Understanding Co-occurring Disorders & Effective Treatment Options

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What Is A Co-occurring Disorder?

People who have substance use disorders and mental health disorders are diagnosed as having co-occurring disorders or dual diagnoses. People with mental illness are more likely to experience a substance use disorder than those not affected by a mental health illness. According to SAMHSA’s 2018 National Survey on Drug Use and Health, approximately 9.2 million adults in the United States have a co-occurring disorder [1].

When a substance use disorder and a psychiatric disorder co-occur, they may differ in severity, and the severity of each can change over time. Compared to individuals who have a single disorder, those with a combination of disorders may experience more severe medical and mental health challenges and may also require longer periods of treatment.

While substance use disorders and other mental health disorders commonly co-occur, that does not mean that one caused the other. Co-occurring disorders can include anxiety disorders, depression, attention-deficit hyperactivity disorder (ADHD), bipolar disorder, personality disorders, and schizophrenia disorder, among others [2]. These illnesses are common, recurrent, and often serious, but they are treatable and many people do recover. Mental health disorders involve changes in thinking, mood, and/or behavior. These disorders can affect how we relate to others and make choices.

Using alcohol or other drugs not only fails to repair the mental health disorder but also prevents a person from developing effective coping skills.
Using alcohol or other drugs not only fails to repair the mental health disorder but also prevents a person from developing effective coping skills.

In the DSM-5, substance use disorders are defined by the class of drugs used, including alcohol, opioids, hallucinogens, inhalants, sedatives, stimulants, and tobacco. These disorders share the defining features of addiction, such as continuing to seek the substance despite harmful consequences, neglecting normal activities, and devoting excessive time to obtaining the substance, as well as cravings, tolerance, and withdrawal.

Popular Mental Health & Addiction Co Occurring Defintions

  1. What Is A Co Occurring Disorder In Relation to Mental Health Disorders?

    Anxiety disorders, depression, attention-deficit hyperactivity disorder (ADHD), bipolar disorder, personality disorders, and schizophrenia are just a few examples of co-occurring disorders.

  2. What Are Addiction Co-Occurring Disorders?

    Co occurring disorders examples. Antisocial personality disorder is the personality disorder with the highest risk of addiction, but people with that disease rarely seek treatment and, when they do, rarely complete it.

  3. What is the Most Typical Co Occurring Disorders Definition?

    Co occurring disorder definition. The phrase “dual diagnosis treatment” is now most frequently used to refer to the approach taken to treat people who suffer from both mental illness and addiction. The term “co-occurring disorders” refers to a number of illnesses that frequently coexist with drug or alcohol addiction.

  4. What Is The Co Occurring Disorders Meaning in Relation to Addiction & Mental Health Disorders?

    Dual diagnosis and co-occurring disorders are quite similar in that they both relate to multiple health concerns that are present at the same time. However, the term “co-occurring illnesses” typically refers to a mental health condition that resulted from substance abuse and addiction to alcohol and/or drugs. It can also be used to describe a mental condition that aids in the emergence of addiction.

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Co-occurring Disorders Statistics

7.7 million adults have co-occurring mental and substance use disorders. While this does not mean that one caused the other, it can be difficult to figure out which condition was first. Of the 20.3 million adults with substance use disorders, about 38% also had mental health illnesses. Source: NIH. Comorbidity: Substance Use and Other Mental Health Disorders – nida.nih.gov/research-topics/trends-statistics/infographics/comorbidity-substance-use-other-mental-disorders.

7.7 million

Co-occurring mental and substance use disorders affect 7.7 million adults.

Source: NIH

20.3 million

37.9% of the 20.3 million persons with substance use problems also suffered from mental health conditions.

Source: NIH

42.1 million

Of the 42.1 million adults with mental illness, substance use disorders affected 18.2% of them.

Source: National Institute On Drug Abuse

Symptoms Of Co-occurring Disorders

People diagnosed with a substance use disorder can experience many associated symptoms or direct symptoms of co-occurring disorders. It’s important to remember that co-occurring disorders are common in these individuals and sometimes complicate their diagnosis. Often, substance use disorder and mental condition go hand in hand. Specialists can diagnose each disorder separately, but a person can struggle with both at the same time, as well. When this occurs, the symptoms of co-occurring disorders may intensify.

The symptoms of co-occurring disorders include those associated with the particular substance use problem and mental health condition affecting an individual. People with co-occurring disorders are at high risk for additional problems such as symptomatic relapses, hospitalizations, financial challenges, social isolation, family problems, homelessness, sexual and physical victimization, incarceration, and serious medical illnesses.

