Co-Occurring Disorders: What They Are and How to Seek Treatment

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Co-occurring disorders, often called dual diagnosis, refers to the individual who is diagnosed with both a mental health disorder and a substance use disorder. The highest incidence of co-occurring disorders is comorbid substance use and depression. To further complicate care, depression is frequently accompanied by anxiety. It is estimated that more than 65% of individuals with substance use disorders also suffer from a mood disorder.

It is well known that individuals with major depressive disorder are at risk for suicide. The risk increases greatly with a comorbid substance use disorder. Left untreated one will worsen or exacerbate the other creating a destructive cycle that impacts the individual and the family.

For some individuals substance abuse becomes a way to temporarily relieve depression. For others depression is the result of the addiction. Overlapping symptoms make diagnosis challenging as well as complicate care. The shame and guilt that are hallmarks of a substance use disorder easily translate to isolation, hopelessness and poor motivation, and symptoms of depression. As both disorders take hold, one fuels the other. Controversy continues about which came first. Without treatment, the suffering and destruction will continue. Early identification, assessment and appropriate care are critical to successful treatment.

Many clients receiving treatment for their addiction also have previous treatment experience for one or more mental health disorders with varying degrees of severity. Those individuals often seek treatment with unresolved or worsening symptoms, non-compliance with prescribed medication as well as premature discontinuation of medications due to lack of efficacy and/or side effects.

They are demoralized by a system that fails to provide adequate care. These issues often result in a hopelessness that lends itself to an ongoing cycle of low self-esteem and substance relapse.  Sadly, the client loses trust in those providing care.   

The individual with co-occurring symptoms often faces significant barriers to treatment. A contributing factor is the lack of integrated treatment. Treatment often occurs in silos further isolating the client.  Long standing philosophies of treatment stand in the way of integrated care. How do we as providers begin to mitigate these barriers? In SAMSHA’s brief, "Overarching Principles to Address the Needs of Persons with Co-occurring Disorders," the challenges and impact of co-occurring disorders are acknowledged and clear recommendations provided.  The recommendations include an integrated system of care that may be accessed at multiple entry points. There is ‘no wrong door’ or one right clinical model. Integrated care that addresses recovery from addiction and mental health disorders serves to bridge existing gaps.

  As providers we bridge those gaps when we meet the client where they are and deliver individualized care that meets their needs and preferences. 

The key to successfully integrated treatment for co-occurring individuals needs to begin with a comprehensive biopsychosocial assessment.  The assessment should ideally be conducted by clinicians both trained and credentialed in mental health and substance use disorders.  This initial assessment serves to identify the individual’s needs and preferences based on their co-occurring diagnoses which helps create the pathway to treatment.  Once the client feels that they’re individual needs are being acknowledged and considered in the treatment planning, they become more engaged and invested in their personal recovery.  This treatment pathway includes individual, family and group therapy using multiple modalities such as Cognitive Behavioral Therapy, Motivational Enhancement Therapy, Twelve Step work, and education around mental health needs.  These evidence-based approaches create an integrated holistic model to best address the needs of the co-occurring client. 

The framework for this treatment process is within a multidisciplinary team that functions as one on behalf of the client.  The treatment team partners with the client and their family to encompass all experiences of the family system. The client’s voice is heard and the family’s perspective is acknowledged, both of which are integral to creating an individualized plan of care. This enables trust to be re-established with optimism, and belief in the possibility of recovery.  It is vital to address both the complex needs of the client and their family, making it possible to meet the needs of those with co-occurring disorders.


Onimette, Paige.  "Co-Occurring Mental Health and Substance Abuse Disorders."  Washington State University Spokane.  The Washington Institute for Mental Illness Research and Training.  Accessed:  July 29, 2015.

"Overarching Principles to Address the Needs of Persons With Co-Occurring Disorders."  Substance Abuse and Mental Health Services Association.  U.S. Department of Health and Human Services.  Published:  2006.  Accessed:  July 29, 2015.

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