Table of Contents
The Complete Guide to Co-occurring Disorders: Mental Health and Substance Use Treatment
Reviewed by:
Brittany Mausolf, MA, LPCC, LADC
- Co-occurring Disorders & Integrated Treatment
- Why Co-occurring Disorders Matter
- How Common Are Co-occurring Disorders?
- How Mental Health Disorders and Substance Use Disorders Interact
- What Is the Difference Between Co-occurring Disorders and Dual Diagnosis?
- Common Examples of Co-occurring Disorders
- Signs and Symptoms of Co-occurring Disorders
- What Causes Co-occurring Disorders?
- How Are Co-occurring Disorders Diagnosed?
- Treatment Options for Co-occurring Disorders
- What to Expect During Treatment
- Can Someone Recover from Co-occurring Disorders?
- Guidance for Family Members
- Insurance and Cost Considerations
- Frequently Asked Questions About Co-occurring Disorders
- Take the Next Step
A co-occurring disorder is when a person experiences one or more mental health conditions and a substance use disorder. The conditions may develop at the same time or one may emerge before the other, but they affect each other in ways that can make recovery more difficult without specialized care.
Common examples include:
- Depression and alcohol use disorder
- Anxiety and prescription drug misuse
- Post-traumatic stress disorder (PTSD) and opioid use disorder
- Bipolar disorder and stimulant use disorder
- Attention-deficit/hyperactivity disorder (ADHD) and cannabis use disorder
When these conditions occur together, treatment that addresses both conditions simultaneously, often called integrated treatment, is considered the gold standard of care. Research consistently shows better outcomes when mental health and substance use disorders are treated together rather than separately.
Definitions
Co-occurring disorders:
The presence of one or more mental health disorders and a substance use disorder in the same person.
Dual diagnosis:
An older term commonly used to describe co-occurring disorders.
Integrated treatment:
An approach that addresses both conditions together through one coordinated care plan.
Why Co-occurring Disorders Matter
How Common Are Co-occurring Disorders?
How Mental Health Disorders and Substance Use Disorders Interact
Why do co-occurring disorders happen?
There is no single cause of co-occurring disorders. Instead, several factors can increase the likelihood that mental health and substance use disorders develop together. At times, it can even be confusing to determine which disorder happened first—or if they happened simultaneously.
Because these conditions can influence each other in complex ways, effective care starts with understanding the whole person, not just individual symptoms.
What Is the Difference Between Co-occurring Disorders and Dual Diagnosis?
What is a co-occurring disorder?
In behavioral health care, co-occurring disorders usually refers to a mental health disorder and a substance use disorder occurring in the same person at the same time.
What is dual diagnosis?
Dual diagnosis is an older term that means essentially the same thing.
Some organizations still use it, but many professionals now prefer the term co-occurring disorders because it reflects a broader understanding of how conditions interact.
What is comorbidity?
Comorbidity is a broader medical term that refers to two or more conditions occurring together.
Examples:
- Diabetes and heart disease
- Depression and anxiety
- PTSD and alcohol use disorder
While all co-occurring disorders are a form of comorbidity, not all comorbidities involve substance use disorders.
Common Examples of Co-occurring Disorders
Co-occurring disorders can take many different forms because every person's experience is unique. The list below identifies some of the most common combinations of mental health and substance use disorders. There are countless other ways co-occurring disorders can appear.
Mental Health Condition |
Common Co-occurring Substance Use Disorder |
|---|---|
|
Depression |
Alcohol use disorder |
|
Anxiety disorders |
Alcohol or sedative misuse |
|
PTSD |
Opioid use disorder or alcohol use disorder |
|
Bipolar disorder |
Alcohol or stimulant use disorder |
|
ADHD |
Cannabis or stimulant misuse |
|
Schizophrenia |
Nicotine dependence, alcohol use disorder or cannabis use disorder |
Mental health diagnoses commonly seen alongside substance use disorders include:
- Depression
- Anxiety disorders
- PTSD
- Bipolar disorder
- ADHD
- Personality disorders
- Obsessive-compulsive disorder (OCD)
- Schizophrenia spectrum disorders
Signs and Symptoms of Co-occurring Disorders
The signs of a co-occurring disorder aren't always easy to recognize. Mental health conditions and substance use disorders can share similar symptoms, and each can influence how the other appears. What may look like anxiety, depression or the effects of alcohol or drug use could be part of a more complex picture involving both conditions.