Signs Of Co-occurring Disorders

Indications for co-occurring disorders will change depending on which mental health disorders are analyzed and treatment options. For example, if your loved one is battling substance abuse and schizophrenia, the symptoms of these problems will never be the same for a patient living with meth addiction and bipolar disorder. In general, people living with co-occurring disorders find that working daily has become a major problem – if at all possible.

Signs of Co-Occurring Disorders may include:

  • Sudden changes in general behavior
  • Difficulty managing daily tasks and responsibilities
  • Avoiding events or social activities that were once enjoyed
  • Neglecting health and hygiene
  • Delusional thinking or cognitive impairments
  • Refusal to seek or comply with treatment
  • Mentions of thoughts of suicide or suicidal behaviors
  • Erratic and impulsive behaviors
  • Issues managing finances
  • Poor performance at school or work

Common Co-occurring Disorders 

The misuse of prescription drugs and alcohol can be caused by underlying mental health concerns, including loneliness, and shame. Individuals abuse these substances to adapt to a broad variety of passions and activities, such as stress, blame, and humiliation. 

In some cases, a co-occurring disorder may appear at the same time as an addiction. In other cases, though, someone may develop a mental health condition either before or after their addiction starts. The relationship between mental illness and substance abuse is a complex one that can present various challenges during the recovery process.

To better understand the role that mental health plays in substance abuse and addiction, it’s essential to be familiar with specific examples of co-occurring disorders. Below are the most common mental conditions that are often diagnosed alongside a substance use disorder.

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The Connection Between Co-Occurring Addiction And Mental Health Disorders

What Is The Connection Between Co-Occurring Addiction And Mental Health Disorders?

There are recognized risk factors for the emergence of some mental illnesses. The use of drugs as a kind of self-medication by people with moderate, severe, or even subclinical mental problems is frequently suggested.


In many cases, people abuse substances to feel joy or pleasure, even if artificially, even if they need to become numb to their emotional pain. Depression is one of the most common mental illnesses across the globe, affecting millions of people worldwide. But substance-induced depression, also recognized as drug-induced happiness, also happens with alcohol and other drugs after the first elation has worn off. Substance abuse then increases, as the individual desires both euphoria and to avoid contradictory emotions. A bad series thus occurs where depression intensifies dependence and vice versa.

Many individuals who struggle with depression, especially people who have not been properly diagnosed, usually turn to alcohol to escape. Hopeless and desperate to feel better or anesthetize the pain, even for a small amount of time. Individuals who suffer from depression often use the numbing and pleasurable effects of alcohol for that purpose. Alcohol abuse is prevalent among people who suffer from depression. Drinking alcohol may increase depression, anxiety, and other mental health condition [3]. 


Many individuals with anxiety and mental illness turn to substance abuse for relief or to ease the burden every day. There are many types of anxiety and it is one of the most prevalent mental health disorders. In social situations, drinking can reduce anxiety, and prescription drugs can take away anxiety. As anxiety and mental illness sufferers consume substances to cope with their anxiety symptoms, their dependency on those substances increases, making them more vulnerable to addiction and making their anxiety worse.

The co-occurrence of alcohol and anxiety disorders is relatively common. The research found that 20% of those with social anxiety have an alcohol misuse problem. Alcohol is considered a CNS depressant, which slows down neural activity and brain functioning. Alcohol does this by enhancing the effects of the neurotransmitter gamma-aminobutyric acid (GABA). If someone consumes too much alcohol too fast, they can depress the central nervous system to the point of coma, respiratory failure, or death.

Co-Occurring Anxiety Disorder

Post-Traumatic Stress Disorder

Individuals with PTSD experience conditions such as traumatic brain injury (TBI) and PTSD more frequently than individuals who do not. Many veterans return from war with PTSD from their traumatizing combat experiences. The development of PTSD may be accompanied by psychological, physical, or sexual abuse. 

Many different symptoms may indicate post-traumatic stress disorder, such as flashbacks, intrusive thoughts, horrors, and hyper-vigilance. Additionally, prescription drugs and alcohol are temporary remedies for PTSD. The indications of PTSD may happen sooner, create more serious contradictory emotions, or interrupt sleep schedules. As PTSD symptoms can be debilitating, some victims lose control and abuse drugs or alcohol to cope.

When a person has posttraumatic stress disorder (PTSD), the symptoms can come and go. Specific PTSD triggers can set off your PTSD. They bring back strong memories. An individual may feel like they’re living through it all over again. Triggers can include sounds, sights, smells, or thoughts that remind the person of the traumatic event somehow.

