Addiction and mental health conditions: why they so often co-occur
Addiction rarely exists in isolation. In the practice of coaches and counsellors, substance use or behavioural addictions are frequently accompanied by mental health difficulties or conditions. Anxiety disorders, depression, trauma, ADHD or personality-related issues are commonly found among people struggling with addiction. This combination is often referred to as a dual diagnosis: addiction alongside a mental health condition.
The fact that these issues so often occur together is not coincidental. Research shows that psychological vulnerability and addiction frequently interact and reinforce one another. For professionals working in coaching and counselling, it is important to understand this relationship, while remaining clear about the boundaries of their role and not stepping into treatment.
Addiction and mental health in the Netherlands
According to figures from the Trimbos Institute, around two million people in the Netherlands engage in risky or heavy alcohol use. Approximately 600,000 people experience problematic alcohol use. In addition, hundreds of thousands struggle with problematic drug use or behavioural addictions such as gambling or gaming.
The most recent Mental Health Monitor (RIVM & Trimbos Institute, 2025) shows that mental health in the Netherlands continues to be under pressure. Around one in five adults experiences psychological complaints such as anxiety, low mood or stress. This vulnerability is particularly evident among young people and young adults, who report higher levels of depressive symptoms, stress, performance pressure and mental exhaustion than previous generations.
In this monitor, RIVM and Trimbos emphasise that mental health difficulties are a significant risk factor for problematic substance use. Combined with the widespread availability and social acceptance of substances and addictive behaviours, this helps explain why addiction and mental health problems so often co-occur.
Mental health conditions and self-medication
For many people, addiction is not a conscious choice but a way of coping with psychological pain. Alcohol may temporarily reduce tension, cannabis can promote relaxation, and stimulant substances may dampen low mood or concentration difficulties. This pattern is commonly described as self-medication.
While this may offer short-term relief, research consistently shows that in the longer term it often leads to a worsening of mental health problems and increasing dependence. The substance does not resolve the underlying issues; it merely masks them for a time.
For coaches, it is important to recognise that stopping substance use alone is often insufficient if underlying psychological vulnerability is not addressed.
When substance use causes mental health problems
The relationship between addiction and mental health also works in the opposite direction. Prolonged or intensive substance use can cause or exacerbate mental health difficulties. Alcohol use is associated with depressive symptoms, stimulant use with anxiety and agitation, and cannabis use with psychotic symptoms in vulnerable individuals.
Behavioural addictions such as gambling or gaming are also frequently linked to stress, shame and low mood. Financial difficulties, relationship problems and social isolation can further intensify psychological distress.
International research shows that among people seeking help for addiction, more than half also meet the criteria for one or more mental health conditions. This significantly increases the complexity of both support and recovery.
Dual diagnosis and recovery
In cases of dual diagnosis, addiction and mental health difficulties often reinforce each other in a vicious cycle. Anxiety or low mood may lead to increased substance use, while that substance use in turn worsens psychological symptoms.
Both research and practice demonstrate that recovery becomes more challenging when only one side of the problem is addressed. Focusing solely on abstinence without attending to psychological vulnerability increases the risk of relapse. Conversely, mental health support is less effective if substance use remains unaddressed.
For coaches and counsellors, this means working with complex presentations while maintaining clear professional boundaries.
Training programme in Addiction and Recovery Coaching and Counselling
In the Addiction and Recovery Coaching and Counselling training programme, we prepare professionals to support people through all stages of addiction and recovery. Participants learn how addictive processes develop, how recovery can take shape, and the role that psychological vulnerability plays within this process.
At the same time, it is central to the training that a coach is not a therapist or clinician. The programme focuses on:
- recognising mental health difficulties;
- providing support within a coaching and counselling framework;
- working with motivation and recovery-oriented thinking;
- collaborating with other professionals;
- and making timely and appropriate referrals when necessary.
This approach reflects what research consistently shows: sustainable change requires collaboration and clear role boundaries between coaching, counselling and treatment.
Knowing your boundaries as a coach
Because mental health conditions are so common in the context of addiction, it is essential that coaches understand what they can and cannot responsibly support. Knowing when coaching alone is insufficient, and when referral is required, is a key aspect of professional practice.
In conclusion
The rise in mental health difficulties in the Netherlands, particularly among young people, makes the connection between addiction and mental health increasingly visible. Research shows that these issues frequently influence and reinforce one another.
For coaches and counsellors, this highlights the importance of broad knowledge, reflective practice and clear professional boundaries. With the right training, it is possible to support people in recovery with sensitivity to their psychological vulnerability, while remaining firmly within one’s professional role.
Sources and research
- Mental Health Monitor. National Report 2025, RIVM & Trimbos Institute
- Kessler et al. (2005), National Comorbidity Survey (USA)
Demonstrates that more than 50% of people with addiction also have a mental health condition. - EMCDDA (European Monitoring Centre for Drugs and Drug Addiction)
Reports consistently high rates of dual diagnosis within addiction services. - NICE Guidelines & WHO
Recognise self-medication as an important factor in the development of addiction.
