Co-Occurring Disorders: Addiction And Mental Health

Co-occurring disorders, also called dual diagnosis, describe the simultaneous presence of a substance use disorder (SUD) and a mental health disorder in the same individual.

The combination is clinically distinct from either condition alone. Co-occurring disorders are associated with greater symptom severity, higher relapse rates, and worse treatment outcomes when each condition is treated in isolation rather than as an integrated picture.

According to the National Institute on Drug Abuse, approximately 7.7 million adults in the United States meet criteria for both a mental health disorder and a substance use disorder. SAMHSA data shows that among the 20.3 million adults with a substance use disorder, 37.9% also experience a mental illness and among the 42.1 million adults with a mental health condition, 18.2% also live with a co-occurring SUD.

At Olympic Behavioral Health’s dual-diagnosis program in Lantana, FL (Palm Beach County), a pattern the clinical team sees regularly is patients arriving after a previous treatment attempt that addressed only the substance use, leaving the underlying mental health condition active. When the depression, anxiety, trauma, or bipolar pattern remains untreated after substance use treatment ends, relapse is not a willpower failure; it is a treatment design failure.

Highlights

• Co-occurring disorders (also called dual diagnosis) describe the simultaneous presence of a substance use disorder and a mental health disorder in the same individual.
• Approximately 7.7 million U.S. adults meet criteria for both an SUD and a mental health disorder, according to the National Institute on Drug Abuse. Among adults with a substance use disorder, 37.9% also experience a mental illness; among adults with a mental health condition, 18.2% also live with a co-occurring SUD (SAMHSA).
• Common co-occurring mental health conditions include mood disorders (depression, bipolar), anxiety disorders (GAD, PTSD, OCD), psychotic disorders, personality disorders, and eating disorders.
• Common co-occurring combinations seen in dual-diagnosis programs include alcohol use disorder paired with anxiety, opioid use disorder paired with PTSD, stimulant use disorder paired with bipolar disorder, and alcohol or benzodiazepine use disorder paired with depression. Olympic Behavioral Health’s integrated program treats all of these.
• Co-occurring disorders are diagnosed using DSM-5 criteria by a qualified clinical team — not through self-assessment alone.

What’s The Definition of Co-Occurring Disorders?

A person with a co-occurring disorder has been diagnosed with both a mental health disorder and a substance use disorder. These diagnoses can be made simultaneously or at different times, but both disorders are present in the same individual.

What Is the Prevalence of Co-Occurring Disorders? 

The National Institute on Drug Abuse reports that approximately 7.7 million adults in the United States struggle with co-occurring mental and substance use disorders. The presence of one disorder does not necessarily indicate causation, and establishing the chronological order of onset can pose challenges. Among the 20.3 million adults contending with substance use disorders, 37.9% concurrently experience mental illnesses.

Conversely, among the 42.1 million adults dealing with mental health conditions, 18.2% also confront co-occurring substance use disorders. These statistics underscore the significant intersection between mental health and substance use, emphasizing the need for a comprehensive approach to address these intertwined challenges.

What Are The Causes of Co-Occurring Disorders?

The causes of co-occurring disorders include several interrelated factors:

• Shared Risk Factors: Genetic predispositions and environmental influences, such as stress or trauma, contribute to both Substance Use Disorders (SUDs) and mental disorders. Family history is significant, as certain genes may increase susceptibility to both conditions.
• Mental Disorders Leading to Substance Use: Individuals with mental disorders like anxiety, depression, or PTSD may resort to self-medication with drugs or alcohol for temporary relief. However, this can worsen their mental health over time and enhance the pleasurable effects of substances, encouraging continued use.
• Substance Use Inducing Mental Disorders: Substance use can alter brain structure and function, increasing vulnerability to additional mental health issues. Furthermore, the act of using substances may trigger the onset of mental disorders.

What Are The Symptoms of Co-Occurring Disorders?

The symptoms of co-occurring disorders include those found in both mental health and substance use disorders, occurring simultaneously in the same person. Only a qualified mental health professional can diagnose these disorders. However, being aware of the common symptoms can help individuals recognize when to seek help. Key indicators encompass:

• Withdrawal from Relationships: Distancing oneself from interactions with family and friends.
• Abrupt Behavioral Changes: Sudden shifts in behavior that may be noticeable.
• Difficulty in Daily Task Management: Struggling to handle routine daily responsibilities effectively.
• Engagement in Risky Behaviors: Participating in activities that pose potential harm.
• Neglect of Health and Hygiene: Disregarding personal health and hygiene practices.
• Substance Use in Unsafe Conditions: Employing substances in environments that compromise safety.
• Loss of Control over Substance Use: Inability to regulate and manage the consumption of substances.
• Increased Tolerance or Withdrawal Symptoms: Developing a heightened tolerance to substances or experiencing withdrawal symptoms.
• Dependency for Normal Functioning: Feeling a perceived necessity to use substances to maintain normal functioning.

