On November 18, 2023
Millions of people struggle with mental health conditions and substance use disorders, often together, which is known as co-occurring disorders. These conditions can occur independently or may influence each other.
About 9.5 million American adults have a co-occurring mental illness and substance use disorder. Together, these conditions can intensify symptoms and risks, as well as creating challenges in treating both successfully.
Co-occurring disorders occur when someone has a mental health condition and a substance use disorder that occur simultaneously. Though this term usually applies to these two groups of disorders, it can also apply to other behavioral health conditions like a mental disorder and an intellectual disability.
When a mental health condition and substance use disorder co-occur, they can differ in severity or change over time. People with co-occurring disorders may experience more significant symptoms and challenges with treatment.
There are some conditions that commonly co-occur, such as anxiety or depression with substance use. Attention deficit/hyperactivity disorder (ADHD), schizophrenia, and some personality disorders are also more likely to co-occur with substance use disorders.
The substances can vary but may include:
There are a range of mental health conditions that can co-occur with substance use disorder, including anxiety disorders like generalized anxiety disorder and depressive disorders like clinical depression.
Co-occurring disorders aren’t limited to these groups of conditions, however. ADHD, which is characterized by impulse control issues, poor focus and attention, and hyperactivity, is a commonly co-occurring disorder.
PTSD and other trauma disorders are also common, which may include nightmares, flashbacks, depression, anxiety, and in some cases, substance use. Conduct disorders may present with co-occurring disorders, as they align with some of the behaviors of substance use, such as deceitful behavior, destructive behavior, issues with authority, and engaging in illegal activities.
Some process disorders, also known as process addictions, may co-occur with substance use. These may include internet addiction, video game use disorder, sex addiction, gambling addiction, or eating disorders. Addiction interaction disorder, which causes a person to go from one addiction to another, may coincide with substance use as well.
Roughly 9.5 million Americans have a co-occurring mental health condition and substance use disorder. Over half of these people are men, indicating it may be more common in men than women. People who struggle with anxiety and depression also have a higher risk of co-occurring substance use disorders.
Some people have genetic risk factors that contribute to mental health conditions, substance use disorders, or both, but the environment can also play a role. For example, alcohol use disorder is associated with conditions like anxiety and depressive disorder. Chronic stress, trauma, peer drug use, family strife, and social acceptance of substance use can also contribute to these conditions.
With co-occurring disorders, one may influence the other and exacerbate the symptoms of both. Substance use may lead to the development of a mental health condition like depression, but it could also worsen an existing disorder. In some cases, a person with a mental health condition may turn to drugs or alcohol to self-medicate symptoms. For example, a person with post-traumatic stress disorder (PTSD) drinking alcohol to relax, which turns into an addiction.
Co-occurring disorders show symptoms related to the specific mental health condition or substance use disorder. The symptoms are often specific to the substance used, but may include:
People with co-occurring disorders experience an increased risk for devastating effects like social isolation, relapses, problems with interpersonal relationships, legal troubles, victimization, and serious medical conditions.
The relationship between substance use disorder and mental health can be complex and involve overlapping risk factors.
Genetics are a big contributor to substance use disorder and mental health disorders. Specific genes can be a risk factor for developing a substance use disorder and affect how an individual responds to different substances.
Certain mental illnesses increase the risk of substance use disorders as individuals seek to control their symptoms, such as with anxiety. This may relieve symptoms temporarily, but over time, it will worsen both the mental health condition and the substance use.
Substance use, and a disorder that arises from it, can lead to a mental health disorder. Ongoing substance use leads to changes in the brain, and the longer a substance is used, the greater those changes become long-term. As a result, these people may develop a mental health condition.
In the past, co-occurring disorders were addressed with separate consecutive treatments. It was believed that one disorder must be treated before the other, which neglected the role and influence two disorders have over one another.
Now, co-occurring disorders are treated with an integrated approach that coordinates mental health and substance abuse interventions. This often includes types of behavioral therapy, such as cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT) to improve negative behaviors and identify the underlying causes of substance use.
In addition, treatment for co-occurring disorders may include a variety of therapeutic modalities that are often used with either substance use disorder or mental health conditions, such as medication, psychotherapy (talk therapy), experiential therapy, relapse prevention, and group therapy.
The overarching goal of co-occurring disorder treatment is to help the person address their experiences and how their conditions overlap. This is more effective than treating conditions on their own.
People with mental health disorders are more likely to struggle with a substance use disorder than those without. About half of the people who have a substance use disorder or mental illness will develop a co-occurring disorder in their life.
There are many ways that co-occurring disorders may develop. In some cases, co-occurring disorders exist independently of each other, but someone with a mental health condition may self-medicate with drugs or alcohol to relieve symptoms like anxiety or depression, leading to tolerance and addiction over time.
Conversely, regular substance use can create anxiety or depression. These individuals are at a higher risk for other problems because of substance, such as sexual victimization, which can also indirectly lead to mental health conditions like anxiety or PTSD.
Co-occurring disorder is a more recent term for dual diagnosis, but they both refer to mental health and substance use disorders that occur together. Other terms for these conditions may include concurrent disorders, dual disorder, or co-morbidity, though the latter is often used to refer to diseases outside of mental health.
Because the symptoms of certain mental health conditions can mimic those of substance use disorders, it’s important that both disorders are correctly diagnosed with a careful assessment. This is often challenging and requires an experienced mental health professional with a keen understanding of both mental illness and substance abuse.
Here at Ascendant New York, we understand the importance of having access to accurate medical information you can trust, especially when you or a loved one is suffering from addiction. Find out more on our policy.
 2021 National Survey of Drug Use and Health (NSDUH) releases. SAMHSA.gov. (n.d.). Retrieved from https://www.samhsa.gov/data/release/2021-national-survey-drug-use-and-health-nsduh-releases on May 1, 2023.
 U.S. Department of Health and Human Services. (n.d.). Substance use and co-occurring mental disorders. National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health on May 1, 2023.
 Working with specific populations of men in Behavioral Health Settings. (n.d.). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK144297/ on May 2, 2023.
 Dual diagnosis: Mental illness and substance abuse – dartmouth. (n.d.). Retrieved from https://www.dartmouth.edu/eap/library/dualdiagnosis1.pdf on May 2, 2023.