Mental health
symptoms
Depending on the condition, symptoms may include:
- Persistent sadness
- Anxiety or panic attacks
- Mood swings
- Difficulty concentrating
- Irritability
- Sleep disturbances
- Feelings of hopelessness
- Social withdrawal
- Intrusive memories
- Excessive worry
- Thoughts of self-harm
Individuals experiencing thoughts of suicide or self-harm should seek immediate support through emergency services or the 988 Suicide & Crisis Lifeline.
Substance use
symptoms
Common signs include:
- Using larger amounts than intended
- Difficulty stopping
- Cravings
- Spending significant time obtaining or using substances
- Continuing use despite consequences
- Increased tolerance
- Withdrawal symptoms
- Neglecting responsibilities
- Relationship conflicts
- Failed attempts to cut back
Warning signs loved
ones may notice
Changes related to co-occurring disorders are not always obvious at first. Family members, partners and close friends may first notice shifts in mood, behavior or daily routines that signal something deeper is going on. While these signs don't necessarily mean someone has a co-occurring disorder, they may indicate it's time to start a conversation or seek professional guidance.
Watch for:
- Increased secrecy
- Sudden mood changes
- Financial problems
- Isolation
- Missing work or school
- Changes in sleep patterns
- Declining physical health
- Loss of interest in activities
- Risky behavior
- Frequent crises
What Causes Co-occurring Disorders?
Brain chemistry
Mental health conditions and substance use disorders both affect communication systems within the brain. Changes involving mood regulation, reward pathways, stress responses and impulse control can contribute to the development and progression of co-occurring disorders.
Environment and stress
Factors such as chronic stress, financial hardship, discrimination, social isolation, housing instability or exposure to substance use can increase the risk of a co-occurring disorder.
While not everyone facing these challenges develops a co-occurring disorder, they can contribute to emotional distress and make healthy coping more difficult.
Family history and learned behaviors
Families influence how people learn to respond to stress, communicate emotions and seek support. Growing up in an environment where substance use is common or mental health concerns go untreated may shape future coping behaviors. Fortunately, family history is only one part of the story. With effective treatment and support, people can develop new skills and healthier ways of managing life's challenges.
While these factors can increase the likelihood of developing co-occurring disorders, they don't determine a person's future. Many people with one or more risk factors never develop a mental health or substance use disorder, while others may experience both. Understanding the potential influences behind co-occurring disorders can help individuals and families make sense of what they're experiencing and find the support that's most likely to help.
How Are Co-occurring Disorders Diagnosed?
A thorough assessment helps create a clearer picture of what's happening and what kind of support may be most helpful. This often includes screening and assessment tools, along with conversations about symptoms, health history, substance use, life experiences and personal goals for recovery. It also considers how symptoms interact over time rather than viewing each condition in isolation.
Why diagnosis can be challenging
Mental health symptoms and substance use symptoms often overlap.
For example:
- Alcohol use can contribute to depression.
- Anxiety can increase substance use.
- Sleep disturbances can occur with both conditions.
- Both addictive use and withdrawal symptoms may resemble psychiatric symptoms.
Because of this complexity, clinicians need time to understand what symptoms existed before substance use, what symptoms emerged afterward and how both conditions influence each other.
Shared decision-making matters
At Hazelden Betty Ford, assessment is not something that's done to a person. It's a collaborative process that combines clinical expertise with an individual's experience, goals and preferences.
