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Co-Occurring Disorder Treatment

When it comes to substance misuse, mental health and substance use are often connected. Some people may be struggling with both a mental health disorder and substance use disorder (SUD) at the same time—often called co-occurring disorders. Co-occurring disorders involve having at least one substance use disorder in addition to at least one mental health disorder, at the same time. For example, an individual can be diagnosed with depression while also having a diagnosis of opioid use disorder.1 According to the 2020 National Survey on Drug Use and Health (NSDUH), 17.0 million people aged 18 or older reported having a co-occurring disorder.2

To address the complex nature of co-occurring disorders, many treatment programs offer a full range of integrated services to simultaneously manage both the substance use disorder and any concurrent mental health issues.1 It is important to treat both disorders at the same time so one doesn’t go left untreated, leaving the individual with a higher relapse potential. Through professional treatment for co-occurring disorders, the successful management of both an SUD and any co-occurring mental health disorders can help promote your recovery.


What are Co-Occurring Disorders?

A co-occurring disorder is marked by the coexistence of a substance use disorder and a mental health disorder. Those with co-occurring disorders have one or more mental disorders and one or more SUDs.1 There has been research that around half of the people experiencing a SUD will also experience a co-occurring mental disorder, or vice versa.3 In those with co-occurring disorders, 2 or more conditions exist at the same time or in succession, potentially exacerbating their progression.4  Though SUDs can occur together with mental illnesses, it is important to note that this does not always mean that one causes the other.4

Historically, co-occurring disorders have been called dual diagnosis or comorbidity. While it was used previously, dual diagnosis has become outdated. While comorbidity is not outdated, it is not typically used because, while not wrong in its description of the situation, it tends to be a broader concept that can be used to describe any type of pathological combination of any kinds of mental/medical health issues. Co-occurring disorders is the preferred term when referring to the existence of both an SUD and a mental health disorder.

Some co-occurring mental health disorders that may be tied to addiction include:

  • Depression: Depression is a serious but common mood disorder that can impact your emotions, behaviors, and daily routines (including eating, working, or sleeping).5 Though depression varies widely, a persistent sad, irritable, and empty mood are common features of depressive disorders.6 There are programs that address addiction and depression treatment.
  • Anxiety: Anxiety disorders are a spectrum of disorders characterized by excessive worry, worry that does not go away and can get worse with time, about a diverse range of events or things.7 A person with an anxiety disorder may find it difficult to control their worry and stress, to the point that it interferes in their work, school, relationships, or daily functioning.7 There are various programs that address addiction and anxiety disorder treatment.
  • Post-traumatic stress disorder (PTSD): PTSD is a type of trauma-and stressor-related disorder that can develop after a person experiences or witnesses a traumatic event, such as near-death, a major injury, or sexual violence.8 Additionally, people with PTSD are 2-4 times more likely to meet the criteria for an SUD than people without PTSD and individuals seeking treatment for PTSD are up to 14 times more likely to develop a substance use disorder compared to individuals without PTSD.9 Many facilities offer programs that provide addiction and PTSD treatment.
  • Attention-deficit/hyperactivity disorder (ADHD): Attention-deficit/hyperactivity (ADHD) involved an ongoing pattern of inattention and/or hyperactivity-impulsivity that inhibits development or functioning. Make sure to find out if the facility you are interested in provides addiction and ADHD treatment.
  • Bipolar disorder: Bipolar disorder is a mental disorder that causes unusual shifts in mood, energy, concentration, activity levels, and the ability to do day-to-day tasks. Those with bipolar disorder may experience intense emotions, uncharacteristic behaviors, and changes in sleep patterns and activity levels.11 Various facilities around the country provide addiction and bipolar disorder treatment.

