Co-occurring disorders are mental health disorders and substance use disorders that occur in one person during the same period of time. Mental illness and substance use disorders often co-occur because each type of condition can contribute to the other. Getting an accurate diagnosis for any mental illness and substance abuse is crucial for getting the best treatment. The most effective treatment for co-occurring disorders addresses all mental health issues and substance use disorders at the same time.
What is a Co-Occurring Disorder?
The term co-occurring disorder usually refers to the diagnosis of a substance use disorder and one or more mental illnesses in the same person at the same time. This is also called a dual diagnosis. Co-occurring disorder may also refer to more than one mental illness, or even to physical illnesses that occur together or with a substance use disorder or mental illness.
Mental illness and substance abuse often co-occur, because there are similar risk factors and life experiences that contribute to both, and because each can contribute to the other; mental illness often triggers substance use, and misuse of drugs or alcohol often triggers symptoms of mental illness. Effective treatment requires that an accurate diagnosis be made for any co-occurring disorders and that a treatment plan includes strategies for addressing all conditions diagnosed.
Types of Co-Occurring Disorders
Co-occurring disorders include any mental health disorder and any type of substance use disorder. There are many possible combinations, such as schizophrenia and marijuana use or eating disorders and stimulant abuse. Among the most common co-occurring disorders are mood disorders and anxiety disorders with substance use disorders. These include depression, bipolar disorder, and any type of anxiety disorder. Any other mental illness may co-occur with substance use, including an alcohol use disorder. For example, someone with a serious alcohol use disorder is 21 times more likely to also have antisocial personality disorder.
Facts and Statistics
Co-occurring disorders are more common than many people realize. There are many possible combinations of substances misused and specific mental illnesses. Some people may even have more than one mental illness that co-occurs with substance abuse.
- Nearly eight million people in the U.S. have co-occurring mental illness and substance use disorder. More than half of those are men.
- Approximately 60 percent of people who misuse substances have one or more co-occurring mental disorder.
- Forty-five percent of adults who seek treatment for substance use are also diagnosed with a mental illness.
- Someone with a mental illness is twice as likely to smoke cigarettes. People with schizophrenia have the highest smoking rates, at 75 to 95 percent.
- Young people who have had one or more episodes of major depression are twice as likely to misuse drugs or alcohol as compared to their peers.
- Twenty-two percent of people hospitalized for an eating disorder also had a substance use disorder.
- Mood and anxiety disorders are the most common co-occurring disorders in people with substance use disorders.
Symptoms and Diagnosis of a Co-Occurring Disorder
The symptoms of co-occurring disorders vary depending on the specific conditions. Because it is common for mental illness and substance use to co-occur, it is important that patients diagnosed for one be screened for the other. Although the signs and symptoms can vary, there are some general signs that someone is struggling with a mental illness, a substance use disorder, or both:
- Unusual and unexpected changes in behavior
- Withdrawal from social activities, from friends, and from family
- Extreme emotional responses, mood swings
- Fatigue and lack of energy, lethargy and an inability to engage in normal activities
- Periods of excessive energy and euphoric mood
- Extreme anxiety, fear, worry, guilt, or shame
- Difficulty relating to other people or giving appropriate emotional responses
- Changes in sleeping and eating patterns
- Difficulty thinking, including with memory, concentration, or making decisions
- Trouble coping with ordinary stress or typical daily challenges
- Detachment from reality, including paranoia, delusions, or hallucinations
- Physical symptoms with no explainable cause, such as headaches or stomach aches
- Self-injury, like cutting
- Thoughts of suicide or suicidal behaviors
- Developing a tolerance to drugs or alcohol
- Continuing to use drugs or alcohol in spite of problems or promises to stop
- Experiencing withdrawal symptoms when not using drugs or alcohol
To be diagnosed with co-occurring disorders an individual needs to be screened by a mental health professional and evaluated by a doctor for any medical issues that may contribute to symptoms. A mental health screening can include questions, interviews, and observations that help a professional determine if a patient has a substance use disorder and any mental illness.