What Are The Mental Disorders that Co-Occur with Substance Abuse?

Several mental disorders, including mood disorders, anxiety disorders, psychotic disorders, personality disorders, and eating disorders, commonly co-occur with substance abuse.

Here are the co-occurring mental disorders:

Mood Disorders

• These disorders, such as major depressive disorder and bipolar disorder, involve disruptions in mood that significantly impact an individual’s life.
• Co-diagnosis of mood disorders and substance abuse is common, and the sequence in which they are initially diagnosed varies.

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Anxiety Disorders

• Generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder are examples of anxiety disorders.
• Substance abuse and anxiety disorders often co-occur, with individuals experiencing more severe symptoms when both disorders are present.

Psychotic Disorders

• Psychotic disorders, including schizophrenia, delusional disorder, and schizoaffective disorder, entail changes in thinking and perception.
• Co-diagnosing psychotic disorders and substance abuse can be challenging, as substance-induced psychosis must be distinguished from psychosis unrelated to substance use.

Personality Disorders

• Conditions like borderline personality disorder, antisocial personality disorder, and narcissistic personality disorder lead to unhealthy thoughts and behaviors affecting daily life and relationships.
• Personality disorders are commonly co-diagnosed with substance abuse disorders, particularly in individuals with drug use disorders.

Eating Disorders

• Dysfunctional eating habits characterize eating disorders, including binge eating disorder, anorexia nervosa, and bulimia nervosa.
• Co-diagnosis of eating disorders and substance abuse is prevalent, potentially influenced by genetic factors that predispose individuals to both conditions.

While distinctions exist among these disorders, similarities in their diagnostic criteria, co-occurrence patterns, and mutual influence on one another are evident. Recognizing these shared characteristics is crucial for comprehensive assessment and effective intervention. For those navigating these challenges, seeking specialized eating disorder treatment in Florida alongside addiction care can make a significant difference in recovery outcomes. It is noteworthy that addressing both mental health and substance use concurrently has shown improved outcomes for individuals dealing with co-occurring disorders.

Co-Occurring Disorder Combinations Olympic’s Dual-Diagnosis Program Addresses

Standard articles on co-occurring disorders list the conditions that can co-occur with substance use without explaining how the combinations actually shape treatment planning. In clinical practice, several substance + mental health pairings present distinct challenges that require an integrated approach rather than treating each condition separately.

• Alcohol use disorder paired with generalized anxiety or panic disorder. This combination often begins with alcohol used to manage social anxiety, performance pressure, or sleep. Over time, the anxiety becomes both a driver and a consequence of the drinking. Treating the substance use alone without addressing the anxiety leaves the patient in the same internal state that led to drinking in the first place, which is why integrated outpatient programs address both simultaneously.
• Opioid use disorder paired with untreated trauma (PTSD or complex PTSD). Opioid use frequently begins after a physical injury or surgery and continues because the medication suppresses both physical pain and unprocessed trauma symptoms. When opioids are discontinued without trauma treatment running in parallel, the trauma re-emerges at full intensity, making sustained recovery significantly harder. This is one reason Olympic conducts a trauma assessment for every incoming client and offers a specialized trauma track using EMDR, CBT, and Rapid Trauma Resolution for clients meeting PTSD criteria.
• Stimulant use disorder paired with bipolar spectrum disorder. Cocaine, methamphetamine, and prescription stimulant use can mimic hypomanic episodes, and the bipolar pattern is frequently misdiagnosed before it is correctly identified. Patients with undiagnosed bipolar who discontinue stimulants may experience depressive episodes that require psychiatric stabilization alongside substance use treatment. Olympic’s board-certified psychiatrist and psychiatric ARNP provide the clinical oversight this combination requires.
• Alcohol or benzodiazepine use disorder paired with depression. Both substances act as central nervous system depressants and can deepen depressive symptoms when use is reduced or stopped. Patients presenting with this combination benefit from close psychiatric monitoring and an integrated treatment plan that addresses mood stabilization alongside substance use.

Integrated dual-diagnosis treatment, both conditions addressed by one clinical team, in one continuum of care, is the standard of care endorsed by SAMHSA and the only approach Olympic Behavioral Health’s program in Lantana, FL uses.

