Understanding Co-Occurring Disorders

Co-occurring disorders is a term that refers to the presence of both a mental health issue and a substance use disorder (SUD). Each condition presents its challenges, but co-occurring disorders tend to interact with one another, causing unpredictable fluctuations in severity and dangerous symptom exacerbation. Understanding the underlying genetic risks, contributing environmental factors, disorder patterns, and common treatment approaches makes navigating the recovery process more effective.

What are Co-Occurring Disorders?

Co-occurring disorders, often referred to as dual diagnosis, can include any combination of two or more SUDs and mental disorders identified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR). 

According to research, about half of all individuals who experience a mental illness throughout life will also experience a substance use disorder ^[1]. Additionally, adolescents with substance use disorders tend to experience high rates of co-occurring mental illness, with over 60 percent meeting the diagnostic criteria for a coexisting mental illness ^[2].

Although mental disorders and SUDs commonly occur together, that does not mean one is responsible for causing the other. Even when obvious symptoms of one condition develop before the other, it can be nearly impossible to determine which one developed first.

Key Characteristics of Co-Occurring Disorders:

• Symptoms of mental health and substance abuse disorders tend to overlap and exacerbate one another.
• Individuals often abuse substances as a form of self-medication when seeking to relieve symptoms of mental health disorders.
• Diagnosing co-occurring disorders requires careful assessment by experienced mental health professionals.
• Successful treatment plans must address both conditions simultaneously to achieve lasting recovery.

Why do Mental Health and Substance Use Disorders Commonly Occur Together?

Mental illness and substance use disorders are closely tied. Experts have identified the following possible reasons for the high prevalence of co-occurring disorders ^[3]:

• There are several common risk factors associated with both mental health disorders and SUDs. These include genetics, chronic stress, and instances of trauma (especially childhood trauma).
• Veterans diagnosed with post-traumatic stress disorder (PTSD) are at a higher risk for SUDs.
• Mental disorders tend to contribute to drug use and SUDs. For example, individuals diagnosed with mental disorders often abuse drugs or alcohol in search of temporary relief (known as self-medication). Certain drugs are known to exacerbate or increase the risk of developing mental health disorders. For example, MDMA misuse is linked to depression.  
• Mental disorders can cause changes to the brain that increase the chances of developing SUDs. Additionally, substance abuse is also known to cause brain changes that increase the likelihood of developing mental disorders.

What are the Causes of Co-Occurring Disorders?

The cause of co-occurring disorders is complex and often influenced by multiple factors. Mental health and substance use disorders often develop due to similar underlying mechanisms, which leads to a high likelihood of co-occurrence ^[4].

Contributing factors include:

• Genetics: A family history of addiction or mental illness increases the risk.
• Brain Chemistry: Neurotransmitter imbalances can contribute to both mental health disorders and substance dependency.
• Environmental Stressors: Trauma, abuse, and chronic stress can trigger or worsen symptoms.
• Early Substance Use: Individuals using drugs or alcohol at a young age can alter brain development, increasing vulnerability to addiction, depression, anxiety, and compulsive disorders.
• “Social Determinants” of Health: These include co-occurring issues like mental health conditions and broader societal conditions such as poverty, trauma, and racism. Understanding these factors can help professionals tailor treatment approaches to the needs of individuals with co-occurring disorders.

Common Examples of Co-Occurring Disorders

There are many types of dual diagnosis conditions, with some of the most common combinations being ^[4]:

• Depression and Alcohol Use Disorder: Individuals may drink to numb emotional pain, leading to a cycle of worsening symptoms.
• Anxiety Disorders and Stimulant Use: Cocaine or methamphetamine use may temporarily alleviate anxiety but increase panic attacks and paranoia.
• Bipolar Disorder and Opioid Addiction: Mood swings can lead to self-medication with opioids, worsening the disorder.
• Schizophrenia and Cannabis Use Disorder: Some individuals use cannabis to manage symptoms, but it can exacerbate psychotic episodes.
• Post-Traumatic Stress Disorder (PTSD) and Alcohol Dependence: Many people with PTSD turn to alcohol to suppress traumatic memories, leading to addiction.

Co-Occurring Disorders and Youth

Young individuals diagnosed with mental health conditions are extremely vulnerable to alcohol and drug use. They tend to experiment with illicit substances for a variety of reasons, including peer pressure, curiosity, the desire to assert some form of independence, or seeking a vehicle to escape life’s stresses ^[5]. For adolescents experiencing signs and symptoms of a dual diagnosis, substance use is often seen as an instant form of escape, making this particular age group (ages 11-18) more susceptible to developing unhealthy coping habits.