Approximately 50% of individuals seeking alcohol and drug abuse treatment also meet the criteria for PTSD. When a substance like alcohol or drugs is used to self-medicate PTSD symptoms, the disorder only becomes more severe. As a central nervous system depressant, alcohol and opiates can worsen anxiety and depression and interfere with normal sleep patterns. Treating PTSD alone will not stop substance abuse. 

Some of the most common mental health disorders found in chemically dependent people include mood- and anxiety disorders. co-occurring disorders
Some of the most common mental health disorders found in chemically dependent people include mood- and anxiety disorders. 

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Schizophrenia is a chronic brain disorder that can distort a person’s perception of reality. People with this mental condition typically experience psychosis, visual or auditory hallucinations, delusions, and distorted thought patterns. This severe mental health condition can hinder a person’s ability to form coherent thoughts, regulate their emotions properly, and relate to other people.

The disturbing experiences caused by schizophrenia can put a person in significant distress. As a result, some people with schizophrenia seek refuge in alcohol or drugs to manage their symptoms. However, substance use often exacerbates the symptoms of schizophrenia, which can prevent someone from receiving the help that they need.

The Connection Between Co-Occurring Alcohol Use Disorder And Schizophrenia

What Is The Connection Between Co-Occurring Alcohol Use Disorder And Schizophrenia?

People with schizophrenia and AUD frequently describe using alcohol and other drugs to reduce general distress brought on by mental illness, poverty, limited prospects, and boredom. They also indicate that using drugs and alcohol makes it easier for them to form identities and social networks.

Borderline Personality Disease

BPD is a mood disorder characterized by sudden mood swings, extreme temperamental restlessness, unpredictable behavior, scattered thoughts of self, others, and the environment, and trouble forming steady connections. Around 6% of adults in America suffer from this disorder. People who suffer from these symptoms often abuse drugs and alcohol to adapt to “controllable” symptoms. This temporary relief is usually short-lived, and can sometimes aggravate symptoms of mental illness. What causes BPD? There’s no single cause of borderline personality disorder (BPD) and it’s possible to be caused by a variety of factors such as genetics, brain chemicals, brain development, and environmental factors. 

Bipolar Disorders

Bipolar disorder is a mental health condition characterized by extreme mood swings. A person who suffers from bipolar disorder oscillates between emotional highs, also known as manic episodes, and emotional lows, also known as depressive episodes. The key difference between bipolar disorder and borderline personality disorder is that people with bipolar disorder experience uncharacteristic highs (mania) or lows (depression). Those with borderline personality disorder (BPD) typically have extremely unstable emotions- swinging from intense idealization of others to devaluation and anger.

Symptoms of a manic episode include high energy levels, a decreased need for sleep, risk-taking behavior, and an increased desire for sex. Depressive episodes, on the other hand, are marked by reduced energy, a lack of motivation, and a loss of interest in previously enjoyed activities.

Individuals with bipolar disorder are more likely to self-medicate. Many begin using substances to reduce the severity of manic and depressive episodes. However, this strategy tends to have the opposite effect, causing users to suffer more intense episodes as a result of substance use.

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10 Common Co-occurring Disorders FAQs

  1. What Is The Difference Between Dual Diagnosis Vs Co-Occurring Disorders?

    Dual diagnosis Vs co occurring disorders

    The nature of the illness is the primary distinction between co-occurring disorders and dual diagnoses. Dual diagnosis refers to two (or more) entirely different diagnoses, even though the conditions found may have been brought on by substance addiction. Contrast that with co-occurring disorders, in which a person’s mental condition prompted them to use drugs or alcohol for self-medication or the terrible consequences and brain damage associated with addiction prompted the onset of mental health disease. Addiction and mental health issues must be treated in tandem because of their inherent connections.

  2. What Is The Connection Between Co Occurring Disorders And Substance Abuse?

    Between 65 and 90 percent of individuals who are examined for substance misuse have at least one co-occurring personality disorder, according to previous study.

  3. Is There Online Co-Occurring Disorders Treatment?

    Co-occurring disorders, often known as dual disorders or a dual diagnosis, are identified in people who have both substance use problems and mental health disorders.

    When a psychiatric condition and a substance use problem co-occur, their degrees of severity can frequently vary, and they can each fluctuate over time. Patients who have several diseases may face more difficult problems and have lengthier treatment times as a result.

