Dual Diagnosis: What Is a Co-Occurring Disorder?


Dual Diagnosis: What Is a Co-Occurring Disorder?

Approximately 50% of people who experience a mental health condition will also experience a problem with drugs or alcohol. With this realization, we thought it wise to look more into ‘Dual Diagnosis: What Is a Co-Occurring Disorder?’  

When addiction and a mental health disorder occur together, it’s called co-occurring disorder. People suffering from co-occurring disorders need a different approach than traditional programs.

Co-occurring disorders need a treatment program that addresses both conditions together. Without an integrated approach to treatment, the condition that persists will hinder recovery.

Keep reading to learn more about this mental health diagnosis. Choosing the right treatment means knowing where to look for help.

What Is A Co-Occurring Disorder?

A co-occurring disorder is when a substance use disorder and a mental health disorder exist at the same time. It’s also known as dual disorders or a dual diagnosis.

The term applies to any combination of addiction and mental health disorder. For example, depression and alcoholism or anxiety and prescription pill addiction. It could also mean posttraumatic stress disorder and gambling.

Co-occurring disorders put an individual at a higher risk for some problems. These include relapses, financial problems, and family problems, and social isolation. Other problems include incarceration, serious medical illness, and sexual and physical victimization.

Understanding Substance Abuse Disorder

Substance abuse disorder can range from mild to severe. It can involve any number of drugs as well as alcohol.

Addiction is a disease that involves alcohol or drug abuse. Sometimes, but not always, it also involves dependence.

Drug and alcohol abuse is the use of a substance to the point that it interferes with life. This includes relationships, work, and school.

Dependence is more severe than abuse. Dependence is when a person is unable to abstain from or control their use of substances.

Drugs and alcohol change your brain chemistry over a prolonged period of use. Over time, this can lead to physiological dependence.

This is why someone with an alcohol or drug dependence experiences withdrawal symptoms. And withdrawal symptoms can be a deterrent to getting and staying clean.

Understanding Mental Health Conditions

Every year, 54 million people in the US suffer from a mental health condition. With over 200 types of mental illness, the specifics of each are wide and varied.

Every mental health condition has its own range of symptoms. And symptoms affect individuals in different ways.

For example, many people experience periods of depression and anxiety. The problem occurs when these symptoms impact daily life and relationships. At the point, it may indicate a mental health condition.

Some mental health conditions are more common in co-occurring diagnoses than others. Mental illnesses commonly found in co-occurring disorder are depression and anxiety. But they can also include bipolar disorder and schizophrenia.

What Comes First?

It’s not always possible to tell what disorder was first. The fact is that both disorders have a compounding effect on one another.

The disorders exacerbate the symptoms of each other. This makes it very difficult to tell what symptoms are caused by what disorder.

Causes of Co-Occurring Disorders

Mental health conditions and substance abuse disorders share common causes. The development of these conditions is usually a combination of the following factors.


Brain chemistry varies between individuals. Some people’s brain chemistry is more prone to developing addictions. Changes in the chemical makeup and function of the brain can be caused by many things. This includes injury, early childhood exposure, prenatal development, and many other things.


Not having a supportive community can affect your tendency towards drugs. Having easy access to drugs and alcohol also makes you a higher risk for drug use. And a home permissive of drug and alcohol use is also a factor in addiction and mental health.


Trauma can be caused by physical, emotional, and sexual abuse. It can also be caused by personal experiences during a natural disaster or in a war. Even exposure to trauma can have a devastating effect on one’s mental health.

These experiences may lead to a condition like PTSD or anxiety disorder. But they can also cause a person to cope with negative thoughts by turning to drugs and alcohol.


If you have a relative that struggles with mental health or addiction, you have a higher likelihood of developing one yourself.

