Understanding and Treating Substance Use With Co-Occurring Mental Disorders

Deal with Co-Occurring Disorders

The term co-occurring mental disorders has become ubiquitous in the field of substance use treatment. But what are co-occurring disorders and how important to recovery are they?

Addiction treatment has come a long way over the past twenty years or so. While models like the 12-Step Program are still extremely popular, there are now far more options available. Even treatment centers that still use the 12-Step Program provide supplemental therapies based on recent research.

The understanding that addiction often co-occurs with other mental illnesses has been a huge factor in this shift. Experts have come to see that treating the addiction in isolation is often ineffective. If the co-occurring disorder persists, a person is likely to turn back to substance use as a coping mechanism.

If you or a loved one are struggling with addiction, you may be wondering what exactly co-occurring mental disorders are. Do you really need mental health treatment in addiction rehab?

What are Co-Occurring Disorders?

It is important to note that addiction – or substance use disorder – is itself categorized as a mental illness. It is no longer treated as a failure in morality or discipline, but rather as a complex disorder that affects the person in almost every aspect of their psyche.

A co-occurring disorder is therefore a second (or even third) mental illness. It is often what leads to the addiction. In other cases, the addiction leads to other mental illnesses.

Rehabs that treat co-occurring disorders are also called dual diagnosis treatment centers. In these centers, treatment of the co-occurring illnesses is a central part of the process and not at all an afterthought.

The Prevalence of Co-Occurring Disorders

Let’s take a look at just how common co-occurring disorders are among poeple seeking treatment for either mental health or substance abuse issues.

Almost 40% of people with substance use disorders are diagnosed with a co-occurring mental illness according to statistics collected in 2024. The corollary is that one in four people with a serious mental health disorder also have a substance use disorder. This rate is significantly higher than that of the general population, emphasizing the strong link between mental health issues and substance abuse.

The relationship between substance use and mental health disorders is particularly pronounced in specific demographics. For example, young adults aged 18 to 25 are the most likely to report co-occurring disorders. This age group is already at a pivotal stage of psychological development and may use substances as a coping mechanism for undiagnosed or untreated mental health issues.

Men are more likely to be diagnosed with co-occurring disorders compared to women, although the gap narrows significantly when considering specific disorders like depression and anxiety.

Diagnosis vs Prevalence

The above statistics go some way towards showing how common co-occurring disorders are. However, the number is likely much higher than reported. Many people with substance use disorders are not assessed for other mental illnesses. They may not seek treatment for their addiction in the first place or may attend a treatment center that does not consider dual diagnoses.

Socioeconomic factors play a particularly crucial role in the reporting of co-occurring disorders. Individuals from lower socioeconomic backgrounds often face barriers to accessing quality mental health care. They may only have access to treatment centers with limited resources. These centers are unable to provide dual diagnosis treatment.

Additionally, cultural and societal stigma around addiction can prevent individuals from seeking help. They don’t end up seeing a professional and attempt to deal with the problem themselves. They find themselves in a vicious cycle, as their gains in recovery are offset by the struggle they face with other mental illnesses.

Challenges in Diagnosing Co-Occurring Disorders

Even when a professional has experience with the dual diagnosis approach, there are challenges in diagnosing co-occurring disorders. Several factors contribute to the difficulty in accurately identifying and diagnosing these conditions:

Overlapping Symptoms

Many symptoms of substance use disorders mimic or overlap with those of mental health disorders, making it hard to distinguish one from the other. For example, substances like alcohol and drugs can induce symptoms such as anxiety, depression, and mood swings, which are also common in mental health conditions. Similarly, mental health issues can lead to behaviors that resemble those of substance abuse, complicating the diagnostic process.

Symptom Masking

Substances might mask symptoms of a mental health disorder or exacerbate them, making it difficult to determine the underlying cause. For instance, a person using substances to cope with undiagnosed depression may show temporary relief from depressive symptoms while under the influence, which can obscure the diagnosis of a mental health condition.

Complex Diagnostic Criteria

The diagnostic criteria for mental health disorders and SUDs are complex and require careful consideration by trained professionals. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides criteria for diagnosing these conditions, but applying these criteria can be challenging in the presence of co-occurring disorders. Clinicians must carefully assess which symptoms are attributable to mental health disorders versus those caused by substance use.