  4. What Are Effective Treatment Strategies For Co-Occurring ADHD And Substance Use Disorders?

    ADHD And co occurring disorders. Long-acting, slow-release stimulants are used to treat ADHD patients who also have substance use disorders. Clonidine and bupropion (Wellbutrin) are also mentioned as potential substitutes.

  5. What Are Co-Occurring Psychiatric Disorders?

    One or more main illnesses or chronic diseases are more likely to develop in people with substance use disorders. People receiving medication-assisted treatment frequently have co-occurring disorders, which are defined as having both a mental health disease and a substance use disorder (MAT).

  6. What Is The Connection Between Alcoholism And Co Occurring Disorders?

    Major depression, bipolar disorder, and anxiety disorder are the three mental illnesses that co-occur most frequently with alcoholism, according to the National Institutes of Health (NIH). Post-traumatic stress disorder (PTSD), dependent personality disorder, and conduct disorder are less usually diagnosed alongside alcoholism.

  7. What Are Co Occurring Personality Disorders?

    Co-occurring substance misuse and other mental health illnesses can make borderline personality disorder (BPD) a more severe disease. Addiction and other mental illnesses present additional difficulties that could make BPD symptoms or co-occurring disorder symptoms worse.

  8. How To Treat Co-Occurring Disorders?

    Substance abuse treatment for persons with co occurring disorders. Hospitalization is more common for those with co-occurring illnesses than for those with just a mental illness or a substance use problem. By connecting patients with additional service providers who can provide specialized and personalized services to treat the physical and emotional elements of mental and drug use disorders, integrated treatment coordinates mental and substance use interventions. Care delivery for co-occurring disorders can be done in one of three ways: coordinated, co-located, or fully integrated. A more complete recovery is attainable with integrated treatment.

  9. Is There Inpatient Treatment Co Occurring Disorders?

    At some point in their lives, about half of those who experience mental health problems also engage in substance misuse. People who have substance use disorders (SUD) are more likely to go on to acquire mental health issues than those without SUD.

  10. What Is The Connection For OCD Co Occurring Disorders?

    Obsessive-compulsive disorder (OCD) is a mental illness characterized by intrusive, obsessive thoughts and compulsive, repetitive behaviors that frequently seriously impair job, academic performance, interpersonal interactions, and other obligations. In fact, one of the top 10 causes of disability worldwide, according to the World Health Organization, is OCD.

Alcoholism As A Mental Health Disease

Is alcoholism a mental health disease? The answer is yes. Alcoholism involves a physical addiction, but it also interferes with the individual’s mental state to such an extent that they may struggle to interact normally with their environment, so it is for this reason that it is referred to as a mental health problem or a mental health disease. Along with physical dependence, the person also has psychological dependence, which means that they experience cravings and just cannot cope without alcohol. The need to continue with the behavior involves a mental compulsion, and it involves denial.

Considered a brain disorder, alcoholism can be mild, moderate, or severe. However, lasting changes in the brain caused by alcohol misuse leads to alcoholism and make individuals vulnerable to relapse. The good news is that no matter how alcoholism may seem, evidence-based treatment with mutual-support groups, behavioral therapies, or medications-assisted treatment (MAT) can help individuals with alcoholism maintain and achieve recovery. According to a national survey, 14.1 million adults ages 18 and older1 (5.6 percent of this age group) had alcohol use disorder (AUD) in 2019. 

Co-occurring Disorders Diagnosis And Treatment

In general, it is preferable to treat the co-occurring mental health disorders and SUD jointly rather than singly. As a result, anyone seeking co-occurring disorder treatment for a SUD or other mental health disorders must have each disorder evaluated by a healthcare professional in any co occurring disorders treatment centers. The use of comprehensive assessment tools by the provider can lessen the likelihood of a missed diagnosis and enable targeted treatment because it can be difficult to make an accurate diagnosis due to overlapping symptoms.

Additionally, it is crucial that the individual’s age, the substance being misused, the specific mental health disease, and behavioral therapies and pharmaceuticals be matched to their unique combination of problems and symptoms. Determine the best course of treatment for you by speaking with your healthcare professional from a co-occurring disorders treatment facilities, then give it time to take effect.

Integrated Treatment

What Is Integrated Treatment For Co-Occurring Disorders?

Integrated treatment for co occurring disorders. Traditional methods are different from integrated treatment for co-occurring disorders in a number of respects. The first step is an integrated organization of the services. For instance, evaluations check for both substance use and mental health disease.

Co Occurring Disorders Behavioral Therapies

Numerous behavioral therapies have been identified by research as promising for the treatment of people with co-occurring mental and substance use disorders. Behavioral therapy may be advised by medical professionals either alone or in conjunction with medicines.