This approach, often called shared decision-making, helps people participate actively in treatment planning and recovery decisions.
Mental health services at Hazelden Betty Ford
Hazelden Betty Ford provides integrated care designed to address substance use disorders and many common co-occurring mental health conditions.
Treatment Options for Co-occurring Disorders
Before diving into specific treatment approaches, it's important to know that help is available. Co-occurring disorders can feel complicated, but effective treatments exist, and millions of people have found recovery from both substance use disorders and mental health conditions. The first step is finding care that recognizes how these challenges interact and addresses them together.
What is integrated treatment?
Integrated treatment is an approach that addresses mental health and substance use disorders at the same time through a coordinated treatment plan.
Instead of treating one condition first and addressing the other later, integrated care recognizes that both conditions influence one another and should be addressed together. Research has shown that integrated treatment generally leads to better outcomes because care is coordinated around the individual's needs.
Why is integrated treatment considered the gold standard?
A growing body of research supports treating mental health and substance use disorders together rather than separately. Integrated treatment allows providers to address the ways these conditions influence one another, which can improve treatment engagement, reduce symptoms and support long-term recovery. Leading organizations including the National Institute on Drug Abuse (NIDA) recommend coordinated approaches that address both conditions as part of a single treatment plan whenever possible.
Risks of treating conditions separately
A person might:
- Visit one provider for addiction treatment
- See another provider for mental health care
- Receive different recommendations
- Be expected to coordinate everything independently
Benefits of treating both conditions together
Integrated care may help:
- Reduce symptoms more effectively
- Improve treatment engagement
- Strengthen recovery skills
- Improve quality of life
- Reduce relapse risk
- Improve communication among providers
- Support long-term recovery goals
Common components of treatment
Treatment for co-occurring disorders often includes a range of evidence-based therapies and supportive services tailored to an individual's needs. Along with addressing symptoms, these approaches help individuals build coping, emotional regulation and life skills that support overall functioning and long-term recovery.
Recovery goals look different for everyone. For one person, success may mean reducing anxiety and rebuilding trust with family members. For another, it may involve maintaining sobriety, returning to work, improving physical health or feeling more present and engaged in everyday life. Effective treatment helps people identify what recovery means to them and develop a plan to support those goals.
What to Expect During Treatment
Taking the first step toward treatment can bring up a range of emotions. Some people feel relieved to finally have answers. Others may feel nervous about what treatment will involve, whether they'll be understood or if recovery is truly possible.
At Hazelden Betty Ford, treatment begins with meeting people where they are. Co-occurring disorders can be complex, but help is available. Our multidisciplinary teams have extensive experience treating both mental health conditions and substance use disorders, and we understand that every person's story, challenges and strengths are different. Treatment is designed to provide a safe, supportive environment where individuals can gain a better understanding of what they're experiencing, develop practical recovery skills and begin building a healthier future. Integrated care, personalized treatment planning and collaboration with patients and families are central to this approach.
Before admission
The process often begins with:
- A confidential conversation
- Insurance verification
- Clinical assessment
- Treatment recommendations
The first week
Early treatment may focus on:
- Stabilization
- Orientation
- Assessment
- Goal-setting
- Building trust with the treatment team
Weeks two through four
As treatment progresses, individuals often participate in:
- Group counseling
- Individual therapy
- Mental health services
- Skill-building to manage symptoms
- Family programming
- Recovery education
- Relapse prevention planning
Discharge planning
Discharge planning begins well before treatment ends.
The goal is to create a realistic plan that supports continued recovery and addresses both mental health and substance use concerns after treatment.
After treatment
Recovery continues long after a formal treatment program ends.
Continuing care planning may include:
- Outpatient treatment
- Therapy
- Medication management
- Recovery meetings
- Alumni support
- Family services
Find Support for Co-occurring Disorders
When mental health and substance use concerns overlap, comprehensive care can make a meaningful difference. Hazelden Betty Ford's integrated treatment approach is designed to address the whole person, not just individual symptoms. Whether you're looking for answers, exploring treatment options or ready to get help, our team can guide you through the next steps.
