Co-Occurring Disorders

People with co-occurring disorders, also referred to as dual diagnosis, have both a mental health disorder and a substance use disorder. These people require an integrated treatment plan that targets both illnesses at once. Mental illness can be classified as anything from minor cases of depression to severe impairments such as schizophrenia and PTSD. Of the 23 million Americans struggling with addiction, nearly 14 million also suffer from some form of mental illness, either stemming from or leading to substance abuse.

Find out more about co-occurring disorders

44 million
American adults have some form of mental illness
10 million
Cases are considered “serious mental illnesses”
14 million
Americans with mental illness also struggle with substance addiction
$300 billion
Dollars spent on serious mental illness

Substance addiction and mental illness go hand in hand. Comorbidity, the simultaneous occurrence of two disorders or illnesses in a person, is common among people with substance abuse problems and can affect the course and prognosis of the disorders.

Nearly six out of 10 addicts also suffer from a mental disorder such as attention-deficit/hyperactivity disorder, post-traumatic stress disorder or schizophrenia. People who are addicted to drugs are twice as likely to suffer from a mood or anxiety disorder, and roughly three-quarters of addicts in rehab treatment also suffer from some sort of mental disorder. Furthermore, many drugs of abuse have qualities that can mimic the symptoms of mental illness and withdrawal side effects that are often diagnosed as mental illness.

Nearly 6 out of 10addicts also suffer from a mental disorder such as ADHD, PTSD or schizophrenia.

Trauma is also a leading cause of substance use disorders. Trauma can take many forms and can have a significant impact upon the individual and on their respective mental health status.

Mental Illnesses

Mental illness is one of the most common health conditions affecting Americans. Some mental illnesses, such as depression or anxiety, are more easily managed than others, such as severe cases of psychosis.

Like physical afflictions, untreated mental disorders can worsen or lead to more serious health conditions if they are not treated.

Of the 44 million people who suffer from some form of mental illness in the United States, 10 million have what is considered a severe mental illness. A severe mental disorder is one that is debilitating to daily life. Some serious mental illnesses include:

mental brain disorders

Common Mental Disorders Linked to Substance Use

Co-occurring disorders of mental illnesses and substance addiction are common and can complicate the path to recovery. Typically, one disorder exacerbates the other.

The disorders also range in severity and complexity. Common psychiatric disorders associated with substance abuse are:

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Stigma

Families continue to have difficulty accepting substance abuse disorders and are inclined to believe that the behaviors encountered with their affected loved ones are mental-illness oriented rather than substance abuse or drug addiction. This belief originates from the perception that a person afflicted with mental illness has a disease while a person afflicted with substance use disorders “has a choice” or in some manner has a moral failing.

Making matters more difficult is that many of the substance abuse symptoms are nearly identical to mental illness. Clearly the shame and guilt associated with addiction can affect families who crave social acceptability. Stigma can tragically delay people in need from getting the appropriate intervention and treatment.

Causes of Co-Occurring Disorders

Although mental disorders and substance use are often linked, one disorder does not always cause the other. However, there are certain factors to keep in mind when determining the cause of co-occurring disorders.

Drug use can cause symptoms of mental health disorders. These disorders are referred to as substance-induced disorders. They usually occur after episodic abuse or one month of regular drug use. In some cases, the symptoms may subside after at least one month of abstention, but that is not always so.

For example, a person who abuses cocaine for 36 hours many times will regret the behavior, will feel guilty over the financial implications and suffer feelings of depression. This cycle of behavior will continue and worsen, leading observers — who don’t realize the depression is fueled by cocaine abuse — to believe that the individual is suffering from a major depressive episode. Regardless of the origin, major depression can lead to suicide.

Disorders such as substance-induced delirium, substance-induced amnestic disorder, substance-induced anxiety or mood disorder, and hallucinogen persisting perceptual disorder (HPPD) are examples of symptoms of mental illness brought on by substance abuse.

Mental health disorders can also lead to substance use. These disorders are called primary mental disorders. People suffering from a primary mental disorder, such as anxiety or depression, may self-medicate with drugs or alcohol to alleviate the symptoms of their illness. For example, someone suffering from PTSD may turn to alcohol to treat anxiety.

However, drug use can also worsen symptoms of primary mental disorders. Recovering from addiction and abstaining from use can help decrease the severity of symptoms, but abstention does not cure primary mental disorders.

Other possible causes of co-occurring disorders include:

Genetic Predisposition

Genetic Predisposition

Genes may make a person more susceptible to addiction and other mental disorders.

Enviromental Triggers

Enviromental Triggers

Stress, trauma and other events can often trigger addiction and mental disorders.