The Relationship Between Substance Use & Mental Health Disorders

Genetic and environmental factors can contribute to the development of a substance use disorder, mental health disorder, or the co-occurrence of both. Sometimes, a mental health disorder such as depression can lead to the development of a substance use disorder, or vice versa. For example, one theoretical explanation for such co-occurrences involves an individual beginning to use drugs or alcohol to cope with their signs and symptoms of depression. This misuse of drugs or alcohol may develop into a co-occurring substance use disorder.4,12

SUDs and co-occurring mental health disorders may also be more prevalent among certain populations. For instance, 60% of adolescents in community-based treatment centers for SUDs have also been diagnosed with a co-occurring mental health disorder. Additionally, among people who experience mental illness at some point in their lives, nearly half will also experience an SUD.12

Co-occurring disorders may be bidirectional, which can make it difficult to diagnose and treat those conditions. Both disorders can influence and impact each other, and there may even be additional conditions that influences one or both disorders, including environmental factors (e.g., extreme stress or homelessness).1 It may be very difficult to figure out which disorder developed first, and even when it is possible, it may not be clear the causal relationship between the two.1


Diagnosing Co-Occurring Disorders

The bidirectional relationship between SUDs and mental disorders can make diagnosing and treating both conditions challenging.1 One of the reasons it’s difficult to diagnose the disorders is because there are often overlapping symptoms.13 Therefore, it is ideal for the diagnosis to be made while an individual does not have any drugs in their systems and is not using any drugs.14

 It is important for each disorder to be identified and evaluated at the same time so that treatment can be provided that is appropriate for each individual.13 Comprehensive assessment tolls will be used to help limit the chance of a missed diagnosis. Individuals entering treatment for mental disorders should be screened for substance use disorders, and vice versa.13 Diagnosis will likely be done at a treatment facility, by a medical professional.

Screening and assessment are key to identifying and treating individuals with co-occurring disorders. There is a multifactor, biopsychosocial, 12-step assessment process to identify symptoms and diagnoses that may be present.

While symptoms may vary based on each mental health disorder, some potential signs of a co-occurring mental health and substance use disorder may include:15,16

  • Extreme emotional highs and lows.
  • Changes in sleeping or eating habits.
  • Giving up once important activities or hobbies.
  • Regularly feeling afraid without a reason.
  • Struggling to focus or think clearly.
  • Increased irritability.
  • Isolation from friends and loved ones.
  • Participating in risky behaviors.

How to Treat Co-Occurring Disorders

According to The National Institute on Drug Abuse (NIDA), treating both substance use disorders and co-occurring mental health disorders at the same time is more effective than treating them separately.17 The simultaneous management of both substance use and mental health issues has historically been called dual diagnosis treatment, though it is now more commonly referred to as integrated treatment for co-occurring disorders.

Co-occurring disorder treatment can take place in various settings depending on the severity of a person’s condition and the level of care they need.1 Treatment usually includes a combination of medication and behavioral therapies. Examples of behavioral therapeutic approaches used to treat co-occurring disorders include :17

  • Cognitive-behavioral therapy (CBT): Designed to help individuals change their harmful beliefs and behaviors.
  • Assertive community treatment (ACT): Integrates behavioral treatments. Highly individualized and involves an assert approach for contact with the patient.
  • Dialectical Behavior Therapy (DBT): Designed to decrease self-harm behaviors (e.g., suicidal attempts/thoughts/urges, cutting, drug use).
  • Contingency management (CM) or Motivational incentives (MI): System uses vouchers or prizes to reward patients who exhibit healthy behaviors and reduce unhealthy ones.

Finding a Co-Occurring Treatment Center

If you or your loved one has decided to seek treatment and are looking for treatment centers that specialize in co-occurring disorders treatment, there are a few considerations to keep in mind. First, it’s important to determine your treatment needs. For example, will you need inpatient treatment for co-occurring disorders? Or will you be able to stick with outpatient programs? Speaking with a medical professional is one of the best ways to determine this. Once you have a general idea of the treatment you’ll need, you should begin searching for specialized co-occurring disorders treatment tracks.

Other considerations may include whether traveling out of state for treatment is a viable option. For some people, leaving home for treatment may remove them from triggers or negative influences that may be contributing to their problems. Seeking co-occurring disorder treatment programs out-of-state opens more possibilities to find specialized treatment for co-occurring disorders. To determine the best option for you, you may consider factors such as access to social and emotional support systems, treatment needs and goals, and rehab costs.


Does Insurance Cover Co-Occurring Disorder Treatment?

Insurance may be able to cover some or all your co-occurring disorders rehab treatment. However, coverage may vary depending on your needs and insurance plan. To find out if your policy covers co-occurring disorders, click here, or fill out the form below. Your information is kept 100% confidential. You can also click here to find a rehab near me.


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