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what are co-occurring disorders

What are Co-occurring Disorders?

Co-occurring disorders are described as mental health disorders that co-occur with a substance use disorder or substance addiction. Addiction is one of the greatest risk factors for a mental health disorder, and vice versa. 

About a third of all people with a diagnosed mental illness, and half of the people diagnosed with a severe mental health issue struggle with substance abuse. In turn, about a third of all alcoholics and over half of all people struggling with substance use have a mental health issue. 

Substance Abuse and Mental Health

One of the key reasons mental health issues and substance use are intertwined is because of the reality of self-medication. While access to mental healthcare has drastically improved in recent years, the number of people getting the help they need is still very low. 

Many people with mental health problems, diagnosed or undiagnosed, turn to drugs as a way to reduce symptoms, or just distract themselves from their intrusive or negative thoughts. 

Other factors that are common in patients with a dual diagnosis are a lower socioeconomic status (treatment can be expensive), military veterans, and people with chronic health issues (especially chronic pain). 

Substance abuse disorder is also a mental health issue. But a co-occurring disorder describes addiction with at least one other mental health diagnosis, with symptoms suggesting not only dependence on drugs or alcohol, but a mood disorder, anxiety disorder, or another mental health issue as well. 

Common Co-Occurring Disorders

Mental health disorders can take on different forms in patients with a history of substance use. Most of the common mental health issues in the United States also correlate with common co-occurring disorders, including: 

Anxiety Disorders

Anxiety disorders are the most diagnosed mental health disorders in the world. These are conditions characterized by intrusive thoughts, worries, and behavior surrounding pressure and panic. Common anxiety disorders include:

  • Generalized anxiety disorder
  • Social anxiety disorder
  • Panic disorder
  • Phobias

Patients with anxiety issues may discover drugs as a way to loosen up, reduce their anxieties, and in some cases calm down. Depressants like alcohol can affect the brain in similar ways to anti-anxiety medication like benzodiazepine. 

However, alcohol use in the long term actually leads to more anxiety and worse symptoms. Because alcohol is an addictive drug, it’s often a bad mix. The same goes for nicotine, another common substance used to reduce stress in the short term. 

Mood Disorders

Mood disorders are a term used to describe disorders characterized by mood dysfunctions, specifically mania, and depression. Common types of mood disorders include: 

  • Major depressive disorder
  • Bipolar disorder
  • Seasonal affective disorder
  • Premenstrual dysphoric disorder
  • Persistent depressive disorder

Both depression and mania can lead someone to consider drugs as a short-term relief from their symptoms or to amplify the positive side of their mania (productivity and sense of grandeur). 

However, utilizing drugs while depressed or manic can lead to severe crashes in mood, creating a vicious cycle that spirals someone towards addiction much faster than the average person. It can also exacerbate their symptoms, especially during withdrawals and comedowns. 


Schizophrenia is a type of psychotic disorder characterized by hallucinations and distortions in perception. A person with schizophrenia will hear and see things that aren’t there and will struggle to distinguish from fiction and reality. 

Anti-psychotic medication is critical to reducing symptoms and helping a patient with schizophrenia ground themselves. Because it is a disorder with such severe symptoms related to seeing the world differently, patients with schizophrenia may have a hard time getting or seeking the help they need. 

They are more likely to struggle with homelessness and incarceration than the general population due to their symptoms and lack of help, and more likely to use drugs, often as an escape from certain symptoms of schizophrenia, such as apathy, dysphoria, and sleeplessness. 


Post-traumatic stress disorder is most often diagnosed in domestic violence survivors and returning soldiers, as well as rape survivors. While harrowing events are the most common cause of PTSD, it isn’t the only cause. 

Seeing a loved one experience a dangerous event – whether or not they survive – can trigger PTSD in a person. While the onset usually requires an event as a trigger, genetics – as well as how resilient a person is, which can come down to chronic stress, childhood experiences, and personality – seem to play a role in when and how PTSD develops. 

Patients with PTSD are 14 times more likely than the average person to struggle with substance use disorder. Self-medication is often a big reason, as drugs like alcohol or cocaine can induce euphoria and overcome periods of low mood. However, drug use usually makes PTSD symptoms worse in the long term. 

Treating a Co-Occurring Disorder 

The treatment process for a co-occurring disorder is similar to other cases of substance use disorder but with a much more holistic and multimodal approach. Treating addiction alone, or treating addiction first, will not guarantee success in a patient’s recovery. 

Because their mental health problem contributed to their substance use and addiction, it will be very difficult for them to continue staying sober while tackling their mental health. 

The idea behind dual diagnosis treatment is to treat both concurrently. This means combining detoxification and rehabilitation with one-on-one therapy sessions, career or academic support, a long-term local support group in the community, and medication. 

Inpatient treatment is usually recommended for a dual diagnosis. Patients will be removed from the triggers for their addiction, and will learn to deal with cravings and recurring withdrawal symptoms while learning new coping mechanisms, addressing their mental health through medication and psychotherapy, and exploring other methods of treatment, such as:

  • Art or experiential therapy
  • Group therapy
  • Animal-assisted therapy
  • Eye-movement desensitization
  • Neurofeedback
  • And more. 

As with substance use disorder itself, treatment for a dual diagnosis or a co-occurring disorder is a long-term process. 

Many mental health issues aren’t “cured” after a few months of therapy – it can take a lifetime of work and learning to effectively cope with a diagnosis like major depressive disorder or PTSD, and addiction can weigh heavily on that process. 

But through consistent support provided by friends and family, professional help, and patience, you can pull through and live a fulfilling life away from old habits and self-destructive behavior. 

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