Co-Occurring Disorders: Mental Health & Substance Use
Understanding and treating co-occurring mental health conditions and substance use disorders through integrated, evidence-based approaches.
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Co-occurring disorders, also called dual diagnosis, refers to the presence of both a mental health disorder and a substance use disorder occurring simultaneously.[1] This is extremely common—according to SAMHSA, approximately 9.5 million adults in the United States had both a mental illness and a substance use disorder in 2019.[1] The relationship between these conditions is complex and bidirectional, with each condition potentially worsening the other if left untreated.
Understanding co-occurring disorders is essential because they require specialized, integrated treatment that addresses both conditions simultaneously. Treating only one disorder while ignoring the other typically leads to poor outcomes and high relapse rates.[4] Fortunately, when both conditions are properly diagnosed and treated together, individuals can achieve successful recovery and improved quality of life.
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All content is written, edited, and medically reviewed by licensed professionals with expertise in addiction medicine and behavioral health.
Benjamin Zohar
NCACIP
Nationally Certified Advanced Clinical Intervention Professional and recovery advocate in long-term recovery, specializing in intervention services and treatment coordination.
Ezra Zohar, M.S.Ed.
Educational Specialist
Educational Specialist with M.S. in Secondary Education, reviewing educational content focused on addiction awareness and recovery.
Brandon McNally
RN
Registered Nurse with specialized training in addiction medicine and behavioral health nursing.
Last Updated
November 2024
What Are Co-Occurring Disorders?
Co-occurring disorders represent the simultaneous presence of mental health conditions and substance use disorders. Common mental health conditions that co-occur with substance use disorders include:[2]
Depression
Major depressive disorder frequently co-occurs with alcohol and drug use. Individuals may use substances to temporarily relieve depressive symptoms, but substance use ultimately worsens depression.
Anxiety Disorders
Generalized anxiety disorder, panic disorder, social anxiety, and PTSD commonly co-occur with substance use disorders. Substances may provide temporary anxiety relief but increase anxiety over time.
Bipolar Disorder
Individuals with bipolar disorder have particularly high rates of substance use disorders. Substance use can trigger mood episodes and interfere with mood stabilization.
PTSD
Post-traumatic stress disorder and substance use disorders frequently occur together, with substances often used to cope with trauma symptoms.
ADHD
Attention-deficit/hyperactivity disorder increases vulnerability to substance use disorders, particularly stimulant use.
Schizophrenia
Serious mental illnesses like schizophrenia have high rates of co-occurring substance use, complicating treatment and recovery.
Why Do These Conditions Co-Occur?
The relationship between mental health disorders and substance use disorders is complex and multifaceted:[2][3]
Self-Medication Hypothesis
Many individuals use alcohol or drugs to cope with difficult emotions, reduce anxiety, improve mood, or manage symptoms of mental illness. While substances may provide temporary relief, they ultimately worsen mental health symptoms and create a destructive cycle.
Shared Risk Factors
Mental health disorders and substance use disorders share common risk factors including genetics, brain structure and function, trauma exposure, chronic stress, and environmental influences. These shared vulnerabilities increase the likelihood of developing both conditions.
Substance-Induced Mental Health Problems
Chronic substance use can trigger or exacerbate mental health symptoms. Alcohol and drugs directly affect brain chemistry and can cause depression, anxiety, psychosis, and other psychiatric symptoms.
Challenges of Co-Occurring Disorders
Co-occurring disorders present unique challenges that complicate diagnosis, treatment, and recovery:
- •Diagnostic Complexity: Symptoms of substance use and mental health disorders overlap, making accurate diagnosis difficult. Substance intoxication or withdrawal can mimic psychiatric symptoms.
- •Treatment Complications: Each condition affects treatment of the other. Mental health symptoms may interfere with addiction treatment engagement, while ongoing substance use prevents psychiatric medication effectiveness.
- •Increased Severity: Individuals with co-occurring disorders typically experience more severe symptoms, greater functional impairment, and higher rates of crisis and hospitalization.
- •Higher Relapse Risk: Without integrated treatment addressing both conditions, relapse rates for either or both disorders are significantly higher.
Integrated Treatment Approach
The most effective treatment for co-occurring disorders is integrated care that addresses both the mental health condition and substance use disorder simultaneously within the same program or by coordinated providers.[4] Key components of integrated treatment include:
Comprehensive Assessment
Thorough evaluation of both mental health and substance use symptoms, severity, history, and how the conditions interact. Assessment should occur after sufficient time without substance use when possible to distinguish primary mental health symptoms from substance-induced symptoms.
Psychiatric Medication Management
Appropriate psychotropic medications for mental health conditions, prescribed by providers experienced in co-occurring disorders. Medications should have low abuse potential and be monitored closely.
Evidence-Based Psychotherapy
Therapies specifically designed for co-occurring disorders, such as Integrated Cognitive Behavioral Therapy, Dialectical Behavior Therapy, and trauma-focused treatments when appropriate.
Addiction Treatment Services
Standard addiction treatment components including detoxification when needed, counseling, support groups, relapse prevention skills, and continuing care planning.
Family Education and Support
Involving family members in treatment, providing education about both conditions, and teaching skills to support recovery while maintaining healthy boundaries.
Peer Support Services
Connecting with others in recovery from co-occurring disorders through specialized support groups and peer support specialists with lived experience.
Recovery is Achievable
Despite the complexity of co-occurring disorders, integrated treatment is highly effective. Many individuals achieve stable recovery and significant improvement in both their mental health and substance use when both conditions are properly addressed. The key is finding treatment providers experienced in dual diagnosis care who can offer comprehensive, coordinated services.
Finding Appropriate Treatment
If you suspect you or a loved one has co-occurring disorders, seek providers specifically experienced in dual diagnosis treatment. Important considerations include:
- Look for programs that explicitly treat co-occurring disorders
- Ensure staff includes both mental health and addiction specialists
- Verify the program can prescribe and monitor psychiatric medications
- Ask about specific therapies used for co-occurring disorders
- Confirm the level of care matches your needs (outpatient, intensive outpatient, residential)
- Check for continuing care planning and long-term support
Related Resources
References
- 1. Substance Abuse and Mental Health Services Administration. Co-Occurring Disorders and Other Health Conditions. SAMHSA, 2023. https://www.samhsa.gov/mental-health/co-occurring-disorders Accessed November 2024.
- 2. National Institute on Drug Abuse. Part 1: The Connection Between Substance Use Disorders and Mental Illness. NIDA, 2021. https://nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness Accessed November 2024.
- 3. National Institute of Mental Health. Substance Use and Co-Occurring Mental Disorders. NIMH, 2023. https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health Accessed November 2024.
- 4. Kelly TM, Daley DC. Integrated Treatment of Substance Use and Psychiatric Disorders. Social Work in Public Health, 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753025/ Accessed November 2024.