Substance Use and Mental Health: When Coping Becomes a Problem
This article is general information published by the practice of Dr. Sholeh Toobaei, Specialist Psychiatrist, Dubai. It has not yet been individually reviewed by a clinician and is not a substitute for personal medical advice. Published: 1 September 2026.
Scope: This article is general information about the relationship between substance use and mental health. It is not a diagnosis and cannot tell you whether your substance use has become a problem. Only a proper clinical assessment can do that.
How are substance use and mental health connected?
Very closely. The connection goes in both directions, and they are often impossible to separate.
People with mental health conditions use substances at significantly higher rates than the general population. This is partly self-medication — someone with anxiety might drink to feel relaxed, someone with depression might use stimulants to feel energy, someone with PTSD might use cannabis or alcohol to quiet nightmares. The substance provides temporary relief, which reinforces the behaviour. But the relief is always temporary, and the substance eventually makes things worse.
The reverse direction is equally important: substance use can cause mental health problems. Heavy alcohol use causes or worsens depression and anxiety. Cannabis can trigger or worsen anxiety, paranoia, and in vulnerable people, psychosis. Stimulants (cocaine, methamphetamine, excessive caffeine combined with other substances) cause anxiety, paranoia, and sometimes psychosis that is indistinguishable from a primary psychotic disorder.
This is why a psychiatrist needs to know about any substance use — alcohol, cannabis, nicotine, recreational drugs, even excessive caffeine — before making a diagnosis or starting treatment. Because if the mental health symptoms are caused or worsened by substances, treating the substance use is the first and most important step.
What does "self-medication" actually look like?
It starts with a clear intention. The person is uncomfortable, and the substance makes it better — at least for a few hours. So they do it again. And again. The pattern becomes routine: alcohol with dinner to unwind, cannabis in the evening to sleep, stimulants before work to focus, energy drinks throughout the day to maintain alertness.
What looks like a coping strategy becomes a dependency when two things happen: the body develops tolerance (needing more to get the same effect), and withdrawal sets in when the substance is stopped (feeling worse than before you started). The person who drinks to calm their anxiety eventually needs the alcohol just to feel normal — and their baseline anxiety is now higher than it was before, because alcohol disrupts the brain chemistry that regulates anxiety.
This cycle is insidious because it starts with something that felt helpful. Nobody decides to develop a substance problem. They decide to feel better, and the path from that decision to dependency is longer and more gradual than it seems in the moment.
What substances are most relevant to mental health?
Alcohol is the most widely used and one of the most damaging. It is a depressant — it slows down the central nervous system. In small amounts, it feels relaxing. But it disrupts sleep architecture (fragmenting the second half of the night), worsens depression over time, increases anxiety the next day (a well-documented phenomenon called "hangxiety"), and is addictive for a significant proportion of users. In Dubai, where social drinking is common in certain circles, it is easy to normalise a pattern that is quietly worsening mental health.
Cannabis is increasingly common and widely misunderstood. Moderate, occasional use may be benign for some adults. But daily or near-daily use — particularly of high-THC products — is associated with increased anxiety, depersonalisation (feeling detached from yourself), memory and concentration problems, and in people with a genetic vulnerability to psychosis, an increased risk of developing a psychotic disorder. THC also affects motivation, which can look like depression or ADHD-like symptoms.
Nicotine and caffeine are both stimulants that affect mood. Nicotine is highly addictive and creates a cycle of withdrawal (irritability, anxiety, poor concentration) that the next cigarette temporarily resolves. Caffeine, at high doses or late in the day, can cause or worsen anxiety, insomnia, and heart palpitations that feel like panic attacks.
Recreational drugs — cocaine, MDMA, ketamine, synthetic cannabinoids ("spice"), and others — carry significant risks for people with mental health conditions. They can trigger severe anxiety, paranoia, psychosis, and in some cases, lasting changes in mood and perception. In the UAE, possession or use of recreational drugs carries severe legal penalties, which adds a layer of legal risk on top of the health risks.
How do you untangle which came first?
This is one of the hardest clinical questions. Did the anxiety come first and the alcohol follow? Or did the alcohol cause the anxiety? The best way to untangle it is time: a period of abstinence from substances, during which the mental health symptoms are monitored. If the symptoms persist after the substance has cleared the system, they were likely primary. If they improve dramatically, the substance was the driver.
This is why honest disclosure to your psychiatrist matters. You do not need to tell every detail — but telling the truth about how much and how often you use substances is essential for an accurate diagnosis and effective treatment.
What treatment is available?
Treatment depends on the substance, the severity of use, and whether there is a co-occurring mental health condition. For alcohol and cannabis, there is no medication that is universally effective, but behavioural therapies — cognitive behavioural therapy, motivational enhancement therapy, and contingency management — are well-studied and effective.
For alcohol, there are medications that reduce cravings (naltrexone, acamprosate) and one that produces an adverse reaction to alcohol (disulfiram). These are adjuncts to behavioural treatment, not replacements.
For nicotine, there are effective cessation aids — nicotine replacement therapy, varenicline, and bupropion — that significantly increase the chance of success.
For stimulants, there are no FDA-approved medications, but behavioural treatments are effective. Supporting someone with stimulant use disorder is particularly challenging because the crash after use can trigger depression, anxiety, and intense cravings that require professional support.
If a mental health condition is driving the substance use, treating that condition is essential. A person who is drinking to self-medicate for anxiety will continue to drink unless the anxiety is treated. The most effective approach treats both conditions simultaneously.
Is there hope for recovery?
Yes. Substance use disorders are among the most treatable conditions in psychiatry when the person is ready for treatment. The key is readiness — external pressure (from a partner, employer, or legal system) can start the conversation, but lasting change requires internal motivation. A good psychiatrist will meet the person where they are, not where they "should" be.
Recovery is not linear. Relapses happen. The question is whether the person has a support system and a treatment plan that helps them get back on track quickly when they do relapse.
When should I seek help?
If you are using substances to cope with stress, anxiety, depression, or sleep problems; if you find that you cannot stop when you intend to; if you are using more than you planned; if people close to you have raised concerns about your substance use; or if your substance use is affecting your work, relationships, or health — seek a professional assessment. These are all signs that the coping strategy has become a problem. Seek urgent help — call 999 (police) or 998 (ambulance) in the UAE, or go to the nearest emergency department — if you are experiencing severe withdrawal symptoms (seizures, severe confusion, hallucinations), if you are having thoughts of self-harm, or if you are using substances in a way that puts you or others at immediate risk. For non-urgent enquiries, use the appointment request form on this website. This practice does not operate a monitored telephone line, and a message sent through the form may not be read straight away.