Their mental illness hits them spontaneously.

So the question is, is addiction just another mental illness?

Addiction as a Mental Illness

As it currently stands the Diagnostic and Statistical Manual of Mental Disorder (DSM) does not have a classification for “addiction.” Substance abuse and substance dependence are the two defined illnesses that cover the concept. Between these two illnesses you have the symptoms of tolerance, withdrawal and harming others or the self with the substance use.

Addiction and the Brain

And while I’ve mentioned on numerous occasions that mental illness, like depression, changes the brain, substance abuse and dependence actually does too. When one becomes dependent on a substance, the brain has chemically changed. An addict simply doesn’t think like a non-addicted person due to the changes in their brain. And craving? That’s a physical, brain-related thing too. Make no mistake about it, the junkie down the block from you does not share your brain chemistry.

My Problem with Addicts

But I have a problem with addicts, probably because I grew up with one, and the problem is this – they made a conscious decision that ended in their addiction. Now, it’s true, no one knows if drinking will turn you into an alcoholic, after all, you and I could both drink the same amount and only one of us will end up being addicted, but still, you’re the one with a drink in your hand of your own freewill.

And people with addicts in the family (not everyone does, of course). Does is not occur to them that they may be next? That maybe, they need to take some responsibility for the decision to imbibe substances while knowing that addiction ran in their bloodline? Isn’t this distinctly different from someone who, through absolutely no action of their own, ends up with depression, bipolar disorder or schizophrenia?

And if that didn’t bug me enough, the fact that addicts get to get better just by not doing their drugs any more drives me crazy. I have to be in treatment and on medication for the rest of my life while they can be successfully treated in weeks, and somehow we’re the same?

Now yes, I grant that addiction is terrible and I grant that quitting drugs must be difficult and I acknowledge that many people struggle with addiction their entire life long. And this isn't meant to disparage people with addiction issues, after all, we all end up in places because of our choices. Nevertheless, it feels different to me. The may both be mental illness, but I’m not sure that makes them the same.

So I throw it over to you, learned reader, what do you think? Is addiction just another mental illness or is it different?

You can find Natasha Tracy on Facebook or GooglePlus or @Natasha_Tracy on Twitter.

APA Reference
Tracy, N. (2012, September 4). Is Addiction Like Any Other Mental Illness?, HealthyPlace. Retrieved on 2024, May 20 from

Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate, and author of Lost Marbles: Insights into My Life with Depression & Bipolar. She's also the host of the podcast Snap Out of It! The Mental Illness in the Workplace Podcast.

Natasha is also unveiling a new book, Bipolar Rules! Hacks to Live Successfully with Bipolar Disorder, mid-2024.

Find Natasha Tracy on her blog, Bipolar BurbleX, InstagramFacebook, and YouTube.

February, 5 2013 at 7:23 am

Having experience in AA and with addiction, and also a recently diagnosed Bipolar 2.. that clearly was massively sabotaging my many seriously committed attempts to get continuous long term sobriety, I think that Addiction IS a mental illness. And also believe that VIRTUALLY all addicts suffer from some form of mental illness. Been to hundreds of AA meetings and there is virtually no one there that is not "out there" in some way sober. And that is OK. Funding is a different issue. I understand the anger at lack of funding for mental illness. I can't even get a PDOC and just have a family doctor.
If you listen to virtually any addicts story their childhoods are majorly messed up. And there is almost always abuse, addiction and mental illness in their family tree. Succeptability to addcition is largely genetic, as research on DNA is showing many common genetic traits among addicts.
The biggest issue with Addiction and Mental Illnesses is funding. Funding needs to massively increased for addiction AND Mental Illness, and almost all addiction treatment needs to also treat the co-existing conditions of the addict on a long term basis, not just for 28 days.
I mean anyone can get an addiction, if someone is on opiates long term they will develop an addiction regardless of their genetic predisposition... but I believe that most alcoholics and chronic drug addicts that use for years and decades mostly have prexisting conditions that they started off self medicating and may not even be aware of... and that over time have morphed their brain chemistry all over the place. I am sure a 40 year old alcoholic person with bipolar 2 is going to have a different brain chemistry then if they had not drank and were 40. Just like if they had been properly medicated for 20 years they have a different brain chemistry now then an untreated 40 year old with bi polar 2.
In Ottawa Canada the main treatment option is this program at the mental health hospital:…
It might be interesting for you to check out some of the content.
I enjoy your blog, thank you.