This makes Olympic Behavioral Health a trusted dual diagnosis treatment center in Florida for individuals needing coordinated care for addiction and mental health.

What Are The Dual Diagnosis Treatment Options for Co-Occurring Disorders?

The dual diagnosis treatment options for co-occurring disorders include various approaches tailored to individual needs. Healthcare providers may recommend behavioral therapies alone or in conjunction with medications based on the specific circumstances. Here are examples of effective treatment options outlined by the National Institute of Mental Health:

Behavioral Therapies for Adults

• Cognitive Behavioral Therapy (CBT): CBT or a talk therapy focusing on helping individuals cope with challenging situations by challenging irrational thoughts and modifying behaviors.
• Dialectical Behavior Therapy (DBT): DBT incorporates mindfulness and acceptance principles, teaching skills to manage intense emotions, reduce self-destructive behaviors, and enhance relationships.
• Assertive Community Treatment (ACT): Community-based mental health care emphasizing outreach and personalized treatment approaches.
• Contingency Management (CM): Encourages positive behaviors by providing vouchers or rewards for desired behaviors.

Psychiatric Medication Management

Psychiatric medications can play an important role in stabilizing mood disorders, anxiety, and other mental health conditions that co-occur with substance use disorders. Olympic Behavioral Health’s treatment team includes a board-certified psychiatrist and a board-certified psychiatric ARNP who provide medication evaluation and management as part of the integrated treatment plan.

Which Comes First, Addiction or Mental Illness?

There is no universally established sequence for the onset of addiction or mental illness in individuals facing a dual diagnosis. The dual diagnosis treatment options for co-occurring disorders include addressing both conditions, regardless of which appears first. The relationship between mental illness and addiction is intricate, with both often influencing each other.

What is The Impact of Substance Abuse on Mental Health?

Substance abuse significantly impacts mental health. The use of substances that alter one’s state of mind can exacerbate the symptoms of existing mental health disorders. Moreover, substance abuse can hinder adherence to prescribed medications for mental health issues, making it challenging to manage and control the associated symptoms. Furthermore, substance use disorders are correlated with heightened tendencies toward aggressive and violent behavior. This underscores the intricate interplay between substance abuse and mental health, highlighting the importance of comprehensive intervention strategies.

How Are Co-Occurring Disorders Diagnosed?

Co-occurring disorders are diagnosed based on specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual guides clinicians by providing clear definitions and diagnostic criteria for various mental health and substance use issues, relying on commonly observed symptoms. Initially, the recognition and description of co-occurring disorders were limited in earlier editions of the manual. The fifth edition, known as DSM-5, addressed this gap by enhancing the definition and understanding of co-occurring substance use and mental health disorders.

This edition acknowledges that individuals with co-occurring disorders generally display similar mental health symptoms as those with standalone mental health disorders but without a simultaneous substance use disorder. Importantly, it emphasizes that substance use disorders are not necessarily more severe in individuals with a mental health disorder. Essentially, individuals with co-occurring disorders exhibit symptoms characteristic of both conditions, contributing to a more comprehensive understanding and diagnosis.

How Does Trauma Affect Mental Health and Lead to Addiction?

Trauma affects mental health and leads to addiction in significant ways. Traumatic experiences can result in mental health issues such as depression, anxiety, and PTSD, which may drive individuals to seek solace in addictive behaviors or substances. Addressing trauma is crucial in effectively treating addiction and promoting overall mental well-being. The impact of trauma on addiction can be significant.

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How Does EMDR Therapy Address Co-Occurring Disorders Such as Addiction and Mental Health?

EMDR therapy addresses co-occurring disorders such as addiction and mental health by targeting traumatic memories that contribute to these conditions. By reprocessing negative experiences, EMDR therapy helps individuals manage triggers, reduce symptoms, and develop healthier coping mechanisms, ultimately leading to improved overall well-being.

Get Help at Olympic Behavioral Health

While the simultaneous occurrence of substance use disorders and mental health disorders has long been noted, the development of treatment for both conditions concurrently has only recently emerged. Treating these disorders separately remains a common practice, and often, the substance use disorder takes precedence before addressing the mental health disorder.

Olympic Behavioral Health in Lantana, FL (Palm Beach County) provides JCAHO-accredited dual-diagnosis treatment through Partial Hospitalization (PHP), Intensive Outpatient (IOP), and Outpatient (OP) programs.

If you or someone you love is navigating a co-occurring disorder and looking for a program that treats both conditions with one clinical team, call (561) 272-0800 or verify your insurance online to start the conversation.