A Systemic Approach to Comorbid Substance Use, Anxiety, and Depression: Applying the 5 Ps Model

Abstract

Substance use disorders (SUD) rarely occur in isolation; they exist in a persistent, mutually reinforcing relationship with anxiety and depressive symptomatology, forming a triad that severely compromises individual and relational functioning. The urgency of integrated approaches is particularly evident in Kenya, where recent national evidence demonstrates substantial levels of alcohol, cannabis, tobacco, and other psychoactive substance use among both the general population and university students, with increasing recognition of co-occurring depressive disorders as a major public health concern (NACADA, 2022, 2024).Traditional treatment models frequently address these conditions sequentially, stabilizing substance use before treating co-occurring mood disorders, an approach that fails to account for the interlocking biological, psychological, and systemic mechanisms sustaining the triad and that frequently drives high rates of relapse. This paper proposes that the 5 Ps model (Presenting, Predisposing, Precipitating, Perpetuating, and Protective factors), long used in individualized clinical formulation, offers a superior, systemically oriented framework for conceptualizing and treating comorbid SUD, anxiety, and depression. Drawing on contemporary neurobiological, psychological, and epidemiological literature, this paper maps each of the 5 Ps onto the clinical presentation of the triad, illustrating how historical vulnerabilities, acute stressors, and self-reinforcing feedback loops interact within the family system to maintain distress. Attention is given to protective factors within the Kenyan context, where community cohesion, layperson-delivered interventions, and culturally embedded resilience offer promising, underutilized buffers against relapse. The paper concludes that integrated, concurrent treatment that engages the family system alongside the individual, and that addresses shared neurobiological substrates, is clinically necessary for sustainable recovery. Implications for private-practice clinicians managing complex; dual-diagnosis presentations are discussed, along with a call for expanded research into systemic and community-based interventions for this population.