What Is a Co-Occurring Disorders Treatment Program?

Read on to learn when substance use disorders and mental health disorders coincide.

What Are Co-Occurring Disorders?

The combination of a substance use disorder (SUD) and mental health disorder can be dangerous. Both problems exacerbate each other, making it difficult to function or reach out for help.

Fortunately, treatment of co-occurring disorders is readily available. If you are concerned that someone you know has co-occurring mental health disorders, don’t be afraid to talk to them about it. Finding support for that first step toward wellness is sometimes the most difficult part of recovery.

Co-occurring disorders are two health conditions that occur at the same time. The term also describes when one condition is caused or made worse by the other. According to the Substance Abuse and Mental Health Services Administration, approximately 9.2 million U.S. adults have co-occurring disorders.¹ 

Examples of Co-Occurring Disorders

Co-occurring disorders may include any combination of mental or substance disorders that have been identified as co-occurring disorders (DSM-5). That includes the following co-occurring disorder examples:

• Mental health disorders, such as bipolar disease
• Mood-related disorders like depression
• Anxiety-related disorders, such as panic disorder or social anxiety disorder
• Severe mental illness or psychotic disorders

Other common mental health disorders that occur along with SUD are schizophrenia, personality disorders, and ADHD.

Why SUDs and Other Mental Disorders May Occur Together

Co-occurring disorders are the result of several factors. For example, some people carry a higher genetic risk for both addiction and mental illness. The National Institute on Drug Abuse reports that genetics cause 40% to 60% of an individual’s risk for SUDs.²  In addition to biology, the two problems also share these common risk factors:

• Experiencing trauma in childhood or early adulthood
• Living with family members whose mental health (or SUD) impairs their ability to provide a safe, supportive home
• Environmental factors, such as drug exposure or chronic stress
• Brain circuitry

The treatment of co-occurring disorders is most successful when mental and addiction issues are seen as symbiotic. Just as one condition can make the other worse, improving one condition can also help improve the other.

How Mental Disorders Contribute to SUDs

It is common for individuals with mental health issues to use drugs or alcohol to self-medicate. This trend is alarming but understandable, especially when there is an average delay of eleven years between the time a person first exhibits symptoms of mental illness and the time they finally receive treatment.

While some drugs do temporarily bring relief to some mental illness symptoms such as depression and anxiety, drug and alcohol use worsen mental health in the long run. Changes in brain activity related to mental illness can intensify drug cravings, driving individuals to use more frequent and larger doses.

Because illicit drug use can magnify symptoms of mental illness, self-medicating leads to a vicious cycle that highlights the dangers of co-occurring conditions.

How SUDs Contribute to Mental Disorders

Substance use can cause changes in the brain where mental disorders occur. Put simply, drug use can jump-start a mental illness by changing brain structure.

Substance use can also mask mental illness symptoms. Erratic behavior, changes in sleeping patterns, or general confusion are all easily blamed on drug or alcohol use. Overlooking the possibility of mental illness can delay proper co-occurring treatment, ultimately allowing both problems to grow worse over time.

The relationship between substance use disorders and mental illness is complex. It can be difficult to diagnose which problem came first in some cases. Nonetheless, co-occurring disorders treatment can be highly effective even if delayed.

Common Co-Occurring Disorders Examples Seen with Substance Abuse

Identifying the signs of a mental health disorder early on can prevent the long delay in treatment that allows a SUD to develop. Below are some of the most common co-occurring mental health disorders and their symptoms.

Generalized Anxiety Disorder

Also known as GAD, generalized anxiety disorder is persistent, intense feelings of anxiety and worry. Some of the symptoms include overthinking, restlessness, and difficulty concentrating.⁴ 

People with GAD do not necessarily feel anxious all the time, but their anxiety is severe enough to interfere with everyday activities.

Eating Disorders

Several types of eating disorders are considered co-occurring conditions, including bulimia nervosa and anorexia nervosa. Eating disorders are unhealthy preoccupations with food, exercise, eating, or body shape.


People with eating disorders may also withdraw from friends and family. This is because avoiding social situations makes it easier to control their food intake and prevents others from scrutinizing what they are or are not eating.

Bipolar Disorder

Bipolar disorder is marked by extreme swings of high and low moods. Everyone feels depressed or extra happy once in a while, but those with bipolar disorder experience periods of mania and depression that disrupt their life, sometimes in dangerous ways. There are at least three types of bipolar disorder, and certain drugs can induce symptoms.⁵ 

Post-Traumatic Stress Disorder

The Anxiety & Depression Association of America reports that approximately eight million people are living with PTSD in the U.S. today. Trauma survivors are the ones who commonly experience PTSD. Sufferers may experience depression, anxiety, emotional numbness, and lapses in memory, especially memories associated with the traumatic event.⁶ 

People who have directly experienced trauma and those who have witnessed it or heard traumatic events repeatedly are at risk for PTSD.

Schizophrenia

Schizophrenia is usually diagnosed in the late teens to early thirties, and the disorder tends to emerge slightly earlier in males. A diagnosis for this disorder is typically made after an initial psychotic episode. Some common symptoms include hallucinations, delusions, and disorder thoughts or speech.

Co-Occurring Disorders Treatment Programs

Co-occurring disorders treatment programs may include a variety of therapies. Once a co-occurring diagnosis is identified, a medical team consisting of mental health and addiction specialists may recommend one or more medications to help manage symptoms. Other treatments include:

• One-on-one counseling
• Behavioral therapies
• Cognitive-behavioral therapy (CBT)
• Dialectical behavior therapy (DBT)
• Assertive community treatment (ACT)
• Therapeutic communities (TC)
• Contingency management (CM)

The successful treatment of co-occurring disorders is possible when both (or all) disorders are properly diagnosed and prioritized equally. All clients with co-occurring conditions will benefit from simultaneous mental illness and substance abuse treatment.

Behavioral Therapies for Children and Adolescents

Children and adolescents are also at risk for substance and mental health disorders. Treatment of co-occurring disorders for this age group may include:

• Brief strategic family therapy (BSFT)
• Multidimensional family therapy (MDFT)
• Multisystemic therapy (MST)
• Integrated treatment
• Medications

Symptoms of mental health disorders can present differently in children than in adults. If your child exhibits changes that concern you, don’t assume it’s a “phase.” Ask your pediatrician for more information and request a mental health evaluation.

Aftercare and Support Groups

Following through with aftercare programs and support groups after completing formal treatment of co-occurring disorders is crucial to long-term wellness. Aftercare may include sober living, attending outpatient care, and participating in appropriate support groups.