Causes and Risk Factors
Causes that underlie co-occurring disorders are complex and may vary by individual. Generally, though mental illness and substance use disorders often co-occur for a few important reasons:
- Both types of conditions have similar risk factors, such as childhood trauma and stressful life events.
- Someone with a mental illness, especially if it is undiagnosed or untreated, is more likely to misuses substances as a way to cope with symptoms. This is known as self-medicating.
- Misuse of substances can contribute to mental illnesses, making symptoms worse or triggering episodes.
Research into co-occurring disorders has also uncovered several risk factors. These are specific to having both a substance use disorder and one or more mental illnesses. Not everyone who has a mental illness will develop a substance use disorder and vice versa, but these risk factors make it more likely:
- Having an unstable home life. co-occurring disorders
- Experiencing trauma
- A family history of co-occurring disorders
- Social isolation
- Belonging to a lower socioeconomic status
- Being homeless or incarcerated
Co-Occurring Disorder Complications
Living with a mental illness or a substance use disorder can cause serious complications beyond the symptoms of the conditions themselves. When there are co-occurring disorders, those complications may be more likely, more severe, and more numerous. This is especially true when the disorders go undiagnosed and untreated. To minimize complications, getting the best treatment for all co-occurring disorders is essential. Possible complications of co-occurring disorders include:
- Low quality of life in general, with a lowered ability to enjoy relationships, work, and other activities
- Difficult relationships, fighting, conflicts at home and with family members
- Social isolation and withdrawal from social activities
- Missed time at work or school, decreased performance, and even losing jobs or getting kicked out of school
- Legal and financial difficulties, possibly incarceration or homelessness
- Injuries or illnesses caused by impulsive and risky behaviors
- Self-harm and suicide attempts
- Medical problems, which may vary depending on substances used, but which may include addiction, seizures, brain damage, heart disease, collapsed veins, infectious illnesses, overdose, and death
Treatment and Prognosis for Co-Occurring Disorders
Research has proven that the most effective treatment for both mental illness and substance use disorders includes treatment for all of a patient’s needs: mental health, substance abuse, physical health, medical conditions, and others. The best and most effective treatment must include strategies for addressing all issues involved with and influenced by co-occurring disorders. By treating only the mental illness, a person may return to using substances, which can trigger mental health episodes again. Only treating the substance use disorder can lead to relapses, because mental health issues were ignored.
Also important for treatment to be effective is sticking with it for a period of at least three months. This, and the fact that co-occurring disorders are complicated, means that residential treatment is often the best option for these patients. Comprehensive residential treatment includes therapy, medications, exercise and nutrition, education, and other strategies that are brought together in an individualized plan for treatment.
Therapies commonly used to treat co-occurring disorders include cognitive behavioral therapy and other behavioral therapies. These are goal- and action-oriented therapies that help patients become more aware of their moods, negative thoughts, and feelings so that they can take active steps to make positive changes. Relationship therapy helps patients learn how to have healthier relationships, and family therapy brings in loved ones to help support patients. Group therapy may also be used for therapy and social support.
For some patients, medications may also be an appropriate part of treatment. Antidepressants, anti-anxiety medications, mood stabilizers, and antipsychotics can help treat mental illnesses, for instance. For some types of substance use disorder, medications can help relieve anxiety, reduce withdrawal symptoms, and minimize cravings to prevent relapse.
Treatment for co-occurring disorders is important, and it must be comprehensive. If you or a loved one is struggling with mental illness or substance abuse, seek a professional evaluation. Getting a diagnosis of co-occurring disorders can be frightening, but also enlightening. Knowing that you have an underlying mental illness can shed light on behaviors and choices and help you move forward with treatment. With a commitment to long-term treatment that includes appropriate therapies and medications, as well as good self-care and lifestyle changes, it is possible to overcome co-occurring disorders and to enjoy life again.