Can Someone Recover from Co-occurring Disorders?
What improves long-term outcomes?
Recovery doesn't happen because of a single decision, treatment experience or breakthrough moment. It is often built through a series of small, intentional steps taken over time. While every person's path is different, clinicians and researchers have identified several factors that can strengthen recovery, support ongoing healing and improve long-term outcomes for individuals living with co-occurring disorders:
- Early intervention
- Integrated care
- Ongoing support
- Family involvement
- Treatment engagement
- A strong recovery network
What about relapse?
When discussing substance use disorders, you may hear the term "relapse." At Hazelden Betty Ford, clinicians often use the phrase return to use because it recognizes that recovery is an ongoing process rather than a pass-or-fail event. Moreover, addiction, along with many mental health conditions, is chronic. It is not uncommon for symptoms to recur and warrant additional or further treatment.
For individuals living with co-occurring disorders, a return to use or a recurrence of mental health symptoms does not mean treatment has failed or that recovery is out of reach. Just as symptoms of depression, anxiety, bipolar disorder or other mental health conditions can recur, some people may experience a return to substance use during the recovery process. What matters most is how those experiences are addressed.
A return to use is not a sign of failure. Instead, it's a key indicator about what support may be needed next. It may signal the need for additional recovery resources, changes in mental health treatment, stronger coping strategies or renewed engagement with a support network. With the right care and support, many people can learn from setbacks, regain momentum and continue making progress toward their recovery goals.
Relapse prevention and recovery support
Recovery from co-occurring disorders involves more than avoiding alcohol or other drugs. It also involves managing mental health symptoms, building coping skills and developing a support system that can help with navigating life's challenges.
Research and clinical experience consistently show that recovery is strengthened when people have meaningful connections with others who support their goals. Whether that support comes from family members, treatment professionals, peers in recovery, faith communities or mutual-help groups, strong relationships can provide accountability, encouragement and perspective during both difficult and successful periods of recovery.
A recovery support system is the support you receive from those around you that uplifts you, encourages a better version of you, and gives you a sense of belonging and connection.
Many people focus on what they need to avoid during recovery. Just as important is identifying what they need to build. A strong recovery support system often includes people who understand the importance of both substance use recovery and mental health management and who can provide encouragement, honest feedback and support during difficult times.
Examples may include:
- Family members and trusted friends
- Therapists and counselors
- Physicians and mental health providers
- Peer recovery specialists
- Twelve Step sponsors
- Recovery support groups
- Faith or spiritual communities
- Others in long-term recovery
For many people, recovery becomes more sustainable when they openly communicate their goals, identify trusted sources of support and develop a plan for responding to triggers, cravings, mental health symptoms or a potential return to use.
Guidance for Family Members
Start with compassion and curiosity
Conversations about mental health and substance use are often most effective when they come from a place of concern rather than criticism.
Instead of assuming you know what's happening, try creating space for a conversation:
- "I've noticed you haven't seemed like yourself lately."
- "You seem to be carrying a lot right now."
- "I've been worried about you and wanted to check in."
- "How can I support you?"
The goal isn't to diagnose, fix or convince. The goal is to listen, learn and keep the lines of communication open.
Learn about both conditions
Families sometimes focus on either the mental health condition or the substance use disorder, but treating one while overlooking the other can create additional challenges.
Learning how co-occurring disorders work can help you:
- Better understand your loved one's experiences
- Set realistic expectations
- Communicate more effectively
- Identify warning signs early
- Support treatment and recovery efforts
The more informed you are, the more prepared you'll be to respond with empathy and confidence rather than fear or frustration.
Encourage professional help
Many people with co-occurring disorders benefit from treatment that addresses both conditions together.
