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What is a Co-Occurring Disorder?

A co-occurring disorder refers to the presence of both a mental health disorder and a substance use disorder occurring simultaneously in an individual. It requires an integrated and comprehensive approach to address the complex interaction between these conditions, ensuring appropriate treatment for both aspects to achieve optimal recovery and well-being.

Co-occurring disorders, also known as dual diagnosis, are a common and serious condition affecting millions of Americans. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 9.2 million people in the United States suffer from co-occurring disorders.

Co-occurring disorders often go hand-in-hand, with one disorder exacerbating the other. They are also more challenging to treat than either condition alone, making it critical to seek professional help from reputable addiction treatment centers.

In this article, we will explore what co-occurring disorders are, their causes and symptoms, risk factors for developing them, common types of co-occurring disorders, and treatments available.

What is a Co-Occurring Disorder?

Key Takeaways

  • Co-occurring disorders refer to the co-existence of a mental health disorder and a substance use disorder and are a common, serious, and treatable condition affecting 8 million Americans.
  • People diagnosed with a mental health disorder are twice as likely to develop a substance addiction and vice versa, and risk factors include mental illness, recurrent substance abuse, lack of appropriate treatment, trauma, and genetic/family history.
  • Co-occurring disorders are complex, causal, and cyclical in nature, and may exacerbate symptoms of each disorder. Left untreated, they can lead to higher risks of suicide, hospitalization, social isolation, violence, victimization, incarceration, and drug overdose.
  • Integrated dual diagnosis treatment is recommended to address both disorders simultaneously, and may include inpatient/outpatient, CBT, group therapy, individual therapy, or combination. Treatment at a reputable addiction treatment center with experience in treating co-occurring disorders is vital.

Understanding co-occurring disorders is crucial as these disorders are complex and cyclical.  These disorders involve the co-existence of a mental health disorder and a substance use disorder, which together can exacerbate symptoms of each other.  Combined they can lead to higher risks of suicide, hospitalization, social isolation, violence, victimization, incarceration, and drug overdose, if left untreated.

Co-occurring disorders are common among individuals with mental illness or substance use disorders. For instance, anxiety disorders, bipolar disorder, and mood disorders often occur in conjunction with substance use disorders.

The consequences of untreated co-occurring disorders can be severe. The interaction between these conditions impacts the course of illness and increases the risk for negative outcomes.

Dual diagnosis treatment offers an integrated approach that addresses both the mental health disorder and the substance use disorder simultaneously. Treatment options may include cognitive-behavioral therapy (CBT), group therapy, individual therapy, or a combination thereof.

It is vital to seek specialized care from reputable addiction treatment centers like Pyramid Healthcare to receive proper assessment and treatment for co-occurring disorders.

Treating Co-Occurring Disorders

Treating Co-Occurring Disorders

Integrated dual diagnosis treatment is a highly recommended approach to addressing both substance addiction and mental health disorders simultaneously. This type of treatment involves personalized care plans that combine medication-assisted treatment, behavioral therapy, and counseling.

As part of the integrated treatment process, individuals with co-occurring disorders may also receive support for managing physical health issues, housing concerns, employment challenges, and other areas that can impact their overall well-being.

To effectively treat co-occurring disorders, it’s important to recognize that these conditions are complex and require an individualized approach. Some specific strategies for treating co-occurring disorders include:

  1. Concurrent Treatment: Addressing both substance abuse and mental health issues simultaneously in order to promote long-term recovery.
  2. Individualized Care: Customizing treatment plans based on each person’s unique needs.
  3. Collaboration: Involving a team of healthcare professionals from different disciplines in order to provide comprehensive care.
  4. Ongoing Support: Providing continued support after completing initial treatments in order to help prevent relapse or recurrence of symptoms.

By utilizing these strategies within an integrated dual-diagnosis treatment plan, individuals with co-occurring disorders can receive the specialized care they need to achieve lasting recovery from both their substance use disorder(s) and mental health conditions.

Risk Factors for Developing a Co-Occurring Disorder

The development of co-occurring disorders, or the coexistence of a mental health disorder and substance use disorder, can be influenced by various risk factors.

  • Biological risk factors: such as genetics and changes in brain chemistry due to substance use can increase the likelihood of developing these conditions.
  • Social risk factors: including chronic stress, trauma, peer drug use, access to drugs or alcohol, family factors, and cultural acceptance of substance abuse may also play a role in their onset.
  • Psychological factors: Adverse life experiences during childhood, unresolved trauma, and chemical imbalances in the brain.

Understanding these risk factors is important in identifying individuals who may be at greater risk for developing co-occurring disorders and providing appropriate interventions.