September, 25 2012 at 4:38 pm

I believe addiction is a mental illness - a lifelong one. I don't believe someone is successfully treated after a few weeks. They may have detoxed, got clean, they still need to manage their illness for the rest of their lives. Then I can understand that they make the choice not to pick up the first drink. But I don't believe it's a self-inflicted illness.
The article mentions just not picking up the first drink especially in families with a history of addiction. I was a child when I first started drinking, I didn't recognize that my family drank/drink alcoholically until I was clean a few years. To me growing up, their drinking was all I knew, and it seemed perfectly normal. I never heard the drinking in my family called addictive, how was I as a child supposed to recognize it as such and not take the first drink to find out if I was also afflicted?
Now that I've stopped drinking, the problem remains with my thinking. I have the hypersensitivity, the grandiose thinking, tendency to isolate that hallmark addiction and existed in me long before I first picked up. I did not choose those characteristics, I can see them in me as a very young child. In the same way that you did not choose to become bipolar. I can now choose how I manage my illness, which for me starts with not drinking but involves a lot more.

Ernie Richards
September, 13 2012 at 10:55 am

After pondering this I have something to throw out to people who are down on addicts. In Canada )and from what I can find online it is the same for the USA) the biggest addiction problem is not illicit drugs, but rather it is prescription pain killers, especially opioid based pain killers.
So is it the fault of the pain killer user that they are an addict? Is it the fault of the doctor?
I subscribe to the belief that addicts are different than others and therefore their brain is different and they become addicts whatever substance through no fault of their own.

Ernie Richards
September, 13 2012 at 10:08 am

I am 49 years old and was diagnosed with bipolar within the past year. Over the years I have developed a drug and alcohol dependency. Is this because I made a "bad decision" or is it because I was self-medicating my undiagnosed bipolar? We will never know.
I ask people to go easy on addicts because nobody is superior to anyone else. To assume an air of superiority over addicts is very judgmental. Also, addicts like those with mental illnesses suffer from stigma.
I am in therapy for my addictions and how to live with bipolar at the same time. Currently we are reviewing open-mindedness and being non-judgmental. I wish all those who have stated that addicts caused their problem could walk in my shoes and see if their biased beliefs are true or not.

September, 8 2012 at 1:46 pm

Wow. I agree that addiction isn't a mental illness, but I do believe that many substance abusers are those with mental illnesses who self-medicate. My father (a sociopath) and brother (bipolar) were both alcoholics; my brother committed suicide two years ago. Additionally, let's be honest - depending on the demographic, there may be few accessible, reasonable treatments available (or perhaps mental health professionals available). Some may choose to drink or drug just to get by. I don't know why those with mental illnesses choose substance abuse over treatment, but I also don't feel that I'm in a position to judge. (Trust me - I faced plenty of abuse over the years and understand the challenges of being on the other end - I have thousands of dollars in therapy to prove it.) I'll be honest, though, there have been plenty of nights that I would have preferred to have been stark-raving drunk than 50 pounds over weight (thanks to my new "treatment" regiment).
My opinion... Is substance abuse a mental illness - no. Does substance abuse deserve to receive funding dedicated to those with mental illnesses - no. Does substance abuse deserve to receive its own funding - absolutely.
Do we need to support our brothers and sisters with substance abuse issues (those with and without mental illnesses) - yes.
In lovingkindness...

September, 8 2012 at 1:03 pm

maybe your friend is also bipolar. diagnosis is difficult (I think, going by my own scenario) to differentiate between extremes (evaluate) human pain (nigh on impossible) There is no reliable control! good luck (you are not alone, might not be ideal but I will listen to you & try to be there for you (if you want)

September, 8 2012 at 12:52 pm

It's too difficult to be a human being! Over sensitive (crazy) communicate (not a chance), escape, suicide (not got the courage, looked up pain free(maybe didn't look far enough (the diversity of human spirit never ceases to amaze me. Went to osteo/acupuncturist (he was desperate for sex so pyschological manipulation attempted & 50% suceeded, didn't help, apart from short term pain (back & hip) relief. Can't say 'God help me, looked at the bible 'old testament' twisted, nasty, who wants to live with that version of God? Not me! So I guess (unless I can connect with somone on my wavelength (who doesn't mind about looks) 'Home Alone' when my husband gets around to stop bugging me!

September, 8 2012 at 6:25 am

Substance use starts as a choice. Abuse leads to dependence (addiction). Addiction is a physical condition in which one's body needs the substance to be functional. Unsupervised withdrawal from an addictive substance ( heroin, alcohol) can lead to death. This is why they have detox centers. Long-time heroin users don't shoot up to get high, they shoot up to (in their words) "get well"... So I say addiction is a physical, not mental condition. But the two often go together..

September, 5 2012 at 4:11 pm

The first drink/hit is not always a conscious choice. Some are actually born with addiction and need *something* to make them feel normal. I know a lot about the biology of addiction. Not a expert, but I know enough to know that it's not as simple as this is read.