The following are a few instances of effective behavioral therapy for persons with SUDs and various co-occurring mental health disorders:

  • Dialectical Behavior Therapy (DBT): DBT employs the ideas of acceptance and mindfulness, or paying attention to and being aware of one’s current situation and emotional condition. DBT also offers techniques that can help manage strong emotions, lessen suicidal thoughts, urges, self-harm, and drug use, and enhance interpersonal connections.
  • Therapeutic Communities (TC): TCs are a typical type of long-term residential treatment that emphasizes assisting patients in forming fresh, more positive ideals, attitudes, and behaviors.
  • Cognitive Behavioral Therapy (CBT): By challenging irrational thinking and altering actions, CBT is a sort of talk therapy designed to assist people to learn how to deal with stressful situations.
  • Contingency Management (CM): By providing incentives or rewards for desired behaviors, CM principles promote healthy behavior.
  • Assertive Community Treatment (ACT): This type of community-based mental health care places a strong emphasis on community outreach and tailored treatment plans.

Co-occurring Disorders Behavioral Therapies for Children and Adolescents

Effective behavioral therapies for kids and teenagers include:

  • Multidimensional Family Therapy (MDFT): To simultaneously treat several interrelated teenage problem behaviors, including substance abuse, mental illnesses, behavioral issues at school, delinquency, and others, MDFT works with the entire family.
  • Multisystemic Therapy (MST): MST focuses on important elements linked to severe antisocial behavior in kids and teens with SUDs.
  • Brief Strategic Family Therapy (BSFT): Family interactions that are thought to perpetuate or exacerbate adolescent SUDs and other co-occurring problem behaviors are the focus of BSFT therapy.

Co-occurring Disorders Medications

Effective drugs are available to treat alcohol, nicotine, and opiate addiction, as well as to diminish the symptoms of numerous other mental illnesses. Several conditions may benefit from the usage of certain drugs as treatment of co occurring disorders.

Co-occurring Disorders Treatment

To provide proper co occurring disorders treatment, the Substance Abuse and Mental Health Services Administration (SAMHSA) recommends an integrated treatment approach. Integrated treatment involves coordinating substance abuse and mental health interventions rather than treating each disorder separately without consideration for the other.

To be effective, both disorders must be treated at the same time, in the same place, by the same treatment team.
To be effective, both disorders must be treated at the same time, in the same place, by the same treatment team.

Integrated or dual diagnosis treatment often involves forms of behavioral treatment, such as cognitive-behavioral therapy (CBT) or dialectical behavior therapy (DBT), that can help improve coping skills and reduce maladaptive behaviors. These may be used in combination with medication-assisted treatment (MAT). Integration is key to achieving a healthy balance and long-term recovery.

Co occurring disorder treatment is a critical aspect of our inpatient treatment experience because co-occurring disorders are strongly connected with instances of substance abuse. Creating a treatment plan that addresses the physical aspects of withdrawal, the psychological connection with drug use, and addressing underlying mental health disorders is all a part of setting clients up for success.

At We Level Up NJ, we believe that if the client can identify the underlying issue and treat it simultaneously with their treatment for addiction, the client’s chances of a successful, relapse-free recovery are much improved. In fact, once we can identify and properly begin treatment on the underlying issue that’s driving or co-occurring with the dependency on alcohol or other drugs, clients will have reached a major milestone and will be that much closer to long-term sobriety. Contact one of our addiction treatment specialists today to learn more about our top-rated co-occurring disorder treatment programs.

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Search We Level Up NJ Co-Occurring Disorder & Resources

[1] SAMHSA – https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/co-occurring-disorders

[2] NIMH – https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health

Substance Abuse and Mental Health Services Administration. (2020). Mental health and substance use disorders.

Flynn, P.M., & Brown, B.S. (2008). Co-occurring disorders in substance abuse treatment: Issues and prospects. Journal of Substance Abuse Treatment, 34(1), 36-47.

Substance Abuse and Mental Health Services Administration. (November, 2021). Co-Occurring Disorders.

Substance Abuse and mental Health Services Administration. (2020). Substance Use Disorder Treatment for People With Co-Occurring Disorders. Treatment Improvement Protocol (TIP) 42.

Hryb, Kathryn, MSW, Kirkhart, Rob, Ph.D., PA-C, and Talbert, Rebecca, PharmD. (September 2007). A Call for Standardized Definition of Dual Diagnosis. Psychiatry, 4(9), 15-16.