Co-Occurring Disorders

Written by Melissa Carmona

& Medically Reviewed by Kate Dube, LCSW

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Last Updated - 08/24/2023

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Updated 08/24/2023

Addiction often goes hand in hand with mental health issues. When a person has two or more substance use and mental health disorders, this is called “co-occurring disorders” or “dual diagnosis.” The two disorders can begin at the same time, overlap or begin one after the other.

Co-occurring disorders are more common than you might think. Around half of the people who experience a mental health disorder have also experienced a substance use disorder (SUD) and vice versa. In addition, a 2018 national survey showed that more than 9 million people in the U.S. have a co-occurring disorder.

Many of the risk factors and symptoms of substance misuse and mental health conditions overlap and amplify each other, making treatment more complex. At The Recovery Village at Palmer Lake, we offer specialized, patient-centered treatment programs that address co-occurring disorders to support individuals in their recovery.

Identifying Co-Occurring Disorders

Co-occurring disorders sometimes arise when a person uses drugs or alcohol to manage their psychiatric symptoms. In these cases, the underlying mental health issues can go undiagnosed for years. A complete medical and psychiatric evaluation can help identify these disorders and determine the most effective course of treatment.

Potential signs of a co-occurring disorder include:

  • Avoidance of friends, family or social situations
  • A sudden change in personality or behavior
  • Frequent feelings of hopelessness, despair or worthlessness
  • Unfounded fears and suspicions
  • Obsessive or outlandish thoughts and beliefs
  • Compulsive behaviors and rituals
  • Extreme mood swings or emotional outbursts
  • Attempts at self-harm or suicide
  • Continued use of drugs or alcohol, despite the negative consequences

Mental Disorders that Co-Occur with Substance Abuse

Some of the most common co-occurring mental disorders include:

  • Mood disorders
  • Anxiety disorders
  • Attention-deficit/hyperactivity disorder (ADHD)
  • Obsessive-compulsive disorders and related conditions
  • Personality disorders
  • Psychotic disorders

Mood Disorders

Mood disorders, including depression and bipolar disorder, impact a person’s emotional state. With depression, a person often feels sad, depleted and uninterested in the things they used to enjoy. Bipolar disorder, on the other hand, involves mood swings and marked changes in energy or activity levels.

People who have co-occurring substance use and mood disorders tend to have more severe symptoms than people who have one or the other. They’ll require specialized treatment that addresses both conditions.

Anxiety Disorders

Three of the most common anxiety disorders are generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder. GAD is what many people think of when they hear the word “anxiety” and includes symptoms like ongoing excessive worry, irritability and restlessness. Panic disorder more specifically involves panic attacks, which can cause chest pain, a rapid heart rate, shortness of breath and even a detachment from reality. Social anxiety disorder is when fear of social interactions, embarrassment or being negatively judged gets in the way of someone’s ability to complete everyday tasks like going to work or school.

The co-occurrence of anxiety and substance use disorders is well established. As with other co-occurring disorders, the symptoms tend to be more severe compared to a person who has one or the other, and specialized treatment is often most effective.


Attention-deficit/hyperactivity disorder (ADHD) is an ongoing pattern of multiple symptoms that include:

Difficulty keeping attention on a particular task (e.g., careless mistakes in school or at work)

Hyperactivity (e.g., inability to sit still)

Impulsivity (e.g., blurting things out)

Research has found that children with ADHD have a higher risk for developing alcohol, nicotine, marijuana or cocaine dependence. This may be due to a decreased sense of inhibition or increased impulsivity. In addition, many of the medications used to treat ADHD are highly addictive.

Obsessive-Compulsive Disorder and Related Conditions

True to its name, obsessive-compulsive disorder (OCD) involves both recurring obsessions and compulsions. Obsessions are intrusive thoughts, while compulsions are rigid and repetitive behaviors (e.g., handwashing) or mental acts (e.g., counting) that are excessive or aimed at preventing an unwanted event in an unrealistic way.

Previously categorized as an anxiety disorder, it’s not uncommon for OCD to co-occur with substance use disorders. Similarly, post-traumatic stress disorder (PTSD), which is now categorized separately from anxiety and obsessive-compulsive disorders, also frequently co-occurs with substance use disorder.

