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Co-Occurring Disorders And Substance Abuse

David Hunter, MA.Ed, LPC

Medically reviewed by

David Hunter, MA.Ed, LPC

June 10, 2019

A person who has a co-occurring disorder suffers from both a mental health condition as well as a substance use disorder. Co-occurring disorders are fairly common and require treatment that is catered to addressing dual diagnoses.

Someone with a co-occurring disorder has been diagnosed with both a mental health disorder and a substance use disorder. An estimated eight million adults in the United States suffer from co-occurring disorders.

Any mental health condition can occur alongside a substance use disorder. The most common mental health disorders in a dual diagnosis include mood disorders, anxiety, personality, and behavioral conditions.

The symptoms of one disorder may become prevalent before the other disorder is known. For example, someone may experience symptoms of bipolar disorder before he or she begins abusing drugs or alcohol. Regardless of which condition occurs first, co-occurring disorders tend to exacerbate the symptoms of each other.

While a co-occurring disorder can certainly make treatment more difficult, there are a number of options that have proven successful in treating dual diagnoses.

Common Mental Health Disorders That Co-Occur With Addiction

While any mental health condition can occur alongside addiction, certain mental health disorders are more common than others in a dual diagnosis. These include anxiety, mood, psychotic, behavioral, and personality disorders.

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The following is a brief description of each mental health disorder category:

  • Anxiety Disorders — Anxiety disorders are when a person experiences anxiety that worsens over time. Common anxiety disorders include generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder.
  • Mood Disorders — This type of mental health condition encompasses a number of different disorders that affect mood. These include depression and bipolar disorder.
  • Psychotic Disorders — Psychotic disorders are characterized by a disconnection from reality. People with psychotic disorders typically experience hallucinations and delusions. Common psychotic conditions include schizophrenia and postpartum psychosis.
  • Behavioral Disorders — Behavioral conditions are when a person suffers from a behavioral problem for six or more months. Common behavioral disorders include attention-deficit disorder and conduct disorder.
  • Personality Disorders — Personality disorders are characterized by unhealthy and inflexible behavior and thought patterns. These disorders include borderline personality disorder and schizoid personality disorder.

In addition to these categories of mental health disorders, there are certain conditions that in each that are more prominent than others.

Mental health conditions that are often seen with substance abuse include:

  • bipolar disorder
  • attention-deficit hyperactivity disorder (ADHD)
  • eating disorders like bulimia and anorexia
  • depression
  • anxiety
  • borderline personality disorder
  • schizophrenia
  • post-traumatic stress disorder (PTSD)

Symptoms of mental health disorders vary depending on the specific condition. Additionally, symptoms of a mental health condition can also be impacted by addiction. Many symptoms of a mental health disorder are similar to that of a substance use disorder.

What Causes Co-Occurring Disorders?

Having a mental health disorder can increase the risk of substance abuse. On the flip side, abusing drugs or alcohol can contribute to the development of a mental health condition. However, it’s not always easy to determine which condition came first or what caused its onset.

One potential cause of co-occurring disorders is self-medication. Often, people with depression or other mental health problems drink alcohol or use drugs to help calm their mind, kill emotional pain, or distract themselves from their problems.

Other factors that may contribute to the development of co-occurring disorders include:

  • Genetics — A person’s genes can influence his or her chances of developing a mental health and/or substance use disorder.
  • Childhood Environment — People who are exposed to drug and alcohol abuse at an early age are more likely to go on to suffer from addiction. Abusing drugs or alcohol at a young age can also increase the chances of developing a mental health disorder.
  • Environmental Factors — Individuals who are exposed to high stress or trauma may be more susceptible to suffer from co-occurring disorders.

Signs Of Co-Occurring Disorders

Determining if someone is suffering from co-occurring disorders isn’t always easy. Some mental health conditions and addiction can have the same symptoms. For example, a person abusing cocaine may display symptoms of psychosis.

However, there are certain signs that may make a co-occurring disorder apparent which can include:

  • trouble keeping up with responsibilities
  • anti-social behavioral and isolation
  • changes in behavior
  • cognitive impairment
  • delusions or hallucinations
  • suicidal behaviors or ideations
  • a decline in health
  • trouble at work or school
  • financial problems
  • refusal to seek treatment
  • impulsive or unpredictable behavior


Self-medication is one of the most common contributing factors to the development of co-occurring disorders. Many people with a mental health condition attempt to mask symptoms of their disorder by using alcohol or drugs. Doing so can increase the risk of addiction.

Examples of self-medication include relying on alcohol to ease anxiety, abusing marijuana to deal with emotions, and using stimulants like cocaine to increase energy. While substances may temporarily ease symptoms of a mental health condition, it can cause serious damage in the long run.

Abusing substances as a means of coping with a mental health disorder can result in the development of a substance use disorder. The more a person abuses drugs or alcohol, the more likely he or she is to build up a tolerance to the substance. This means that more of the drug is needed to experience the same effects.

Many people will continue increasing their drug or alcohol consumption to find relief from mental health symptoms. Continued substance abuse can quickly result in physical and mental dependence as well as addiction.

Treatment Options For Co-Occurring Disorders

Dual diagnosis treatment is the most commonly prescribed option for co-occurring disorders. This treatment plan works to treat both a physical addiction and the mental/emotional problems that contribute to it. It attacks both fronts in an effort to fully eliminate all addiction symptoms, relieving people of the coinciding disorders, as well.

Typically, individuals will undergo a detoxification procedure to rid the body of any addictive substance and give them a more focused state of mind. The physical aspect of dual diagnosis treats withdrawal symptoms as well as any health problems caused by addiction.

The psychological aspect of dual diagnosis is likely going to be the hardest part of recovery. First of all, psychological disorders need to be diagnosed, which takes analysis and frank discussion. Then, a treatment plan is created to eliminate or lessen the severity of the disorders.

Typical treatment options for co-occurring disorders include:

Working through these treatment therapies will help identify contributing factors and find coping behaviors to eliminate them. Many people with co-occurring disorders may also receive prescription medicines to treat chemical imbalances.

To learn more about co-occurring disorders and the treatment options available for dual diagnosis, contact a treatment specialist today.

John Hopkins Medicine - Mood Disorders

National Institute On Drug Abuse - Common Comorbidities with Substance Use Disorders

Journal of Substance Abuse Treatment - Co-Occurring Disorders in Substance Abuse Treatment: Issues and Prospects

SAMHSA - Mental Health and Substance Use Disorders

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