Is My Loved One Using Drugs to Cope With Mental Illness?
Many families reach a moment of painful clarity — looking back at a loved one's history and realizing that the substance use seemed to begin, or intensify, at the same time as a period of emotional pain, trauma, or mental health struggle. The question that follows is usually some version of: are they using because of something deeper? This guide explains what self-medication is, why it happens, the signs that suggest it may be occurring, and why it matters profoundly for how treatment should be approached.
Medically Reviewed by:
Dr. Darrin Mangiacarne
Chief Medical Officer
At Banyan Treatment Centers, Chief Medical Officer Dr. Darrin Mangiacarne leads our nationwide clinical team with over a decade of addiction medicine experience, helping ensure evidence-based, compassionate care across every level of treatment.
Author / Written by: Banyan Editorial Staff
Medically reviewed by: Dr. Darrin Mangiacarne, CMO
Updated on: June 2026
Family Resources Hub › Mental Health Resources › Dual Diagnosis & Co-Occurring Disorders
Why People Use Substances to Manage Emotional Pain
The self-medication hypothesis — developed by psychiatrist Edward Khantzian at Harvard Medical School — proposes that many people who develop substance use disorders are initially drawn to substances not randomly, but because those substances address specific psychological pain or psychiatric symptoms they do not know how to manage any other way. The choice of substance is not arbitrary: people tend to gravitate toward substances whose pharmacological effects most directly relieve the specific symptoms they are experiencing.
A person with severe social anxiety may drink because alcohol is the only thing that has ever made social situations feel tolerable. A person with PTSD may use cannabis because it blunts hyperarousal and intrusive memories. A person with depression may use stimulants because they temporarily lift the flatness and exhaustion that has become their baseline. These are not irrational choices — they are imperfect, self-discovered solutions to real clinical problems, by a person who does not yet have better ones.
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Signs That Suggest Self-Medication May Be Occurring
No family can diagnose a co-occurring disorder — that requires clinical assessment. But these patterns are frequently observed by family members before any clinical evaluation takes place, and recognizing them can be an important first step toward getting a more complete picture of what is happening.
The Substance Use Began During a Period of Clear Emotional Distress
Looking back, the significant escalation of substance use coincided with a specific period: a trauma, a loss, a relationship breakdown, the onset of anxiety or depression, or a period of extreme stress. The timing is not coincidental. The substance use emerged as a response to something that felt unmanageable without it.
Their Mood or Behavior Changes Dramatically Without Substances
During periods of sobriety, the underlying mental health condition emerges in full — severe depression, debilitating anxiety, intrusive trauma symptoms, or extreme mood instability. The person appears to 'need' the substance to function at a baseline that others find normal. What looks like craving is often the return of unmanaged symptoms.
They Use Specific Substances in Specific Situations
The choice of substance tracks with the emotional state being managed: alcohol for social anxiety, stimulants for depression-related fatigue, cannabis for hyperarousal or intrusive thoughts, opioids for emotional pain or numbness. The specificity of the pattern suggests a pharmacological function rather than indiscriminate use.
They Have Told You Directly, or Indirectly
Many people who are self-medicating say so — not always in clinical terms, but in statements like 'it's the only thing that helps me sleep,' 'I can't face people without it,' 'it's the only thing that makes the noise stop,' or 'I just need it to feel normal.' These statements deserve to be taken seriously as clinical information, not dismissed as excuses.
Previous Addiction Treatment Has Not Held
Multiple treatment attempts that produced sobriety but not sustained recovery — particularly when relapse was preceded by identifiable emotional distress — are a strong indicator that an unaddressed mental health condition is maintaining the cycle. Treatment that addresses addiction alone, without the co-occurring condition, is structurally incomplete.
A Mental Health Condition Has Been Identified but Not Treated
A diagnosis was made at some point — depression, PTSD, anxiety, bipolar disorder — but treatment was never pursued, was pursued only briefly, or was pursued separately from addiction treatment. The mental health condition has been identified but never effectively addressed.
The Cruel Paradox of Self-Medication
The deepest problem with self-medication is that the short-term relief it provides masks a long-term worsening of both conditions. Substances do provide genuine symptom relief initially — which is why people use them and why they are so difficult to give up. But over time, the neurobiological effects of chronic substance use make the underlying mental health condition worse, require escalating doses to produce the same effect, and create physical dependence that adds withdrawal to the existing suffering.
Alcohol Worsens Depression Long-Term
Alcohol is a central nervous system depressant that provides initial sedation and relief from anxiety — but chronic use disrupts serotonin and dopamine regulation, producing or deepening depression. The person drinking to manage depression is making their depression worse with every drink, even as each drink provides temporary relief.
Cannabis Worsens Anxiety Over Time
While cannabis may produce short-term anxiolytic effects in some people, chronic use is associated with increased anxiety, particularly when the effects wear off. The withdrawal anxiety — sometimes called 'rebound anxiety' — reinforces use and can be more severe than the original anxiety the person was managing.
Opioids Blunt Emotional Processing
Opioids produce profound relief from physical and emotional pain — which is why they are so compelling for people with trauma, depression, or chronic emotional suffering. But chronic opioid use suppresses the brain's natural capacity to process and regulate emotion, producing a deeper emotional blunting that makes recovery from the underlying condition harder.
Stimulants Deepen Depressive Crashes
Stimulants temporarily lift the energy and motivation deficits of depression — and then produce a pronounced crash as they wear off that is often more severe than the baseline depression. The cycle of stimulant use and withdrawal can produce a mood dysregulation that is worse than the original depression the person was trying to manage.
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You Don't Have to Figure This Out Alone
Integrated Assessment of Both Conditions
At Banyan, every person entering treatment receives a comprehensive psychiatric evaluation and substance use assessment. If a co-occurring mental health condition is present — whether previously diagnosed or not — it will be identified and incorporated into the treatment plan. We do not treat addiction in isolation from the mental health picture that surrounds it.
Banyan's Family Program
Understanding that your loved one's substance use may have begun as an attempt to manage genuine mental health suffering can be both clarifying and painful for families. Banyan's Family Program provides education about self-medication and co-occurring disorders specifically, helping families reframe what they've been witnessing and understand what comprehensive treatment addresses.
Call Us to Talk It Through
If what you've read here resonates with what you've been observing in your loved one, call us. Our clinical team can help you understand whether a co-occurring disorder assessment is the right next step. 855-722-6926, 24/7.
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