Compliance and Honesty

Patients with co-occurring disorders might not be completely honest during assessments due to their own denial about the severity of their situation. This can further complicate the accuracy of diagnoses.

Addressing these challenges requires a multidisciplinary approach and a high level of expertise from healthcare providers. Training in dual diagnosis and developing integrated treatment models are crucial steps towards improving the diagnostic accuracy and treatment outcomes for individuals with co-occurring disorders.

Impact of Co-Occurring Mental Illnesses

Co-occurring disorders can significantly impact nearly every aspect of an individual’s life, including physical health, psychological well-being, social relationships, and economic status.

hysical and Psychological Health

Individuals with co-occurring disorders often experience worse health outcomes than those with a single disorder. Substance use can exacerbate mental health issues. It interferes with the effectiveness of medications used for mental health disorders, leading to an increase in psychiatric symptoms.

Mental illnesses also lead to increased use of substances, as the person seeks ways to cope with the symptoms they face.

Relationships and Employment

The complexities of managing two disorders can strain personal relationships and lead to social isolation. Substance use disorders can erode trust between individuals and their families or friends, while mental health disorders can create barriers to social interaction. Additionally, the unpredictability of symptoms can make maintaining employment difficult, resulting in financial instability and further impacting social and economic status.

Quality of Life

The overall quality of life for individuals with co-occurring disorders is typically lower than for those with a single disorder. The burden of managing two conditions can lead to increased stress, decreased life satisfaction, and a pervasive sense of hopelessness, which can further complicate recovery and treatment adherence.

Treatment Approaches for Co-Occurring Disorders

The top rehab centers in 2024 provide dual diagnosis treatment, which significantly improves outcomes. They also have more treatment modules to integrate into their programs based on the continuing evolution of the mental health field.

Integrated Treatment Programs

These programs offer a range of services that are coordinated to address the complexities of co-occurring disorders. Services typically include a combination of psychological therapy, psychiatric medication, substance abuse counseling, and support groups, ensuring that all aspects of a person’s health are addressed.

Evidence-Based Therapies

Cognitive Behavioral Therapy (CBT) is widely used in treating both mental health disorders and substance use disorders due to its effectiveness in changing harmful behaviors and thoughts. Dialectical Behavior Therapy (DBT), which helps patients develop skills to manage emotions, reduce self-harming behaviors, and improve relationships, has become very popular due to its practicality as well as its ability to help build towards a more meaningful life.

Medication-Assisted Treatment (MAT)

MAT combines behavioral therapy and medications to treat substance use disorders. Medications like methadone, buprenorphine, and naltrexone can reduce cravings and withdrawal symptoms, making it easier to treat the substance use aspect of the co-occurring disorder. New non-addictive medications are being researched, with very promising evidence emerging.

Support Groups and Peer Support

Support groups for both addiction and mental health recovery provide important peer support. Community is crucial, especially for those who have had to leave their circles of friends still using substances behind.

Personalized Treatment Plans

Because co-occurring disorders affect each individual differently, personalized treatment plans are essential. These plans should consider the severity of both the substance use disorder and the mental health disorder, and be adaptable to respond to changes in the patient’s condition over time.


The prevalence of co-occurring mental illnesses with substance use disorders is high – and almost certainly underreported. Fortunately, the field of addiction recovery has accepted dual diagnosis treatment as the norm. In 2024, treatment cetners are better prepared than ever to treat co-occurring disorders, with promising new treatments being itnegrated with tried and true approaches.

If you think you or a loved one may be suffering from co-occurring mental disorders, get in touch with Seasons in Malibu to find otu more about your treatment options.

  1. NIMH – Substance Use and Co-Occurring Mental Disorders. Accessed April 25 2024.
  2. Addiction Group – 2024 Addiction Statistics: Accurate Data on Substance Abuse in the US. Accessed April 25 2024.
  3. NIDA – Common Comorbidities with Substance Use Disorders. Accessed April 25 2024.
  4. SAMHSA – TIP 24: Substance Use Disorder Treatment for People With Co-Occurring Disorders. Accessed April 25 2024.