Risk Factors of Co-Occurring Disorders

There are some factors that put you at a higher risk of developing a co-occurring disorder. These include:

  • Having one or more mental illnesses
  • Being newly diagnosed with a mental illness
  • Not receiving adequate treatment for a mental illness
  • Recent traumatic experience(s)
  • Prolonged or untreated substance abuse

Addiction and mental health don’t discriminate on social status, race, occupation, or gender. They can affect anybody at any time in life.

Symptoms of Co-Occurring Disorders

There are significant variations in the symptoms of a co-occurring disorder. The symptoms depend on the mental health condition involved. It also involves the type of substance and degree of abuse.

Some symptoms of a co-occurring disorder are as follows:

  • Financial trouble
  • Legal trouble
  • Instability in employment
  • Instability in housing
  • Social isolation
  • Sexual deviance (including prostitution)
  • Aggression and violent behavior
  • Unexplained shifts in mood
  • Poor personal hygiene
  • Health problems
  • Noncompliance

Suicidal thoughts are a common symptom for people suffering from co-occurring disorders. For that reason alone, seeking immediate help after receiving this diagnosis is crucial.

Diagnosing a Co-Occurring Disorder

The symptoms of mental health overlap with the symptoms of substance use disorders. This makes it difficult to identify which condition caused the other. This can also make co-occurring disorder difficult to diagnose.

But two key factors help a medical professional diagnose the co-occurring disorder. These symptoms make themselves present during treatment.

One symptom is a mental health condition that worsens while receiving treatment. If treatment isn’t working, the problem might be that there’s a co-occurring disorder.

People who have mental health disorders sometimes use substances to self-medicate. Self-medicating brings relief for their symptoms.

While receiving treatment for the mental health condition, they’re unable to take substances. When you take away the substance, their mental health symptoms become more pronounced

Another sign of a co-occurring disorder is substance abuse treatment that doesn’t help. When someone with a co-occurring disorder gets clean, their mental health condition persists.

Without addressing the underlying mental health condition, they’ll find it difficult to stay sober as those symptoms persist.

Co-Occurring Disorders Treatment

Mental health disorder and addiction problems used to be treated as separate issues. But we’ve learned more about co-occurring disorders.

Today we know that treating the conditions separately doesn’t have much success. Treating the mental health condition will not automatically improve the substance use disorder. The same can be said for the other way around.

Instead, treatment for co-occurring disorders requires one, integrated treatment plan. An integrated treatment plan means coordinating both the substance use program and mental health intervention.

This integrated approach to treatment should begin while an individual is detoxing. Following detox, an inpatient or residential rehabilitation program should be attended.

This gives the individual a chance to address both conditions without the influence of drugs and alcohol. It also provides a safe and structured environment. There, they can begin therapy and building life skills.

Treatment programs specializing in co-occurring disorders will typically offer similar schedules. This includes group sessions, family therapy, and individual therapy.

In individual therapy, patients will use behavioral treatments such as cognitive behavioral therapy. These therapies help the patient to understand and change their behaviors.

Because of the mental health condition, many programs also offer pharmacotherapy. This involves using medication to treat the underlying mental health condition.

Co-occurring disorders need different treatment than single-diagnosis. Typically, that means longer and more intense treatment.

The combination of disorders means that there is more to understand. There are more behaviors to manage and the patient needs to learn coping tools for both conditions.

It also means that co-occurring disorders require a comprehensive aftercare program to support the patient in their real world circumstances.

The Right Diagnosis and Treatment

A co-occurring disorder involves substance abuse disorder and a mental health disorder. These two conditions exist at the same time, and they exacerbate one another. Meaning they make the symptoms of each worse than they would be on their own.

Because they’re intertwined, there’s no way to tell which caused the other. Regardless of which came first, they must be treated at the same time. Treating one and not the other doesn’t work.

These disorders need an integrated approach to treatment. But only specialized facilities have the resources for this type of treatment.If you or a loved one has been diagnosed with a co-occurring disorder, we have the tools and resources you need to get help. Contact us for more information.