How Mental Health Shapes Addiction: Why Treating Both Matters

By Madison Hamm, LCSW, Clinical Director

What We See Every Day in Treatment

Most people arrive at treatment focused on the substance they have been using. They want to stop drinking or using drugs, and that makes sense. Substance use is the most visible part of the problem.

Once treatment begins, however, we almost always discover there's something more than just the addiction. Anxiety, depression, trauma, mood instability, and long-standing emotional patterns are common. In many cases, these issues were present long before substance use escalated. Over time, I have learned that treating substance use without addressing these mental health factors leaves important gaps. Those gaps often show up later as frustration, relapse, or a sense that treatment “worked for a while, but didn’t last.”

Clinical Director Madison Hamm, LCSW, at Plum Creek Recovery Ranch in Lockhart, Texas.

What Clinicians Mean by Co-Occurring Disorders

When we talk about co-occurring disorders, we are describing someone who is dealing with both a mental health condition and a substance use disorder at the same time. This is more common than many people realize.

Sometimes mental health challenges or difficult life circumstances come first, and substances become a way to cope. In other cases, long-term substance use begins to mimic or worsen mental health symptoms. Certain drugs can increase anxiety, depression, or paranoia. Others can dull motivation and emotional responsiveness. Over time, it becomes hard to separate cause from effect.

At Plum Creek, we focus less on labeling and more on understanding a person’s full history. What someone has lived through, how they have coped, and how their symptoms interact all matter.

Mental Health Patterns Commonly Linked With Substance Use

During assessment, we look for patterns rather than isolated symptoms. Some of the most common mental health patterns we see alongside addiction include:

• Anxiety and depression, often influenced by changes in brain chemistry from substance use.

• Trauma-related symptoms, where substances have been used to detach or numb emotional pain.

• Emotional dysregulation, when feelings become overwhelming and difficult to manage.

• Sleep and cognitive disruption, which can intensify stress and impair decision-making.

These patterns do not define a person. They help guide how treatment should be structured.

Why Treating the Substance Alone Often Isn’t Enough

If treatment only focuses on avoiding substances, people are often left trying to manage intense emotions without adequate tools. Over time, that strain builds.

Untreated mental health symptoms continue to drive stress, reactivity, and relapse risk. Many people feel discouraged when they understand what needs to change, but still struggle to follow through. Shame tends to grow in these moments. Our clinical focus is on helping people regulate their nervous systems, understand their emotional responses, and build skills they can actually use in daily life.

Stabilizing the Mind Before Doing Deeper Work

Early recovery is a fragile period. Before meaningful therapeutic work can happen, the body and mind need a degree of stability.

Substance use significantly alters brain chemistry. For example, stimulant use can dramatically spike dopamine levels, followed by long periods of emotional flatness or depression once use stops. Expecting someone to process complex emotional material without first addressing this imbalance sets unrealistic expectations.

We focus first on emotional regulation and stabilization. When people can think more clearly and feel more grounded, therapy becomes more effective.

How Mental Health and Addiction Treatment Work Together

At Plum Creek, mental health and addiction treatment happen side by side. We begin with a comprehensive bio-psycho-social assessment that looks at history, patterns, and current functioning.

Clients participate in individual therapy, group therapy, and psychoeducational work that addresses both substance use and mental health. We use practical tools to help people see the connection between emotions, thoughts, and behaviors. Over time, this builds awareness and choice where there once felt like none.

Our medical, clinical, and experiential teams work closely together so care stays coordinated rather than fragmented.

Why Shame Keeps People Stuck

Shame plays a powerful role in both addiction and mental health struggles. When someone believes they are fundamentally flawed or unworthy, engagement in treatment becomes difficult.

Dignity and respect are not extras in clinical care. They are essential tools. I have found that people cannot make lasting changes unless they believe they are worth the effort.

At Plum Creek, we treat clients as partners in their care. As individuals progress, they take on increased responsibility through our phase system. This may include mentoring peers or leading groups. The focus is on repair and growth rather than punishment. Responsibility builds confidence, and confidence supports recovery.

What Families Need to Know About Co-Occuring Conditions 

Families often struggle to understand why a loved one continues to behave in ways that seem self-destructive. It helps to remember that addiction is a brain-based condition, not a moral failing.

Recovery is rarely linear. Progress often includes setbacks, learning moments, and adjustments. Families play an important role by setting clear, supportive boundaries rather than trying to fix or control outcomes. Boundaries protect relationships and reduce resentment on all sides.

Treating Co-Occurring Disorders at Plum Creek Recovery Ranch

Plum Creek is designed to support integrated treatment. Our licensed clinicians provide trauma-informed care that addresses both mental health and substance use.

Experiential therapy plays a supportive role in this work. Hands-on activities such as working with horses, art, and movement help clients regulate their nervous systems and apply therapeutic concepts in real time. These experiences reinforce the work happening in therapy sessions and help bridge insight with action.

Family involvement is also a core part of treatment, not an add-on. Recovery impacts more than one person, and healing often requires support on multiple levels.

The main house at Plum Creek Recovery Ranch.

If You’re Exploring Treatment Options

Untangling mental health and addiction can feel overwhelming. You do not need to have everything figured out before reaching out.

If you are exploring treatment for yourself or a loved one, our admissions team can help you think through next steps and understand how integrated care works. Whether care happens at Plum Creek or elsewhere, having clear information matters.

Learn more about our admissions process and how to get started.