September, 5 2012 at 3:38 am

I don't have an addiction nor any education about it, but my understanding is that the brain and body of someone who is predisposed to an addiction responds to a given substance differently to non-addicts. So basically, give that person x amount of a substance and they are likely to become addicted, versus non-addicts having the same amount of the substance and never having an issue. I guess what I'm trying to say is that it's not as simple as "well, you shouldn't have picked up that first beer or you shouldn't have taken those pain killers prescribed for your back injury, but you did and so it's your fault that you are now an addict". I'm not sure if you can call it a mental illness, but it most certainly is an illness. Note: I'm not saying that people don't have some control over the course of the illness. I'm also not saying that behaviours carried out when under the influence of substances are excusable. It's tricky.

September, 5 2012 at 3:27 am

I don't have an addiction nor any education about it, but my understanding is that the brain and body of someone who is predisposed to an addiction responds to a given substance differently to non-addicts. So basically, give that person x amount of a substance and they are likely to become addicted, versus non-addicts having the same amount of the substance and never having an issue. TheredI'm not sure if you can call it a mental illness, but it most certainly is an illness.

September, 4 2012 at 10:12 am

Childhood Sexual abuse causes many psychiatric disorders. I think that you were pretty insensitive to his issues. I cannot even believe what I just read. Somehow you think that if hemdoesmthingsmhe won't have a drinking problem anymore. When he gives up drinking that is when the cat gets out of the bag.

September, 4 2012 at 9:54 am

This is a personal one for me. My ex-best friend is an alcoholic. He would half heartedly seek treatment by sort of going to AA but he lied a lot about it. He was sexually abused as a young child and refused to get treatment but showed textbook symptoms. Definately a connection between the drinking and the abuse. For years I tried to help. I even had an interventionist number on my phone. Hell I think it is still on there. Then I was diagnosed with bipolar. I thought he would be there for me. But no that was a pipe dream. I am drug resistant and have gone through multiple specialists and was concise ring ects and all he would talk about would talk about is him going to rehab. He has a choice in going to therapy and dealing with being a survivor of sexual abuse, he has a choice to go to rehab, he has a choice to go to AA, he has a choice to follow the steps and in the end have a relatively normal life. No matter how much therapy I have I will always have to fight bipolar, I have yet to be stable longer than 3 months, I have to learn to suffer numerous side effects and least have to ask myself if the side effect is worth the benefit of the med. I live in fear that I will run out of options and shock treatment will be the next choice.
Everytime he talked about his "problem" being equal to mine- or he would say he had a manic day... My skin would crawl. Addition and mental illnesses are different. The treatments and solutions are different. The severities are different. And most of all the stigmas and levels of acceptance are difference. Taking time off to go to hospital is treated much differently than going to rehab. Look at the attitudes towade senator Jesse Jackson Jr. If treated for addiction much higher chance of keeping his job than being treated for bipolar.
Thank you for reading.

September, 4 2012 at 9:32 am

My dad used to say how could it be a disease if you give it to yourself. That was in regards to my alcoholism. My dad was nearly 400 pounds, had diabetes and died of a massive heart attack. Yeah dad, what kind of disease does a person give to themselves......
So many Americans are addicted to over eating. Not just the obese, but those that suffer from bulimia as well. Some say that they feel high eating a lot of food, purging and eating again.
These is obviously a mental disease going on. Many of those that get the lap band become alcoholics. It s just the next step.

September, 4 2012 at 9:30 am

My father was an alcoholic, I think he drank to cope with depression(not diagnosed, just my opinion). I believe that some addicts use drugs,alcohol, gambling, etc. to self medicate a mental illness. They aren't successful and thus have one more problem to deal with. It took decades for my father to stop drinking after many, many failed attempts. So, back to the question, do I think addiction is a mental illness. No I don't think so.

September, 4 2012 at 9:09 am

Addiction *is* different, and the ”dual diagnosis” thing appears to me (having addicts in my family) to often be due to being undiagnosed and self-medicating - as a conscious choice, yes.
My family is chock-full of bipolars who've had substance abuse problems, and any talk of genetic propensity to addiction is, to me, ignoring the more logical biological tendency to mental illness. There are people in my immediate family who are bipolar and didn't become junkies (I'm one of them); we sought professional help. Of course that made us the victims of the addicts' dramas.
Nope, I've pretty much lost all sympathy for substance abusers.

September, 4 2012 at 8:01 am

Ooooh another tricky one!
I think that asking this question about addiction is like saying it's something very simple and discrete.
Many addicts have comorbid mental disorders, and not all addictions have arisen from the simple action of making one decision.
Also, as you say, "addicts" aren't all treated successfully in a few weeks.
Everyone is individual, no mental illness or addiction is exactly the same. Maybe acceptance and compassion for everyone (both patients and carers) would help to raise mutal self-esteem to a level where we have the power and confidence to ask for help and to participate in our own healing.

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