Medical Reviewer

Co-Occurring Disorder Treatment

Last Medical Review On: July 17, 2024
Updated On: June 15, 2024
6 min read
Written by:

Amanda Stevens, B.S.

Medical Review by:

Dr. Po-Chang Hsu, M.D., M.S.

Co-occurring disorders, also known as dual diagnosis or comorbidity, refer to the presence of both a substance use disorder and a mental health disorder at the same time.[1] This complex interaction between addiction and mental illness can significantly impact one’s overall well-being and treatment outcomes.

Understanding and addressing co-occurring disorders is essential for providing comprehensive and effective care. These conditions often exacerbate each other and require integrated treatment approaches for successful recovery.

Co-Occurring Disorders

Key Points

  • Co-occurring disorders, also known as dual diagnosis or comorbidity, occur when an individual experiences both a substance use disorder (SUD) and a mental health disorder simultaneously.
  • These conditions often interact and exacerbate each other, leading to more severe symptoms and challenging treatment outcomes.
  • Co-occurring disorders can manifest in various combinations, including substance abuse alongside mood disorders like depression or anxiety, psychotic disorders such as schizophrenia, or personality disorders like borderline personality disorder (BPD).
  • Individuals with co-occurring disorders are disproportionately more prone to SUDs compared to those without such conditions, with approximately 21.5 million adults in the United States affected by co-occurring disorders.
  • Integrated treatment approaches that consider both substance abuse and mental health needs simultaneously are essential for effectively addressing co-occurring disorders and achieving improved outcomes and long-term recovery.
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    What Is a Co-Occurring Disorder?

    A co-occurring disorder, also referred to as a dual diagnosis or comorbidity, describes the simultaneous presence of a substance use disorder (SUD) and a mental health disorder. This dual diagnosis complicates the clinical picture, as both conditions interact and influence each other, often leading to more severe symptoms and challenging treatment outcomes.[2]

    Co-occurring disorders can exist in several combinations, with common pairings including substance abuse alongside mood disorders like depression or anxiety, psychotic disorders such as schizophrenia, or personality disorders like borderline personality disorder (BPD).[3] The interplay between substance abuse and mental illness can exacerbate symptoms of both conditions, making diagnosis and treatment more complex.

    People struggling with mental illness are disproportionately more prone to SUDs compared to those without such conditions. SAMHSA’s 2022 National Survey on Drug Use and Health reported that roughly 21.5 million adults in the United States live with a co-occurring disorder.[4] Additionally, over half of individuals with co-occurring disorders do not receive any form of treatment. In contrast, a mere 9.1% receive comprehensive care addressing both their mental health and substance use issues.[5]

    Effectively addressing co-occurring disorders necessitates a holistic and integrated treatment approach that considers both substance abuse and mental health needs simultaneously. By acknowledging the interconnected nature of these conditions and providing comprehensive care tailored to individual circumstances, individuals with co-occurring disorders can achieve improved outcomes and long-term recovery.

    Common Dual Diagnosis Disorders

    Dual diagnosis, or co-occurring disorders, can encompass a wide range of combinations involving substance use disorders and mental health conditions.[6] Some of the most common dual-diagnosis disorders include:

    • Depression: Depression, characterized by persistent feelings of sadness and hopelessness, often co-occurs with substance abuse. Individuals may turn to drugs or alcohol as a means of self-medication to alleviate symptoms, leading to a worsening of both conditions.
    • Anxiety: Anxiety disorders, such as generalized anxiety disorder (GAD) or panic disorder, frequently coincide with substance abuse. Substance use may temporarily relieve anxiety symptoms but can ultimately exacerbate them over time, resulting in a cycle of dependence and heightened anxiety.
    • Bipolar disorder: Bipolar disorder involves extreme mood swings, ranging from manic highs to depressive lows. Individuals with bipolar disorder are at an increased risk of developing substance abuse issues, as they may use drugs or alcohol to self-medicate during manic or depressive episodes.
    • Schizophrenia: Schizophrenia is a severe mental illness characterized by hallucinations, delusions, and impaired thinking. Substance abuse is common among individuals with schizophrenia, as they may use drugs or alcohol in an attempt to alleviate symptoms or cope with the distress associated with their condition.
    • Post-traumatic stress disorder (PTSD): PTSD can develop following exposure to a traumatic event, and individuals with this condition often turn to substance abuse as a way to numb painful memories or cope with overwhelming emotions. Substance abuse can exacerbate PTSD symptoms and interfere with the recovery process.
    • Personality disorders: Personality disorders, such as borderline personality disorder (BPD), frequently coexist with substance abuse. Individuals with these disorders may engage in impulsive behaviors, including drug or alcohol misuse, as a way to cope with emotional dysregulation or interpersonal difficulties.

    How Are Co-Occurring Disorders Treated?

    Treating co-occurring disorders involves a multifaceted approach that considers both the substance use disorder and the mental health condition at the same time.[7] This integrated treatment model recognizes the complex interplay between substance abuse and mental illness, addressing both aspects simultaneously to promote comprehensive healing and recovery.