Biological Risk Factors for Developing a Co-Occurring Disorder

Genetic and environmental factors play a crucial role in the development of co-occurring disorders involving substance use and mental health disorders. Biological risk factors such as genetic predisposition to addiction, epigenetic changes due to trauma, and brain structure abnormalities can increase the likelihood of developing these complex conditions. For example, studies have shown that individuals with a family history of substance abuse disorders are at higher risk for developing addiction themselves. Additionally, childhood trauma may cause genetic changes¹ that increase susceptibility to both substance abuse and mental health disorders.

Environmental factors can also contribute significantly to the development of co-occurring disorders. Chronic stressors such as poverty or social isolation can lead individuals to turn to drugs or alcohol as a coping mechanism, increasing their risk for addiction. Access to drugs and peer drug use also increases the likelihood of developing substance abuse disorders. An accurate diagnosis is essential for effective treatment of co-occurring disorders since each disorder affects different areas of the brain. An integrated treatment approach that considers both biological and environmental risk factors is necessary for successful outcomes.

Co-Occurring Disorder Biological Risk Factors Environmental Risk Factors
Substance Use Disorder – Genetic Predisposition – Access to Drugs
– Epigenetic Changes – Peer Drug Use
– Brain Structure Abnormalities – Chronic Stress
Mental Health Disorder – Childhood Trauma – Social Isolation
– Genetics – Poverty
Brain Structure Abnormalities – Trauma

Effective intervention requires an integrated approach where clinicians work with patients to identify and address all underlying issues simultaneously. Accurate diagnosis, evidence-based treatment, and ongoing support are crucial for long-term recovery from co-occurring disorders.

Social Risk Factors for Developing a Co-Occurring Disorder

Environmental factors play a significant role in the development of co-occurring substance use and mental health disorders, with social risk factors such as peer pressure, social isolation, and lack of social support contributing to an increased likelihood of developing these complex conditions.

Peer pressure can lead to experimenting with drugs or alcohol, which can then escalate into addiction. Social isolation and lack of social support can exacerbate the symptoms of psychiatric disorders such as depression and anxiety, leading individuals to self-medicate with substances.

Family history is another environmental influence that increases the risk for comorbidity. A person who has a family member with a substance use disorder or mental illness may be genetically predisposed to developing one or both conditions themselves. Additionally, growing up in a household where substance abuse or mental illness is present can normalize these behaviors and increase the likelihood of engaging in them later on in life.

Overall, addressing environmental risk factors through therapy and supportive interventions is crucial for preventing and treating co-occurring disorders.

Common Co-Occurring Disorders

Anxiety disorders, depression, bipolar disorders, psychosis, ADHD, personality disorders, and schizophrenia are among the most common co-occurring disorders that require intervention in all areas of life for effective treatment. These conditions often coexist with substance use disorder (SUD) and can exacerbate psychiatric symptoms if left untreated.

Co-occurring behavioral health conditions can have a causal relationship with SUD as individuals may use substances to cope with their mental health condition or develop a mental health condition due to substance abuse.

Integrated treatment programs offer an effective approach to treating dual disorders by addressing both mental health and substance use concerns concurrently. A comprehensive assessment is necessary to identify all underlying conditions before developing an individualized treatment plan.

Treatment plans may include behavioral therapy such as Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), medication management, group or individual therapy sessions, family support services, and aftercare planning.

By addressing both co-occurring disorders simultaneously through integrated treatment programs, individuals have a better chance of achieving long-term recovery from their mental health condition and substance use disorder.

What Causes Co-Occurring Disorders?

The complex interplay between substance use and mental health can be likened to a vicious cycle, with each disorder exacerbating the symptoms of the other. Co-occurring disorders, also known as dual diagnosis, are a common occurrence in individuals who struggle with drug use disorders and psychiatric conditions.

It is critical that individuals seeking substance use treatment also receive comprehensive care that addresses any underlying mental health disorder. An integrated approach through a dual-diagnosis treatment program can help individuals break free from the cycle of co-occurring disorders and improve their chances for sustained recovery.

Co-Occurring Disorders and the Brain

Co-occurring disorders can be a complex and challenging issue to address, as they involve both mental health issues and substance use. The comorbidity of these two conditions can have a significant impact on the brain chemistry of individuals, leading to changes that exacerbate symptoms of each disorder. Furthermore, genetic predisposition may contribute to the onset of co-occurring disorders.

Studies by the National Institute on Drug Abuse (NIH) have shown² that areas of the brain involved in decision-making, reward processing, impulse control, and emotions are impacted by co-occurring disorders. This highlights the importance of effective treatment for both mental illnesses and substance use in order to address underlying issues and promote recovery.

A comprehensive approach is necessary for addressing co-occurring disorders in order to ensure lasting success.



  1. Khoury, Lamya et al. “Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population.” Depression and anxiety vol. 27,12 (2010): 1077-86. doi:10.1002/da.20751
  2. NIDA. “References .” National Institute on Drug Abuse, 20 Sep. 2021, https://nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/references Accessed 27 Jun. 2023.


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