Co-Occurring Disorders: Substance Abuse & Mental Health

Many people who struggle with a substance use disorder also struggle with a mental health disorder at the same time. In 2017, 20.3 million adults in the United States had a substance use disorder and 37.9% also had a mental health disorder.1 Additionally, among the 42.1 million adults with a diagnosed mental illness, 18.1% also met the criteria for a substance use disorder.1
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Co-Occurring Disorders

What Are Co-Occurring Disorders?

Woman in withdrawal

Co-occurring disorders refer to the simultaneous presence of both a mental health and a substance use disorder. Comorbidity, another term used in reference to co-occurring disorders, refers to the interaction between mental health and substance use disorders that can exacerbate the progression of both disorders.2 It is important to note that not everyone who is diagnosed with a mental health disorder will develop a substance use disorder and vice versa.

While the co-occurrence of mental health and substance use disorders is common, it doesn’t mean that one caused the other.3 However, they can influence one another. For example, studies have shown that individuals with certain mental health disorders (such as anxiety and depression) may be more likely to use substances as a way to self-medicate and cope with the symptoms of the mental illness they are experiencing.3 Furthermore, substance use can change the structure and function of the brain, which can increase a person’s risk of developing a mental health disorder.3

Certain mental health and substance use disorders occur more commonly with one another. Common co-occurring disorders include:3


How Are Co-Occurring Disorders Diagnosed?

A licensed medical or mental health professional can diagnose a co-occurring disorder. A formal evaluation by a professional is conducted to determine the presence of a mental health and substance use disorder; each type of disorder will be addressed and evaluated.3

Assessment tools are available to help in diagnosing a co-occurring disorder. Determining the presence of co-occurring disorders can be difficult, but comprehensive tools can help reduce the risk of misdiagnosis and to provide appropriate treatment options.3

Signs & Symptoms of Co-Occurring Disorders

In order to be diagnosed with a co-occurring disorder, you must meet the criteria for both a mental health disorder and a substance use disorder. Therefore, it can be beneficial to know the signs and symptoms of common mental health disorders as well as signs of a substance use disorder. Let’s look at some signs and symptoms of substance use disorders and common mental health conditions.

Depression—Symptoms of depression usually begin between 15–30 years old and can include:4

  • Fatigue or loss of energy.
  • Feeling down or sad.
  • Anhedonia, or loss of pleasure in previously enjoyed activities.
  • Problems falling or staying asleep.
  • Thoughts of suicide or death.
  • Feelings of worthlessness.

Anxiety—Generalized anxiety involves chronic feelings of dread as well as:5

  • Feelings of fatigue.
  • Feelings of restlessness or on edge.
  • Difficulty falling or staying asleep.
  • Body aches, including stomach aches, muscle aches, and unexplained pain.
  • Problems falling or staying asleep.

Post-traumatic stress disorder (PTSD)—PTSD symptoms usually present within 3 months after a traumatic, life threatening  event and can include:6

  • Avoidance of situations, people, and circumstances that remind you of the trauma.
  • Having flashbacks of the trauma and re-experiencing the trauma.
  • Avoiding thoughts and feelings about the event.
  • Experiencing angry outbursts and irritability.
  • Feeling on edge or tense.
  • Feeling blame or guilt.
  • Memory problems related to the event.

Bipolar disorder—There are 3 different types of bipolar disorder, however, all 3 types involve distinct changes in energy, mood, and activity levels and can also include:7

  • Feelings of irritability.
  • Feelings of elation.
  • High energy levels.
  • Feelings of hopelessness.
  • Feeling down.
  • Feelings of indifference.

Substance use disorder—Symptoms can present as behavioral, social, and/or physical and can include:8

  • Taking drugs or alcohol in larger amounts or for longer than was originally planned.
  • Experiencing cravings.
  • Continued substance use in situations that are physically hazardous.
  • A desire to stop misusing substances, but being unsuccessful at attempts to do so.
  • Giving up important social, occupational, or recreational activities due to substance use.
  • A need to regularly increase amounts of the substance being used to achieve the desired effect (known as “tolerance”).

Commonly misused substances include alcohol, cocaine, benzodiazepines, opioids, sleep medications and amphetamines/methamphetamine.



What Causes Co-Occurring Disorders?

Woman thinking

While there is no “cause” for co-occurring disorders, there are risk factors that can contribute to their development. Risk factors include:3

  • Genetics—Your genes can make you more vulnerable to developing substance use disorders and/or mental health disorders.
  • Environmental factors—This can include experiencing chronic stress and trauma due to one’s living, working, or learning environment.
  • Family history—Having a family history of mental health and substance use disorders can make you more vulnerable to developing a co-occurring disorder.
  • Mental health disorders—Having an underlying mental illness can increase your risk for substance use disorders due to self-medicating as a means of coping.
  • Substance use disorders—Substances can change the structure and functioning of the brain which can lead to the development of a mental health disorder.3

How to Treat Co-Occurring Disorders

People attending a alcoholic recovery group after leaving treatment

It is recommended to treat both mental health and substance use disorders simultaneously.4 Many substance use disorder and addiction treatment facilities offer specialized programs for co-occurring disorders.

AdCare offers a variety of co-occurring disorder treatments, including detox, inpatient, and long-term residential rehab.

Learn more about what to expect in inpatient rehab, explore outpatient rehab programs, and find out how to help a family member get into addiction treatment.

Call AdCare at to start addiction treatment and get admitted today. Admissions navigators can help determine your insurance coverage for addiction treatment and answer any questions you may have about treatment. You can also instantly check if your insurance covers rehab at AdCare with our .

Help for co-occurring disorders is available to you. Let AdCare help you along your path of recovery.

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