Co-Occurring Disorders

Co-occurring disorder refers to having a co-existing mental illness and substance use disorder. While commonly used to refer to the combination of substance use and mental disorders, the term can also refer to other combinations of disorders, such as a mental disorder and an intellectual disability. 

When a substance use disorder and a psychiatric disorder co-occur, they may differ in severity, and the severity of each can change over time. Compared to individuals who have a single disorder, those with a combination of disorders may experience more severe medical and mental health challenges and may also require longer periods of treatment.

Which develops first: addiction or mental illness?

There are many pathways to developing a co-occurring disorder.

Sometimes individuals with mental illness turn to drugs or alcohol to self-medicate their anxiety, depression, or PTSD, which can then turn into an addiction. For others, chronic substance use and the problems that follow may lead to depression, anxiety, and other conditions. Both disorders can also exist without causing the other, due to underlying genetic or environmental factors.

Treatment

The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends an integrated treatment approach to provide appropriate treatment for co-occurring disorders. Integrated treatment involves coordinating substance abuse and mental health interventions, rather than treating each disorder separately without consideration for the other. Integrated treatment often involves forms of behavioral treatment, such as cognitive-behavioral therapy or dialectical behavior therapy, that can help improve coping skills and reduce maladaptive behaviors. These may be used in combination with medication. Treatment may also entail collaboration between clinicians and organizations that offer support in handling issues related to housing, health, and work.