- Approximately 9.5 million American adults have both a mental health condition and a substance use disorder
- Co-occurring disorders (dual diagnosis) require integrated treatment addressing both conditions simultaneously
- Common pairings include depression with alcohol use, anxiety with benzodiazepine use, and PTSD with opioid use
- Treating only one condition significantly increases relapse risk for both
- Integrated dual diagnosis treatment produces better outcomes than sequential or parallel treatment
- Genetic, environmental, and neurological factors contribute to co-occurrence
- Recovery is possible with comprehensive, individualized treatment plans
Published: February 2026 | Last Updated: February 2026 | Reading Time: 8 min
What Are Co-Occurring Disorders?
Co-occurring disorders, also known as dual diagnosis or comorbid conditions, refers to the simultaneous presence of a mental health disorder and a substance use disorder (or behavioral addiction) in the same individual. Rather than being separate, coincidental conditions, co-occurring disorders typically interact with and exacerbate each other in complex ways.
How Common Are Co-Occurring Disorders?
According to SAMHSA's National Survey on Drug Use and Health, approximately 9.5 million adults in the United States experience co-occurring disorders. Among individuals with substance use disorders, roughly 50% also have a diagnosable mental health condition. Among those with serious mental illness, approximately 25-30% also have a substance use disorder.
Common Co-Occurring Combinations
Depression and Alcohol Use Disorder
Depression and alcohol use frequently reinforce each other. Individuals may drink to numb depressive symptoms, while alcohol's depressant effects on the brain worsen depression over time. This is one of the most common dual diagnosis presentations.
Anxiety Disorders and Benzodiazepine/Alcohol Use
Anxiety sufferers may self-medicate with benzodiazepines or alcohol for their calming effects. Over time, dependency develops, and rebound anxiety during withdrawal creates a cycle that worsens both conditions.
PTSD and Opioid/Alcohol Use
Trauma survivors frequently use substances to manage intrusive memories, hyperarousal, and emotional numbing. Approximately 46% of individuals with PTSD also meet criteria for a substance use disorder.
ADHD and Stimulant/Cannabis Use
Individuals with untreated ADHD may self-medicate with stimulants, cannabis, or other substances. The impulsivity characteristic of ADHD also increases vulnerability to substance experimentation and addiction.
Bipolar Disorder and Substance Use
Up to 60% of individuals with bipolar disorder develop a substance use disorder at some point. Substances may be used to manage manic energy, alleviate depressive episodes, or enhance euphoric states.
Why Do Co-Occurring Disorders Develop?
Self-Medication
The most common pathway is self-medication — using substances to manage untreated or undertreated mental health symptoms. While substances may provide temporary relief, they ultimately worsen the underlying condition and create additional problems.
Shared Neurological Pathways
Mental health disorders and addiction often involve overlapping brain circuits, particularly those related to stress response, reward processing, and emotional regulation. Dysfunction in these shared systems increases vulnerability to both types of conditions.
Genetic Vulnerability
Research indicates significant genetic overlap between mental health disorders and substance use disorders. Shared genetic factors may predispose individuals to both types of conditions, particularly involving genes related to dopamine and serotonin systems.
Environmental Factors
Childhood trauma, adverse childhood experiences, chronic stress, and social determinants of health are risk factors for both mental health disorders and addiction. These shared environmental factors contribute to co-occurrence.
Why Integrated Treatment Matters
The Problem with Treating Only One Condition
Historically, mental health and addiction were treated separately — patients were told to get sober before addressing mental health, or mental health providers would not treat individuals with active substance use. This approach produces poor outcomes because untreated mental health symptoms drive relapse, and continued substance use undermines psychiatric treatment.
Integrated Treatment Approach
Evidence-based integrated treatment addresses both conditions simultaneously within the same treatment setting, with a coordinated team. This approach recognizes that recovery from either condition is unlikely without addressing both. Key elements include combined individual and group therapy, psychiatric medication management, substance use counseling, trauma-informed care, and relapse prevention for both conditions.
Treatment Components
Assessment and Diagnosis
Comprehensive evaluation identifies all co-occurring conditions, their severity, and their interactions. This often requires observation during a period of stabilization, as substance use can mask or mimic psychiatric symptoms.
Medication Management
Psychiatric medications may be essential for stabilizing mental health symptoms. Non-addictive medications are preferred, and medication management is coordinated with addiction treatment.
Evidence-Based Therapies
CBT, DBT, EMDR (for trauma), motivational interviewing, and other evidence-based approaches address both mental health and addiction components simultaneously.
Intensive Outpatient Programs
IOP provides the structure and intensity needed for dual diagnosis treatment while allowing individuals to maintain daily responsibilities. Programs typically include 3-5 sessions per week with both mental health and addiction-focused components.
FAQ
Can mental health medication be prescribed during addiction treatment? Yes. In fact, appropriate psychiatric medication is often essential for successful recovery from co-occurring disorders. Non-addictive alternatives are available for most psychiatric conditions, and medication management is coordinated with addiction treatment.
Which should be treated first — addiction or mental health? Neither. Evidence strongly supports integrated treatment that addresses both conditions simultaneously. Treating one while ignoring the other significantly increases the risk of relapse for both.
How do I know if I have co-occurring disorders? If you struggle with substance use and also experience persistent mental health symptoms (depression, anxiety, mood swings, trauma responses), a comprehensive evaluation by a dual diagnosis specialist can determine whether co-occurring disorders are present.
Is recovery possible with co-occurring disorders? Yes. While dual diagnosis can complicate treatment, integrated programs that address both conditions produce strong recovery outcomes. Many individuals achieve lasting recovery from both their mental health condition and their addiction.
References
- SAMHSA. (2023). Key Substance Use and Mental Health Indicators in the United States: Results from the National Survey on Drug Use and Health.
- Kelly, T. M., & Daley, D. C. (2013). Integrated treatment of substance use and psychiatric disorders. Social Work in Public Health, 28(3-4), 388-406.
- Mueser, K. T., et al. (2003). Integrated treatment for dual disorders: A guide to effective practice. Guilford Press.
Written by the Valley Spring Recovery Center Editorial Team
Ready to take the first step toward recovery? Contact Valley Spring Recovery Center today at (201) 781-8812 or reach out to our admissions team for a confidential consultation.