Dual Diagnosis: Understanding How to Treat Co-Occurring Disorders

co-occurring disorders

More than than 23 million adults in the United States have experienced drug and alcohol addiction. 43.8 million have struggled with mental illness. A smaller group of people experiences co-occurring disorders. They have experienced substance abuse and mental health issues at the same time.

In fact, 50% of adults with a substance abuse problem also have a co-occurring mental illness. Co-occurring disorders has also been referred to as dual diagnosis. However, more treatment professionals are using the term “co-occurring disorders”. That term is perceived as including more of the mental disorders that can occur.

Understanding how to treat co-occurring disorders is critical to the recovery of the patients who struggle with both substance abuse and mental health issues. Leaving one untreated almost always causes the other to reappear.

What Is Addiction

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders(DSM-5) defines substance abuse as a single disorder measured on a spectrum from mild to severe. It’s recognizable when someone seeks out drugs or alcohol no matter what the consequences are.

The most common symptoms can include:

  • Difficulty controlling the amount of a substance that’s being used. The alcoholic can’t seem to stop with one glass of wine, for example.
  • The addict consistently seeks out the drug. He often ignoring responsibilities like work, child care or personal hygiene.
  • Repeated use of drugs or alcohol in situations where it’s physically dangerous. Driving drunk is one example.
  • Problems in relationships that are caused by drug and alcohol use. The addict may get into physical fights or verbal arguments on a regular basis with friends, relatives or even co-workers.
  • Poor financial health. The addict may spend all his money on drugs and neglect the bills that are piling up. He may have court costs and attorney’s fees resulting from the legal consequences of substance abuse.
  • Tolerance for the drug of choice, needing higher and higher doses.
  • The addict continues to take prescription medication long past the doctor’s orders.
  • The addict may refuse to talk about his use of drugs or alcohol. He may also hide his consumption from friends and loved ones.

What Is Mental Illness

Mental illness refers to a range of mental health conditions that affect a person’s mood, thinking and behavior. Mental illness includes disorders like depression, anxiety and schizophrenia. The symptoms often affect a person’s ability to function. People with mental health issues may have trouble handling responsibilities at home, work or school.

What Are Co-Occurring Disorders

An estimated 7.9 million men and women in the U.S. have co-occurring disorders. They have one or more mental health issues and struggle with substance abuse. For example, someone with anxiety may use alcohol to help him calm down. He might be unable to function without a few drinks. Likewise, someone with depression may seek out cocaine to lift the fog of sadness.

It’s difficult to say which came first, the mental health issues or the substance abuse problems. Every patient is different. Childhood trauma may cause Post-Traumatic Stress Disorder (PTSD). That may then drive a person to self-medicate with drugs and alcohol.

In other cases, experimentation with drugs and alcohol can cause mental health problems. This is especially true in children and teenagers. Toxic chemicals can alter their mental state and development.  The longer a person uses alcohol or drugs, the more significant the changes to the brain are.

Diagnosing Co-Occurring Disorders

They can be extremely difficult to diagnose. Symptoms of substance abuse can mask symptoms of mental illness. Symptoms of mental illness can be confused with symptoms of addiction.

That’s why it’s so important for a patient to be evaluated for both as part of his treatment and rehabilitation. If a mental illness is contributing to a person’s addiction, treating the addiction only deals with half the problem.

For example, someone with schizophrenia who is treated for drug abuse is still a schizophrenic, albeit a sober one. Someone with PTSD caused by childhood sexual abuse may be able to stop drinking. However, without mental health treatment, his prognosis is poor.

Continuing to use alcohol or other drugs prevents the person from developing effective coping skills. It also makes therapy highly unsuccessful. Additionally,  alcohol and illegal drugs interfere with medications prescribed for mental health disorders.


Patients with either mental health issues or substance abuse problems can often choose between in-patient or out-patient treatment. It really depends on the severity of their symptoms and the length of time they’ve experienced difficulties.

However, the research is clear that patients with co-occurring disorders do significantly better with in-patient treatment at a facility with the resources to address both issues.

The National Alliance on Mental Illness (NAMI) recommends a multi-pronged approach to treatment, starting with detox. This process helps the patient get the drugs or alcohol out of his system. He is typically monitored by medical personnel for up to seven days and may be given medications to ease the effects of withdrawal.

Removing the drugs and alcohol will inevitably surface a patient’s mental health issues. That’s one reason why additional treatment is so important.

Once the patient is free of the drugs and alcohol, he may receive therapy, medication and mental health services to treat both the substance use and its underlying causes. Psychotherapy is usually a part of the treatment plan. Cognitive behavioral therapy (CBT) helps people learn how to change their patterns of thinking which may have led to substance use.

Their treatment program must address their current addictions and mental health issues. A therapist should also examine the patient’s lifestyle and living arrangements. The program should also treat any underlying health conditions they’re experiencing.

Support groups may also help a patient share frustrations, celebrate successes and even contribute recovery tips. They also provide a safe place to develop healthy friendships.

Wrapping It Up

Treating co-occurring disorders is a complicated issue, but a critical one for both the patient and his loved ones. Untreated mental illness, especially when combined with substance abuse, is quite literally a life-threatening situation.

If you would like more information about treatment options, please contact us. We can also help you start the admissions process.

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