If your loved one is open to help, you can assist by:
- Researching treatment options
- Offering transportation
- Helping with insurance questions
- Participating in family programming
- Encouraging follow-through with treatment recommendations
Integrated treatment approaches are generally associated with better outcomes because they address both mental health and substance use concerns as part of a coordinated plan.
Remember, recovery involves the whole family
Co-occurring disorders don't just affect the individual experiencing symptoms. They can impact communication, trust, finances, routines and family relationships.
Many families find that their own healing begins when they seek support, education, skill-building opportunities and connection with others who understand what they're experiencing. Family counseling, support groups and educational programs can help family members better understand recovery while caring for their own well-being. Family involvement is also a key component of many integrated treatment models.
Take care of yourself, too
Supporting someone with a co-occurring disorder can be emotionally demanding. Taking care of yourself isn't selfish. It's part of being able to provide healthy, sustainable support.
Consider:
- Maintaining boundaries
- Staying connected to supportive friends and family
- Seeking counseling or support groups
- Prioritizing sleep, exercise and self-care
- Continuing activities that bring meaning and balance to your life
Caring for yourself and caring for a loved one are not competing priorities. Both matter.
Give time for healing
Families do not cause co-occurring disorders, and they cannot cure them. What families can do is provide encouragement, accountability, understanding and hope. Recovery often happens one conversation, one decision and one step at a time. By learning about co-occurring disorders and engaging in the process, families can become an important source of support while helping create an environment that promotes healing for everyone involved.
Insurance and Cost Considerations
Many health insurance plans provide coverage for mental health and substance use disorder treatment.
Coverage varies depending on:
- Provider network
- Level of care
- Location
- Specific benefits
Questions to ask include:
- Is the program in-network?
- What services are covered?
- What will out-of-pocket costs be?
- Is prior authorization required?
Hazelden Betty Ford's admissions team can help individuals and families understand available options and verify benefits.
Frequently Asked Questions About Co-occurring Disorders
What is a co-occurring disorder?
A co-occurring disorder occurs when a person experiences both a mental health disorder and a substance use disorder. In some cases, they may have more than one of each condition.
Is dual diagnosis the same as a co-occurring disorder?
Yes. Dual diagnosis is an older term commonly used to describe co-occurring disorders.
What causes co-occurring disorders?
Co-occurring disorders may result from a combination of genetics, trauma, environmental factors, brain chemistry and life experiences.
How common are co-occurring disorders?
Millions of Americans experience both mental health and substance use disorders, according to the 2021 National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration (SAMHSA).
What percentage of people with substance use disorders have a co-occurring mental health disorder?
According to SAMHSA, approximately 44 percent of people with a substance use disorder also have a mental health condition.
What are the most common examples of co-occurring disorders?
Common examples include depression and alcohol use disorder, PTSD and opioid use disorder, anxiety and prescription drug misuse, and bipolar disorder with substance use disorders.
What is integrated treatment for co-occurring disorders?
Integrated treatment addresses mental health and substance use disorders simultaneously through a coordinated plan of care.
Should co-occurring disorders be treated at the same time?
Research generally supports treating both conditions together because each condition can affect the other.
How are co-occurring disorders diagnosed?
Diagnosis typically involves a comprehensive assessment of mental health symptoms, substance use patterns, medical history and treatment needs.
What does the best treatment for co-occurring disorders involve?
The most effective treatment plans are individualized and often include therapy, recovery support, family involvement, mental health services and substance use treatment.
How do I find treatment for co-occurring disorders?
Look for programs that provide integrated care and have experience treating both mental health and substance use disorders. Learn more through Hazelden Betty Ford's Co-occurring Disorders Facts for Families.
Take the Next Step
Seeking help for co-occurring disorders can feel overwhelming, especially when mental health symptoms and substance use concerns have become intertwined. The good news is that effective treatment exists, and recovery is possible.
If you're concerned about yourself or someone you care about, consider taking one of these steps today:
