Facts for Families About Co-occurring Disorders

As many as 65% of people with alcohol and other drug addictions suffer from co-occurring mental health disorders.

What is a co-occurring disorder?

Co-occurring disorder refers to the coexistence of a substance use disorder—alcohol or other drug abuse or addiction—and a mental health disorder. Mental health disorders that may commonly occur with addiction include mood disorder, such as depression or bipolar disorder, and anxiety disorder, such as generalized anxiety disorder, social anxiety, panic disorder, post-traumatic stress disorder, or obsessive-compulsive disorder.

When people are diagnosed as having a co-occurring disorder, it means that they have been diagnosed with two or more disorders at the same time during the past year.

What are common indicators of a co-occurring disorder?


Having a co-occurring disorder can present with problems such as:
  • Use of alcohol or other drugs to reduce problems or pain associated with mental health issues
  • A worsening mental health disorder because of alcohol or drug use
  • A worsening substance use disorder because of mental health problems
  • Difficulty getting treatment for both disorders, or difficulty benefiting from treatment
  • Difficulty finding supportive professionals or peers who understand both disorders

What causes co-occurring disorders?

Often times there is a genetic risk factor for both substance use and certain mental health disorders, but genes alone usually don't explain all causes of co-occurring disorders. Other factors include family, environment, and life stress, including traumatic life events, poverty, and loss. Stressful experiences can also trigger genetic factors that contribute to co-occurring disorders. It is possible that people with mental health disorders may be more biologically sensitive to the effects of mood altering substances. They may use alcohol or other drugs to cope with mental health symptoms or to counter social anxiety. People who have a mental health disorder are at much higher risk of also having a substance use disorder and, conversely, people who have a substance use disorder are at much greater risk of developing a mental health disorder.

What's involved in the treatment of co-occurring disorders?

It is important to recognize that both the addiction and the mental health disorder need to be treated. Treating only one of the disorders will result in inadequate treatment and a potential worsening of the other condition. The most common treatment for co-occurring disorders involves an integrated treatment model that can stabilize both the symptoms of the co-occurring disorder and provide the foundation for lasting recovery.

Integrated treatment involves a combination of the following:
  • Accurate diagnosis of both disorders
  • Education about substance use and psychiatric disorders
  • The interaction between both the addiction and mental health concerns and the options for treatment
  • Exploration of the individual's motivation and commitment to address his or her co-occurring disorder
  • Therapies, including cognitive behavioral therapy, and Twelve Step facilitation that teach new skills and provide new insights
  • Appropriate use of medications—there are many safe and non-addictive medications used to treat mental health disorders that will not interfere with an individual's recovery
  • Involvement in treatment, including opportunities for education and skills development
  • Ongoing and frequent monitoring for the return of psychiatric symptoms and substance use
  • Participation in peer support groups such as Alcoholics Anonymous and Dual Recovery Groups

What is the family's role in treatment and recovery for individuals with co-occurring disorders?

  • Educate yourself about your loved one's addiction and mental health issues.
  • Learn about the impact of addiction and mental health issues on family members and loved ones.
  • Participate in family support such as Al-Anon, Families Anonymous, or a support group for families coping with addiction and mental health issues.
  • Support your loved one's involvement in a Twelve Step program and therapy.
  • Learn new ways of coping with a loved one's addiction and mental health issues, including what it means to "detach with love" and why it's important to develop your own self-care program.
  • Encourage participation in peer support groups for your loved one.
  • Know the signs of relapse.
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