Co-Occurring Disorders and Dual Diagnosis Treatment Programs

A co-occurring disorder involves a person having both a substance use disorder and a mental health disorder at the same time.¹ Co-occurring mental illness and substance use issues are relatively common; according to the National Institute on Drug Abuse (NIDA), around 50% of people who have a mental health disorder will also have SUD at some point in their lives, and vice versa.² Results from the 2020 National Survey on Drug Use and Health indicate that around 17 million people had a co-occurring disorder in the past year.³

If you think that you or someone you care about might be struggling with co-occurring disorders, studies show that treating both disorders simultaneously may be more beneficial than separate treatment of each condition.² Research shows that integrated co-occurring disorders treatment that addresses both the SUD and the mental health disorder at the same time can help people feel better and become more functional in their daily lives.² Many rehabs offer evidence-based, integrated treatment for co-occurring disorders that can help people start the path to recovery.

What is a Co-Occurring Disorder?

The term co-occurring disorders has been increasingly used to describe a situation that historically was referred to as a dual diagnosis. The concept describes a particular comorbidity or co-occurrence wherein a person simultaneously struggles with both SUD and a mental health condition.¹

Co-occurring disorders can severely impact a person’s physical, emotional, social, and economic functioning and overall wellbeing.¹ Co-occurring disorders can also negatively impact addiction recovery, especially if left untreated.¹ As each disorder can influence and potentially exacerbate the course of the other, specialized treatment that simultaneously addresses both conditions can be important and beneficial to recovery.¹

Common Co-Occurring Disorders

A wide range of mental health disorders can exist along with SUDs. Examples of co-occurring disorders that commonly occur with SUDs include:

• Generalized anxiety disorder.²
• Panic disorder.¹
• Schizophrenia or other psychotic illness.¹
• Post-traumatic stress disorder (PTSD).⁵
• Borderline personality disorder.¹
• Antisocial personality disorder.¹
• Depression.⁵
• Bipolar disorders.⁵
• Attention-deficit/hyperactivity disorder (ADHD).⁵

Symptoms of Co-Occurring Disorders

Every mental health disorder has its own unique set of diagnostic criteria.⁶ Doctors and qualified mental health professionals may diagnose various mental illnesses based on such specific diagnostic criteria, as outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The criteria for different mental health disorders are comprised of several characteristic signs and symptoms, of which a person must have experienced a certain number and/or combination over the course of a given time frame to receive such a diagnosis.

Though the following list isn’t specific to any single co-occurrence, some common signs of mental illness include:⁶

• Pronounced worry and fear.
• Excessive sadness.
• Extreme mood swings.
• Marked feelings of anger or irritability.
• Avoidance of social situations.
• Problems with concentration or learning.
• Sleep and/or appetite changes.
• Changes in sex drive.
• Problems perceiving reality, such as hallucinations (seeing, hearing, or feeling things that aren’t there) or delusions (believing something is true when it isn’t or believing something isn’t true when it is).
• A lack of insight into changes in your emotions, behaviors, or thoughts.
• Unexplainable physical ailments.
• Suicidal thoughts or ideation.

Symptoms of Addiction

The DSM-5 lays out several criteria that are used in the diagnosis of SUDs and co-occurring mental health disorders. As with other mental health diagnoses, SUDs have their own unique set of diagnostic criteria that encompass various cognitive, behavioral, and physiological symptoms.⁷ The general criteria for an SUD diagnosis include the following:⁷

• Using substances in higher amounts or more frequently than you intended.
• Being unable to cut down or control your substance use.
• Spending a lot of your time obtaining, using, and recovering from the effects of the substance.
• Cravings, or strong urges to use the substance.
• Being unable to fulfill obligations at home, work, or school due to recurrent substance use.
• Continuing to use a substance despite social or interpersonal problems that are caused or exacerbated by such use.
• Giving up or reducing important social or recreational activities due to substance use.
• Using substances in situations where it is physically hazardous to do so, such as while driving or operating machinery.
• Continuing to use substances although you know that you have a psychological or physical problem that is likely due to your substance use.
• Tolerance, or needing to use more of the substance to experience its desired effects.
• Withdrawal symptoms when you stop using it.

Integrated Treatment for Co-Occurring Disorders

Integrated treatment for co-occurring disorders allows for both the addiction and mental health disorder to be addressed simultaneously—a recovery approach considered by many treatment professionals to be superior to separately addressing each issue.¹ Research supports integrated treatment approaches for people with co-occurring disorders for full recovery. Treatment should not neglect either disorder, as focusing on merely one may not necessarily promote recovery of the other.⁸

Integrated treatment for co-occurring disorders may entail the coordinated treatment of both disorders in one treatment setting and at the same time.⁸ An integrated approach may incorporate a variety of treatments and interventions, such as medication, detox, and inpatient rehab, and therapies like motivational interventions, cognitive-behavioral therapy (CBT), and counseling.^{2, 4} The range of treatments you receive will likely depend on both the specific diagnoses  as well as other individual recovery needs.²

When compared with nonintegrated treatment, people who receive integrated treatment experience relatively more positive outcomes in areas such as:⁹ 

• Reduced substance use.
• Improved mental health symptoms and functioning.
• Decreased hospitalizations.
• Increased housing stability.
• Fewer arrests.
• Improved quality of life.

Finding Treatment for Co-Occurring Disorders Near Me

If you or a loved one are struggling with a co-occurring disorder, seeking the support and care from a dual diagnosis treatment program can help start the recovery process.

You might start by consulting your physician to discuss your situation and your unique needs. Your doctor can assess your conditions and also likely provide you with referrals to appropriate rehabs. You can also search the Substance Abuse and Mental Health Services Administration’s FindTreatment.gov for dual diagnosis treatment near you that meet your criteria.

You may also benefit from calling an addiction helpline, like the one operated by American Addiction Centers. Our admissions navigators can answer your questions about co-occurring disorders, help you understand your treatment options, and refer you to co-occurring disorder treatment centers. Co-occurring disorders may worsen if left untreated, but it’s never too late to seek help so you can take back control of your life.¹¹