    Dual-diagnosis treatment programs offer specialized care for individuals with co-occurring disorders, providing services delivered by a multidisciplinary team of professionals. These programs emphasize the importance of addressing both substance abuse and mental health issues concurrently, offering integrated care that promotes lasting recovery and improved overall well-being.

    Integrated treatment plans are key to effectively managing co-occurring disorders.[8] These plans are tailored to each individual’s unique needs and circumstances, incorporating evidence-based practices for both substance abuse and mental health treatment. By integrating therapeutic interventions and support services, individuals receive holistic care that addresses both conditions’ root causes and consequences.

    Medical detoxification may be necessary for individuals with severe substance use disorders to manage withdrawal symptoms and stabilize their physical health safely. Under medical supervision, detoxification aims to alleviate discomfort and minimize health risks associated with withdrawal, paving the way for ongoing treatment and recovery efforts.

    Therapy and counseling play a vital role in dual diagnosis treatment, allowing individuals to explore underlying issues, develop coping skills, and address maladaptive thought patterns and behaviors. Individual, group, and family therapy sessions provide a supportive environment for processing emotions, learning effective communication strategies, and building a strong support network.

    Continuing care and aftercare are essential components of the recovery process for individuals with co-occurring disorders. Ongoing support, including outpatient therapy, support group meetings, and regular follow-up appointments with healthcare providers, helps individuals maintain progress and navigate challenges as they transition back to their daily lives.

    By addressing both substance abuse and mental health issues simultaneously, individuals with co-occurring disorders can achieve improved outcomes and a higher quality of life.

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    Alpas Wellness Co-Occurring Disorder Treatments

    Everyone deserves to receive compassionate, personalized care that addresses both their substance use disorder and mental health needs holistically. At Alpas Wellness, we’re committed to providing comprehensive dual-diagnosis treatment programs that integrate evidence-based therapies and comprehensive care to promote lasting recovery and overall well-being.

    Co-Occurring Disorders Treatment Levels of Care

    Dual-diagnosis treatment centers typically offer a range of care settings tailored to meet your specific needs:

    • Medical Detoxification (Detox): Detoxification, often known as detox, involves the intentional removal of harmful substances like drugs or alcohol from the body. It is usually carried out under careful supervision in medical facilities or specialized detox centers. The primary goal of detox is to safely manage the physical symptoms of withdrawal, preparing individuals for the next phases of treatment and rehabilitation.
    • Medically Managed Care: Medically managed care combines medical expertise with therapy to offer comprehensive support to patients during their recovery journey. This level of care involves continuous monitoring by medical professionals who tailor treatments and collaborate closely with other team members. This integrated approach promotes holistic healing and supports long-term well-being by addressing patients’ physical and psychological aspects of their conditions.
    • Inpatient Residential Treatment: Inpatient treatment, also known as residential treatment, involves individuals residing within a facility for their care. This level of care is suitable for severe addiction or mental health concerns requiring intensive, round-the-clock attention. Patients engage in various therapeutic activities, including individual and group therapy, and receive medical and psychiatric assistance. The structured environment supports focused recovery, with program durations ranging from weeks to months based on individual needs and progress.

    Therapies Used in Co-Occurring Disorders Treatment

    Alpas offers our clients several evidence-based approaches to treat co-occurring mental health and substance use issues:

    • Cognitive Behavioral Therapy (CBT): Cognitive Behavioral Therapy (CBT) is frequently utilized to address negative thought patterns and behaviors linked with mental health disorders such as depression and addiction. In collaborative sessions with a therapist, individuals learn to challenge distorted thinking, develop coping strategies, and manage cravings effectively. This empowering method fosters insight into thought processes and behavior patterns, empowering individuals to make positive changes and achieve lasting recovery.
    • Dialectical Behavior Therapy (DBT): Dialectical Behavior Therapy (DBT) integrates mindfulness, acceptance, and behavior change strategies within a cognitive-behavioral framework. Originally designed for borderline personality disorder (BPD), DBT has expanded to address a range of mental health issues, including addiction. It emphasizes acquiring skills in emotion regulation, interpersonal effectiveness, and distress tolerance. Therapists utilize a combination of individual sessions, group training, coaching, and assignments to provide individuals with coping mechanisms and promote emotional stability throughout treatment.
    • Motivational Interviewing (MI): Motivational Interviewing (MI) centers on boosting motivation for behavior change. Therapists facilitate collaborative discussions, demonstrating empathy and employing reflective listening techniques to help individuals align their actions with their aspirations. MI empowers individuals by reinforcing their readiness and commitment to making significant life changes.
    • Contingency Management: Contingency management is a therapeutic approach that utilizes rewards to encourage desired behaviors, such as maintaining sobriety. Individuals receive rewards for achieving treatment milestones, such as attending sessions or passing drug tests. These incentives, including vouchers or prizes, enhance motivation and encourage adherence to treatment objectives.
    • Motivational Enhancement Therapy (MET): MET, or Motivational Enhancement Therapy, is a counseling approach to boost motivation and commitment to behavior change. MET helps individuals clarify their values and goals through structured conversations and feedback, addressing uncertainties about altering behaviors. By instilling confidence in their ability to change, MET emphasizes internal motivation for positive transformation, focusing on personal drive rather than delving into the root causes of addiction.
    • Experiential Therapy: Experiential therapy employs interactive activities to stimulate emotional processing and promote personal growth. Departing from traditional talk therapy, it integrates hands-on approaches like role-playing and art therapy. Through these activities, individuals can express emotions and cultivate coping skills within a supportive environment that addresses the body, mind, and spirit, fostering profound personal transformation.
    • Relapse Prevention: Relapse prevention is a crucial component of the recovery journey, helping individuals identify triggers, develop coping strategies, and create plans to avoid relapse. In this therapy, participants gain insight into warning signs such as stress and emotional triggers while acquiring skills to manage them effectively. By fostering self-awareness and providing practical tools, relapse prevention therapy addresses the root causes of addictive behaviors, promoting long-term sobriety.
    • Twelve-Step Facilitation: Twelve-step facilitation plays a pivotal role in addiction recovery by guiding individuals through programs like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). These programs foster community and accountability through group meetings, step work, and peer support. By actively participating in these programs, individuals can establish and sustain sobriety while gaining valuable tools for long-term recovery.