Many young people don’t yet fully understand their feelings of sadness or distress, making it difficult to recognize the typical red flags of depression. In an attempt to numb emotional pain, they may turn to alcohol or drugs, unaware that these substances can deepen their depression over time.

Alcohol, like any drug, carries significant risks and can lead to harmful consequences. Marijuana and other substances may seem harmless, but they can be addictive and impact brain development. Even casual use of substances like inhalants, steroids, or “club” drugs can cause lasting damage to cognitive function and overall health for young individuals.

How are Co-Occurring Disorders Diagnosed and Treated?

When experiencing a substance use disorder and a co-occurring mental health condition, an integrated treatment approach is typically the most effective ^[6]. Rather than addressing each disorder separately, simultaneous treatment ensures that underlying causes and overlapping symptoms are properly managed. Because symptoms of substance use and mental health disorders often mimic one another, healthcare providers must conduct thorough assessments to ensure an accurate diagnosis and a personalized treatment plan.

A tailored approach to treatment is essential, considering factors like the individual’s age, the specific substance(s) being misused, and the nature of the co-occurring mental health condition. 

Medications for Co-Occurring Disorders

Pharmacological treatments play a crucial role in managing both substance use and mental health conditions ^[9]. Certain medications are approved for the treatment of opioid, alcohol, and nicotine addiction, while others alleviate symptoms of psychiatric disorders like depression, anxiety, and others. In some cases, a single medication may effectively treat multiple conditions simultaneously. 

Effective treatment strategies often combine behavioral therapies with appropriate medications. Long-term recovery is possible with the right treatments and support systems in place.

Behavioral Therapies for Co-Occurring Disorders

Extensive research supports using various behavioral therapies when treating individuals with dual diagnosis conditions ^[7]. These therapies can be implemented alone or with medication, depending on the individual’s needs.

• Cognitive Behavioral Therapy (CBT): This structured form of psychotherapy helps individuals recognize and modify negative thought patterns and behaviors that contribute to substance use and mental distress.
• Dialectical Behavior Therapy (DBT): Using mindfulness and emotional regulation techniques, DBT teaches individuals to manage intense emotions, reduce harmful behaviors, and improve interpersonal relationships.
• Assertive Community Treatment (ACT): A community-based approach that provides continuous, personalized mental health support to individuals with severe and persistent conditions.
• Therapeutic Communities (TCs): These long-term residential programs foster personal growth, positive behavioral changes, and a supportive recovery environment.
• Contingency Management (CM): A motivational approach that reinforces positive behaviors through reward-based incentives.

Behavioral Therapies for Children and Adolescents

For young individuals struggling with both substance use and mental health disorders, family-based interventions have shown significant success ^[8].

• Brief Strategic Family Therapy (BSFT): Focuses on reshaping family dynamics that contribute to adolescent substance use and behavioral issues.
• Multidimensional Family Therapy (MDFT): A comprehensive approach that addresses substance use, academic difficulties, delinquency, and other co-occurring challenges within a family setting.
• Multisystemic Therapy (MST): Targets multiple factors influencing antisocial behavior in youth, providing interventions that address family, school, and community environments.

Finding Support Groups for Co-Occurring Disorders

Support groups play a crucial role in the recovery journey by providing a safe space for individuals to share experiences, receive encouragement, and learn from others facing similar challenges.

Popular support groups include the following:

• Dual Recovery Anonymous (DRA): A 12-step program specifically for individuals with co-occurring disorders.
• Alcoholics Anonymous (AA) & Narcotics Anonymous (NA): While not dual diagnosis-specific, these programs offer valuable peer support.
• National Alliance on Mental Illness (NAMI) Groups: Provides education and support for individuals and families.
• Local Mental Health Organizations: Many communities offer in-person or virtual support groups.

Finding the right group can make a significant difference in maintaining recovery and mental wellness.

Embracing Hope and Healing for Co-Occurring Disorders

Living with a co-occurring disorder presents significant challenges, but the right treatment and support make recovery possible. Accurately diagnosing both a mental health disorder and a substance use disorder marks the first critical step toward lasting success. Too often, one of these conditions goes unrecognized because mental health issues and addiction share similar biological, psychological, and social factors.

Raising public awareness about co-occurring disorders and their unique treatment needs is essential. When people understand the importance of dual diagnosis and integrated care, they can make informed decisions that dramatically improve their quality of life. Mental health professionals play a key role in this process, offering expert guidance that helps individuals heal, grow, and reclaim their lives. With the right care, support, and determination, a fulfilling and empowered life is absolutely within reach.