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Involvement of Similar Brain Regions

Brain systems responsible for functions such as reward or stress may be affected by drug use and mental illness simultaneously.

Genetic Predisposition

Early Exposure

Being exposed to drug use from a younger age or during cognitive development may create a higher risk of mental illness and substance dependence for an individual.

Self-Medication

Unfortunately it is not uncommon for people with mental health issues to self-medicate. Self-medication can take many forms, from having a glass of wine or a beer when feeling down to abusing heroin to escape feelings of PTSD. In reality, many substance abusers choose the “wrong” substance when self-medicating.

For example, drinking alcohol will not address feelings of depression but will, in fact, worsen these feelings. Furthermore the individual can become physically addicted to a substance by rationalizing to themselves that they need the substance because of their mental health status.

Symptoms of Co-Occurring Disorders

Individuals with co-occurring disorders frequently struggle with everyday tasks, leading to a number of hardships. They often develop multiple dependencies and try to self-medicate the side effects of drug use and mental illness.

There are recognizable signs that an individual may be suffering from a co-occurring disorder. Typical symptoms include:

Symptoms of Co-Occurring Disorders
  • Employment and housing instability
  • Difficulty budgeting funds
  • Legal problems
  • Social isolation and repeated social difficulties
  • Prostitution or sexual deviance
  • Sudden unexplained mood shifts
  • Disruptive or aggressive behaviors
  • Evidence of current intoxication (e.g., alcohol on breath)
  • Dilated or constricted pupils
  • Hygiene and health problems
  • Cognitive impairments
  • Treatment noncompliance
  • Violent behavior and suicidal ideation

Recognizing these symptoms in your own behavior or your loved one could mean that treatment is needed to reach recovery.

Co-Occurring Disorder Treatment

In the mid-1980s, the medical community began to recognize the need to treat people with co-occurring disorders. Dual diagnosis programs began to integrate the psychiatric and chemical sides of treatment. Thus, dual recovery programs were born.

For decades, individuals with co-occurring disorders were referred to as dually-diagnosed patients. A number of other terms are also used, including:

In recent years, the American Psychological Association standardized the term “co-occurring disorders” to avoid confusion between individuals with developmental disorders and those with mental health disorders.

A significant challenge in co-occurring disorder treatment is that individuals and their families may not report the substance abuse, which makes it difficult to properly diagnose them. The toxic effects of drugs are not well understood by families, and the stigma may make proper diagnosis and treatment difficult. In many cases, integrated care is the appropriate course of action, especially if the person is experiencing the toxic effects of a substance.

Integrated Treatment

Integrated Treatment

Some individuals develop an alcohol or drug addiction before experiencing a mental health disorder. Other people develop their addiction after an episode of mental illness. Regardless of which came first, the individual still needs to address both. Therefore, those with co-occurring disorders should receive simultaneous treatment for existing substance use disorders and mental health disorders.

Research shows that an integrated approach is more effective at treating co-occurring disorders than separate, parallel treatments that target each disorder individually. This is especially true because of the toxic effects that substance abuse can have on the individual. In these cases, the person is best treated in an inpatient or protected environment until the toxic substances clear from the body and a proper diagnosis can be rendered.

Individuals with co-occurring disorders require a high level of care and attention during treatment. They often start treatment in various states of distress — perhaps paranoid or chemically imbalanced — and in poor general health. The combination of substance abuse and psychiatric issues can make them more unpredictable than average treatment patients.

The best care for co-occurring disorders integrates combined treatments at every level. Best practices include:

Comprehensive, integrated treatment plans are designed to fit recovering individuals’ specific health needs. Depending on the severity of the illnesses, which may involve withdrawal or mental instability, an individual may need urgent care or access to a hospital.

Once the person is settled into a rehabilitation program, treatment begins and may incorporate any number of therapies and medications. Counselors may hold individual and group therapy sessions as well.

Inpatient rehab facilities offer integrated treatment programs, employ trained professionals and possess the proper resources to help patients with co-occurring disorders. There are also a number of independent organizations that specialize in treating co-occurring disorders. Many function as temporary housing for patients in addition to employing staff who conduct therapy and counseling. Additionally, if medication is required, trained physicians will prescribe appropriate medications.

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Integrated Treatment

Does Treatment Work?

Treatment works by creating an opportunity for the patient to understand and accept their behaviors while creating an environment for change. The success of a treatment program depends on multiple factors, including:

Success rates for individuals suffering from co-occurring disorders are lower than for other individuals recovering from addiction. Still appropriate treatment gives people a better chance of starting a meaningful recovery. It is important to remember that one goal of treatment is to improve the overall quality of life while enabling an individual to reduce or eliminate the impact of drug and alcohol abuse.

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