    At our Alpas Wellness detox centers in Maryland, our approach integrates both proven methods and innovative techniques for treating substance use disorder. We are here to assist you in achieving balance and pursuing a holistic path to recovery.

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    Frequently Asked Questions About Co-Occurring Disorder Treatment


    What are the signs and symptoms of co-occurring disorders?


    Signs and symptoms of co-occurring disorders can vary widely but may include mood swings, changes in behavior, social withdrawal, difficulty concentrating, problems with memory or cognition, sudden changes in weight or appetite, insomnia or oversleeping, increased sensitivity to sensory stimuli, and recurring thoughts of suicide or self-harm.


    What is integrated treatment, and why is it important for co-occurring disorders?


    Integrated treatment is a comprehensive approach that addresses both substance use disorders and mental health conditions simultaneously. It recognizes the interconnected nature of these issues and aims to provide holistic care that considers the unique needs of each individual. Integrated treatment often involves a multidisciplinary team of professionals working collaboratively to develop and implement personalized treatment plans that incorporate evidence-based practices for both substance abuse and mental health treatment.


    How long does treatment for co-occurring disorders typically last?


    The duration of treatment for co-occurring disorders can vary depending on individual needs and circumstances. Some individuals may benefit from short-term intensive treatment programs, while others may require longer-term care with ongoing support and monitoring. Treatment plans are typically tailored to each individual’s specific needs and may include a combination of therapy, medication management, support groups, and other interventions.


    How can family members support a loved one with co-occurring disorders?


    Family members can play a crucial role in supporting a loved one with co-occurring disorders by providing emotional support, encouragement, and understanding. They can also help facilitate access to treatment and encourage participation in therapy and support groups. Educating themselves about co-occurring disorders and effective ways to communicate and offer support can help family members provide the best possible care for their loved ones.


    What steps can individuals take to prevent relapse after completing treatment for co-occurring disorders?


    Preventing relapse after completing treatment for co-occurring disorders often involves ongoing support, monitoring, and the implementation of coping strategies learned during treatment. This may include continued participation in therapy or support groups, practicing healthy lifestyle habits, avoiding triggers or high-risk situations, and developing a relapse prevention plan with the help of healthcare professionals. Regular communication with treatment providers and a commitment to maintaining sobriety and mental wellness are also important aspects of relapse prevention.


    [1] National Institute of Mental Health. (2023). Substance use and co-occurring mental disorders. National Institute of Mental Health. on April 9, 2024

    [2] SAMHSA. (2023, February 7). Mental health and substance use co-occurring disorders. on April 9, 2024

    [3] Bethesda. (2020). Common Comorbidities with Substance Use Disorders Research Report. In PubMed. National Institutes on Drug Abuse (US). on April 9, 2024

    [4] SAMHSA. (2023, July 26). Co-Occurring disorders and other health conditions. on April 9, 2024

    [5] National Institute on Drug Abuse. (2018, August 15). Comorbidity: Substance Use and Other Mental Disorders. National Institute on Drug Abuse. on April 9, 2024

    [6] SAMHSA. (2023, July 26). Co-Occurring disorders and other health conditions. on April 9, 2024

    [7] National Institute on Drug Abuse. (2020, April). What are the treatments for comorbid substance use disorder and mental health conditions? National Institute on Drug Abuse. on April 9, 2024

    [8] U.S. Department of Health and Human Services. (2009). Building Your Program Integrated Treatment for Co-Occurring Disorders. on April 9, 2024

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