Co-Occurring Disorders: Mental Health & Addiction

Several people who experience a substance use disorder also experience a mental health illness – and vice versa. When both a substance use disorder and a mental health condition are occurring at the same time, it is known as a co-occurring disorder. About 1 in 3 individuals with a mental health condition also has an addiction to drugs or alcohol.1 Conversely, about 50% of those with a substance use disorder have a mental health condition.2 In this article, we will learn more about what co-occurring disorders are, how they are diagnosed, and how they can be treated.
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Co-Occurring Disorders

What Are Co-Occurring Disorders?

A co-occurring disorder is defined as a mental health condition and a substance use disorder that are occurring at the same time. Co-occurring disorders are complex and bidirectional, which means that each condition tends to affect and possibly exacerbate the other. What this means is that symptoms of both the substance use disorder and the mental health condition can worsen the other, making both more severe.3

Sometimes it is clear that one disorder came first. A person may experience a substance use disorder prior to a mental health condition, or vice versa. For example, those who misuse substances put themselves at risk for experiencing brain changes that can cause them to become more vulnerable to developing other mental health disorders, such as anxiety and depression.2 At the same time, symptoms associated with a mental health disorder can become overwhelming and challenging to handle, and a person may use a drug or alcohol to alleviate them, eventually getting to the point where misusing addictive substances becomes a maladaptive coping mechanism.2 Misusing substances as a form of self-medication is not an effective option for resolving symptoms and can increase the likelihood of developing a substance use disorder.

In many cases, however, it is not clear which disorder came first. This is because both co-occurring disorders typically wax and wane over time. Although it can be helpful for treatment providers to know which disorder came first, what’s important is that both are treated with equal seriousness.3

Common Co-Occurring Disorders

What Are the Most Common Co-Occurring Disorders?

There are many different combinations of substance use disorders and mental health conditions that make up co-occurring disorders. Some of the most common mental health conditions that co-occur with substance use disorders include:5

  • Depression and addiction: Depression is marked by symptoms such as regularly depressed mood, loss of interest in things previously enjoyed, and withdrawal from others.
  • Bipolar disorder and addiction: There are three types of bipolar disorder, including bipolar I, bipolar II, and cyclothymic disorder. Each type is defined by different symptoms, but it is common for a person with any type of bipolar disorder to experience a combination of depression and mania.6
  • Post-traumatic stress disorder (PTSD) and addiction: Those who have lived through one or more traumatic experiences can develop PTSD, which is characterized by flashbacks of the traumatic event(s), distressing thoughts, avoidance of reminders of the trauma, being easily startled, and irritability.7
  • Borderline personality disorder and addiction: Borderline personality disorder is a difficult mental health condition to live with, as it creates several challenging symptoms such as an unstable sense of self, self-harming behaviors, suicidal thoughts, and impulsivity.8
  • Anxiety disorders and addiction: There are many various types of anxiety disorders, however most all of them include symptoms such as excessive fear and worry, problems concentrating, and feeling out of control.9
  • Attention-deficit/hyperactivity disorder (ADHD) and addiction: Common in children, but also prominent in adults, ADHD is often defined by symptoms such as inattention, hyperactivity, and impulsiveness.10
  • Schizophrenia and other Psychotic Disorders and addiction: Schizophrenia can consist of psychotic, negative, and cognitive symptoms that include delusions, hallucinations, limited facial expressions, and problems focusing.11

Substance misuse can impact these mental health conditions by worsening symptoms, regardless of if the substance misuse started first or not. For example, if someone uses alcohol to cope with depression, alcohol may make it more likely that they will continue to withdraw from others, struggle with disordered sleep, and have difficulties with work or recreational activities, all of which are things that could protect from experiencing symptoms of depression.5


How to Diagnose Co-Occurring Disorders

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Diagnosing co-occurring disorders can be challenging due to their complexity and because symptoms can wax and wane over time.3 However, various assessment methods are available to help clinicians provide thorough and accurate diagnoses. A diagnosis should always be done by a qualified health professional such as a psychiatrist, psychologist, or doctor.

Diagnosis typically involves a comprehensive series of structured interviews with the patient to assess for substance misuse, emotional and physical symptoms, how long symptoms have been occurring, presence of withdrawal symptoms, and degree of impairment these symptoms have had on their functioning.5

To make a co-occurring disorder diagnosis, other assessments and evaluations are included, such as:12

  • Blood or urine tests to detect the presence of substances.
  • Self-assessments that can be analyzed by professionals.
  • Assessment of withdrawal symptoms.
  • Surveys and questionnaires to measure behaviors.
  • Comparison to the DSM-5.

Proper assessment and diagnosis are essential for providing effective treatment for co-occurring disorders. Diagnosis should only be done by a qualified health professional. If you want to help a loved one with addiction or co-occurring disorders, reach out to our team at for confidential, no-obligation help.

Risk Factors

What Are the Risk Factors & Causes of Co-Occurring Disorders?

Co-occurring disorders are not directly caused by anything in particular, rather there are a number of risk factors that exist that may make someone more likely to experience one. For example, genetics play a significant role in the development of both substance use disorders and many mental health conditions.2, 4 Research suggests that genetics can predispose individuals to develop both a substance use disorder and a mental health disorder, or increase the likelihood that one develops another disorder after the emergence of a mental health disorder.2,4

Environmental factors also play a significant role in the development of substance use and co-occurring disorders.Environmental stressors, such as adverse childhood experiences, can increase the likelihood of developing both a substance use disorder and a mental health condition. Stress, in particular, seems to have implications for addiction and other mental disorders. High periods of stress can reduce behavioral control, increase impulsiveness, and make one more vulnerable to relapsing. 2,4

Additionally, individuals who have a mental health disorder may be more vulnerable to developing a substance use disorder, as they may look to cope with or self-medicate their symptoms with mind-altering substances. This can be true for those already diagnosed but also for people whose mental health disorders are not yet diagnosed, but they are struggling with symptoms. While drugs or alcohol may initially alleviate symptoms, they can worsen symptoms in the long term, increasing the likelihood of developing a substance use disorder.2,4


How to Treat Mental Health Conditions & Addiction

Integrated, concurrent treatment of a substance use disorder and any co-occurring disorder is the standard of care for treating co-occurring disorders.5 Treatment centers utilize techniques that address both the substance use disorder and the mental health disorder at the same time.This can include individual or group therapies where the patient learns recovery skills for both disorders, as well as medication management for both the substance use and the mental health condition.5

Integrated treatment has been associated with reduced substance use, improved mental health outcomes, and other functional improvements (e.g., employment, self-esteem, life satisfaction, etc.).Integrated treatment for co-occurring disorders is available at our rehab facility, an inpatient rehab near Tampa. Our facility offers various levels of addiction treatment, including outpatient addiction treatment.

If you believe that it is time for you or your loved one to get help, reach out to us right now by calling . Our admissions navigators can help you get the process started, and explain what to expect in inpatient rehab. Our admissions team will also help with finding ways to pay for rehab, and will help you to use health insurance to cover rehab.

Taking the step to begin addiction treatment can be anxiety-provoking. Fortunately, our rehab facility in Tampa is dedicated to helping you or your loved one receive personalized care. Contact us to gather more information about our programs and start the rehab admissions process today.

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