Personality Disorders

One thing that differentiates personality disorders from other mental disorders is a lack of self-awareness that a person’s symptoms are a problem. There are three main categories and multiple types of personality disorders, though each is marked by longstanding, inflexible patterns that negatively impact a person’s life. This can include distorted thinking, dysregulated emotional responses, problems with impulse control, and difficulty with relationships.

Borderline personality disorder is one of the more commonly co-occurring personality disorders requiring specialized treatment.

Psychotic Disorders

Schizophrenia is a psychotic disorder that can show up as persistent delusions (e.g., believing you’re famous), hallucinations (e.g., hearing voices that aren’t there), incoherent speech, chaotic behavior, and a lack of emotional expression.

While schizophrenia is commonly co-diagnosed with substance use disorders, it can be hard to tease apart the symptoms, particularly if a person is experiencing drug-induced psychosis. Substance use can worsen the symptoms of schizophrenia and greatly impact a person’s capacity for treatment.

Risk Factors of Co-Occurring Disorders

Substance use and co-occurring mental disorders are complex issues that often involve a person’s brain, genetics and environment. Risk factors can stem from any of these categories and include having early caregivers with substance use or mental health conditions, experiences of abuse or neglect, neighborhood poverty, violence or lack of economic opportunity.

Early drug use or early mental health conditions are also risk factors for both substance use and other mental disorders, perhaps because decision-making and impulse control are some of the last components of brain development.

It’s important to note that having a risk factor doesn’t necessarily mean you’ll develop a mental health or substance use disorder, and not having one doesn’t mean you won’t. People of all ages, races, ethnicities, cultures, religions and socio-economic backgrounds develop co-occurring disorders.

Which Comes First?

It’s often very difficult to determine whether a substance use or co-occurring mental disorder came first. There’s no typical pathway, and it’s possible for the two disorders to co-occur without one having caused the other.

Some ideas around why SUDs and mental health disorders overlap include:

  • They share the risk factor of running in families, which suggests both genetic and environmental components to both.
  • Drugs or alcohol are sometimes used to self-medicate and cope with challenging symptoms of mental disorders.
  • Brain changes that occur with certain mental disorders can impact the reward effects of drugs or alcohol.
  • Changes in the brain that can occur with SUDs can contribute to the development of additional mental disorders.

Diagnosing Co-Occurring Disorders

Because there are so many potential combinations of co-occurring disorders, there’s no one set of diagnostic criteria to follow. In addition, the symptoms can often overlap or mask one of the conditions while the other is more pronounced. What’s important is that each condition is identified and assessed to develop a personalized treatment plan.

Dual Diagnosis Treatment

The most effective treatment for co-occurring disorders is to treat both issues at once. A treatment plan may include detoxification, therapy and medications. Group therapy, self-help groups and family counseling can also help to reinforce relationships and establish a strong social support network.

If co-occurring disorders are identified during your assessment, you’ll be provided with a dual diagnosis treatment program that could include:

  • Medications
  • Group therapy
  • Individual psychotherapy
  • Family therapy
  • Recreational activities
  • Ongoing support

Dual Diagnosis Treatment in Palmer Lake, Colorado

At The Recovery Village at Palmer Lake, we know making the decision to get help may not have been an easy one, especially if you are struggling with your mental health. Our caring team will help facilitate the admissions process to make it easier for you or your loved one to get the support you need. Contact us today to get started.


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National Alliance on Mental Illness. “Substance Use Disorders.” May 2020. Accessed September 2, 2021.

National Institute on Drug Abuse. “Common Comorbidities with Substance Use […]s and Mental Illness.” April 13, 2021. Accessed September 2, 2021.

National Institute of Mental Health. “Substance Use and Co-Occurring Mental Disorders.” March 2021. Accessed September 2, 2021.

Substance Abuse and Mental Health Services Administration (SAMHSA). “Co-Occurring Disorders and Other Health Conditions.” August 2020. Accessed September 2, 2021.

Trull, Timothy; Freeman, Lindsey; Vebares, Tayler; Choate, Alexandria; et al. “Borderline personality disorder and subs[…]s: an updated review.” Borderline Personality Disorder and Emotion Dysregulation, September 19, 2018. Accessed September 2, 2021.

Vorspan, Florence; Mehtelli, Wajdi; Dupuy, Gaël; Bloch, Vanessa; et al. “Anxiety and substance use disorders: co-[…] and clinical issues.” Current Psychiatry Reports, February 17, 2015. Accessed September 2, 2021.


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