To the extent that social inequality, social interaction, and drug culture contribute to substance use, it is a mistake to contribute substance use only to biological and psychological factors. While these factors do play a role, it would be a mistake to ignore the social environments in which people participate in substance use. The role that the family plays in substance abuse potential in members is vastly underestimated. Weak family bonds and school connections are often seen as a major role in the development of substance use in adolescents. Weak bonds to family members prompt adolescents to be less likely to conform to conventional norms and more likely to engage in using drugs and other deviant behavior. Healthy family bonds, coping with trauma, learning how to identify feelings, and open communication all play a positive role in the reduction and prevention of potential substance use of family members in the future.

Mental Health

So what exactly is Mental Health? And how is it defined today? Well, first, lets shine a brief but illuminating light on its history in the U.S. The mentally ill have been treated very poorly for hundreds of years. In the 1800s, it was believed that mental illness was caused by demonic possession, witchcraft, or an angry god. For example, in medieval times, abnormal behaviors were viewed as a sign that a person was possessed by demons. Actually, most people who displayed abnormal behavior were viewed as being possessed by demons. This was not an uncommon societal belief in the 1700s. The idea that mental illness was the result of demonic possession by either an evil spirit or an evil god incorrectly attributed all inexpiable phenomena to deities deemed either good or evil.^[1] As a result of these prevailing theories of psychopathology, derived from folklore and inadequate scientific beliefs, these systems are still perpetuated today. Although science has shed a light to a better understanding of mental health, it is still common for stigma, discrimination, and ignorance to be the deciding factors in how people with mental health are cared for and treated.

Psychological disorders are very common in the U.S, yet there is still a great deal of inequity that encompasses mental health issues. Stigma, labeling, ignorance, discrimination and judgement are all still very prevalent and harsh realities in our society today. The biological, sociological, physiological and cultural determinants of mental health disorders vary from case to case and most mental health issues are still often difficult to understand, since the roots of mental illness are often misunderstood. We mentioned the DSM-5 earlier, which is another tool that psychologists and psychiatrists and Certified Alcohol and Drug Counselors (CADC) often use to diagnose mental health and substance use disorders. Our society has made a lot of progress in understanding how some operate, but we still have a ways to go until we as a society can see mental health through a collective, compassionate lens. It is important to remember that those who struggle with psychological disorders are not their disorder. It is something they have, through no fault of their own. As with cancer and diabetes, these people who have psychological disorders often suffer from debilitating, often painful conditions through no choice of their own. These individuals deserve to be treated and viewed with compassion, dignity, and understanding.

Substance Abuse

So what exactly is the relationship between substance abuse and mental health? Substance abuse and mental health are interconnecting and overlapping systems. There has been years and years of stigma, discrimination, and misunderstanding with people who both have mental health issues and substance abuse issues. Many people who suffer from substance abuse often have undealt-with trauma, depression, anxiety, and environmental and genetic factors that contribute to the use of substances as a way to self-medicate and cope with how they feel, regardless of the negative consequences that might happen as a result of using. For example, conduct disorder and antisocial personality disorder are strongly associated with the development of both substance use and serious mental illness such as major depression and bipolar disorder. Some substance abuse can even mimic mental health issues, making a diagnosis difficult without dealing with the substance abuse issues first. Psychopharmacological reactions to withdrawal can also induce psychiatric symptoms and exacerbate underlying mental health issues for people as well.

Mental health issues are interconnected with substance abuse. Most people who practice counseling often deal with the substance abuse issues with a client and then proceed to determine if that individual is suffering from mental health issues after the substance abuse is addressed.

Mental Health, Substance Abuse, and the Criminalization of Drugs

Although slavery has been abolished, and the Jim Crow Laws are no longer legal, the systems that have oppressed people of color and marginalized communities from 300 years ago are perpetuated still to this day. It can be argued that the criminal justice system and the legislation and policies that were created to punish drug users and drug crimes were designed to perpetuate discrimination and oppression of people of color at disproportionate rates.

A significant aspect of the War on Drugs, a piece of legislation that disproportionately affected people of color in the United States, was that it imposed mandatory minimum sentencing laws that sent non-violent drug offenders to prison, rather than enrolling them in treatment programs. Seventy percent of inmates in the United States are non-White—a figure that surpasses the percentage of non-Whites in US society, which is approximately 23%, according to the 2015 US census. That means that non-White prisoners are far over-represented in the US criminal justice system. The United States has the highest incarceration rates for drug-related crimes. This figure based on the article “The Black/White marijuana arrest gap, in in nine charts,” demonstrates the implicit bias our justice system still has for people of color in the United States.

It is a very sad and common societal view that addicts and substance abuse users as lesser human beings, a lower standard of individual than the rest of society. This is known as stigma. This overarching and negative view on people who struggle with substance abuse plays a role in the passing of policies and criminalization of millions of people every year in the United States, most importantly, affecting families of color. When people of color are targeted for nonviolent drug-related crimes, they are more likely to receive harsher punishments than White people. This has absolutely deleterious consequences for people of color and their families, with the head of households usually being the ones who receive these harsher punishments.

Women of color have been arrested at rates far higher than White women, even though they use drugs at a rate equal to or lower than White women. Furthermore, according to Bureau of Justice statistics from 2007, nearly two-thirds of US women prisoners had children under 18 years of age. Before incarceration, disproportionately, these women were the primary caregivers to their children and other family members so the impact on children, families, and communities is substantial when women are imprisoned. Finally, inmates often engage in prison labor for less than minimum wage. When these individuals are incarcerated, corporations contract prison labor that produces millions of dollars in profit. Therefore, the incarceration of millions of people artificially deflates the unemployment rate (something politicians benefit from) and creates a cheap labor force that generates millions of dollars in profit for private corporations. How do we make sense of this? What does this say about the state of democracy in the United States? When seen through an equity lens, we can establish some interesting points. One is that the rates that people of color and White people use drugs are about the same, but one important factor plays a role in the disproportionate rates that POC are incarcerated. This is implicit bias. People have subconscious ideas about who uses drugs in the United States. These ideas are based on false narratives derived from implicit biases that perpetuate the inequitable incarceration of people of color. And two, the War on Drugs focused and funneled money into the punishment of and incarceration for drug-related offenses.

A question to ponder is this: What would society look like if instead of punishment and criminalizing drug use and drug users, we used that money to focus on treatment, recovery centers, and social services?