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What are Co-Occurring Disorders

The term co-occurring disorder refers to the condition in which an individual has 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 also refers to other combinations of disorders, such 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.


The symptoms of co-occurring disorders include those associated with the particular substance-abuse and/or mental health conditions affecting an individual. People with co-occurring disorders are at high risk for many additional problems such as symptomatic relapses, hospitalizations, financial problems, social isolation, family problems, homelessness, sexual and physical victimization, incarceration, and serious medical illnesses.


Mental health and substance use disorders result from a combination of factors. Certain people have a high genetic risk for such disorders, but one’s environment can also contribute to the risk.

People with mental health disorders are more likely to have a substance use disorder than those who do not. Roughly half of individuals who have either a mental illness or a substance use disorder will have the other at some point in their lives, according to the National Institute on Drug Abuse.

According to the DSM-5, an increased risk of alcohol use disorder, for example, is associated with conditions including bipolar disorders, schizophrenia, and antisocial personality disorder, and alcohol use disorder may also be related to certain anxiety and depressive disorders. Other substance-related disorders also commonly co-occur with distinct psychiatric conditions. As in the case of opioid use disorder and depressive disorders, it is possible that a substance use problem leads to the development of other mental health challenges or that it worsens a preexisting disorder.


To provide appropriate treatment for co-occurring disorders, the Substance Abuse and Mental Health Services Administration (SAMHSA) recommends an integrated treatment approach. 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 a collaboration between clinicians and organizations that offer support to handle issues related to housing, health, and work.

As a part of programs that treat co-occurring disorders, psychoeducational classes can help increase awareness of the symptoms of disorders and the relationship between mental disorders and substance abuse. Relapse-prevention education can help clients become aware of cues that make them more likely to abuse substances and help them develop alternative responses.

Dual-recovery groups located on treatment sites or offsite can also play a role in recovery by offering a supportive forum for the discussion of psychiatric symptoms, medication, substance-related impulses, and coping strategies.


Psychology Today

The BreakAway Approach

Co-occurring disorder occurs when an individual is affected by both chemical dependency and an emotional or psychiatric illness. A person’s ability to function effectively physically, socially, and psychologically can be impaired when either or both illnesses have not been addressed properly. Co-Occurring disorders may affect other co-occurring disorders. Each disorder may predispose a relapse in the other disease. Overlap and masking of either illness creates difficulty in diagnosis and treatment. Additionally, many people have symptoms of mood disorders that may in fact lead to self-medicating with pills, street drugs, and alcohol. Traditionally, programs that treat individuals with substance abuse problems do no treat an individual’s mental disorders and programs for mental disorders do not treat their substance abuse. The SAMSHSA has stated that “People with dual disorders have a much better chance of recovery from both disorders when they receive combined, or integrate mental health and substance abuse treatment from the same clinician or treatment team.”

BreakAway’s Outpatient Program for Co-Occurring is an integral approach to treating clients with substance abuse and co-morbid psychiatric disorders. A multidisciplinary treatment team of a psychiatrist, nurse, consulting psychologist, PsyD, forensic counselor, certified alcohol and drug counselors. Psychiatrist and Marriage and Family Therapists address the issues involved with overlap and masking of symptoms created with a client dealing with Co-Occurring disorders. BreakAway sees that a client’s affliction, be it mental or substance use, is a family issue. It is crucial that the family and/or significant other (when applicable) participate in the treatment process. Along with help of the client and family members, a structured and individualized treatment plan is designed. An individual’s treatment program is divided into 3 phases. Each phase is integrally designed to focus on the level at which the client is able to assimilate the concepts of the substance abuse and mental disorder. The criteria of each phase is based on the client’s knowledge and understanding of their physical, social, mental and emotional well being, coupled with their recovery.

BreakAway’s Co-Occurring disorder treatment is an individualized program that focuses on the following topics and subjects to assist an individual in recovery and to understand their behavior and mental disorder:

  • Risk factors associated with mental health and addiction
  • Psychosocial stressors
  • Identifying the behaviors of self medicating to deal with mental health issues
  • Patterns of substance abuse related to mental disorders
  • Recognizing and confronting denial
  • Codependency and enabling
  • Development of coping skills
  • Understanding powerlessness
  • Impact of family dynamics
  • Interactions between psychiatric illness and substance abuse
  • Develop or find a higher power to help with addiction
  • Self Image/Self Esteem
  • Empowerment process
  • Taking responsibility and accountability for their disorder and/or substance use