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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 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 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, among others [2]. These illnesses are common, recurrent, and often serious, but they are treatable and many people do recover. Mental disorders involve changes in thinking, mood, and/or behavior. These disorders can affect how we relate to others and make choices.

Co-occurring Disorders
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 drug 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.

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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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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.

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. 

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

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. 

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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.

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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Alcoholism as a Mental Disease

Is alcoholism a mental 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 disease. Along with the physical dependence, the person also has a 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 Treatment

To provide proper treatment for co-occurring disorders, 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.

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.

Treating co-occurring disorders 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.

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

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[1] SAMHSA –

[2] NIMH –

[3] CDC –