Co-Occurring Disorders: Explaining Mental Health and Addiction

Comorbidity refers to the condition where an individual is diagnosed with more than one type of medical condition or psychological disorder.1 Also implied is that these illnesses interact with one another and affect each other. One such pairing of disorders is that of a specific mental health disorder (a psychological or psychiatric disorder) and a comorbid diagnosis of a substance use disorder (substance misuse or addiction). When clinicians encounter this, they use the term co-occurring disorders.2 Read on to learn about various co-occurring disorders and how to find effective treatment for them.
Did you know most health insurance plans cover addiction and co-occurring disorder treatment?
Prevalence of Co-Occurring Disorders

How Common Are Co-Occurring Disorders?

Sometimes also referred to as a dual diagnosis, co-occurring disorders are highly prevalent. Statistics from the National Institute on Drug Abuse (NIDA) and Substance Abuse and Mental Health Services Administration (SAMSHA) indicate the following regarding co-occurring disorders:3,4,5

  • 17 million people (6.7%) had both a mental illness and a substance use disorder (SUD) in 2020.
  • 5.7 million people (2.2%) had a serious mental illness (one that results in serious, life-limiting functional impairment) and an SUD in 2020.
  • Approximately half of those who experience a mental illness will also experience a substance use disorder at some point in their lives, and vice versa.
  • About 1 in 4 people living with a severe mental illness (SMI), such as bipolar disorder, schizophrenia, major depression, and other SMIs, also have a substance use disorder.
  • Certain socioeconomic and health factors are strongly associated with co-occurring disorders.
  • Mental health issues and addiction have a bidirectional relationship. This means each disorder can contribute to the development or worsening of the other.

Although mental health disorders and addiction frequently co-occur, it does not necessarily mean that one causes the other. There are, however, certain risk factors common to both that can contribute to both the development of mental illness and problematic substance use. These include:6

  • Genetic vulnerabilities.
  • Similarly predisposing changes in certain brain functionality.
  • Epigenetic influences (changes in the regulation of gene activity and expression).
  • Environmental factors.
  • Adverse experiences as a child and trauma.
  • Exposure to stressors.

Certain types of mental health issues may more prevalently co-occur with substance use disorders.5

Common Co-Occurring Disorders

Common Mental Health Issues That Co-Occur With Addiction

Although there are many combinations of co-occurring mental health and substance use disorders, some of the most common mental health issues that co-occur with addiction include:5

Anxiety Disorders and Addiction

Anxiety disorders are characterized by excessive worry and fear in addition to behavioral disturbances.5 Three anxiety disorders that commonly co-occur with addiction are:

  • Generalized anxiety disorder (GAD): Excessive worry and fear about a range of topics/events including work/school performance, finances, relationships, and everyday living.
  • Panic disorder: Recurring panic attacks in which individuals experience intensely distressing and debilitating symptoms including hyperventilation, dizziness, numbness/tingling, heart palpitations, and feeling as though they are going to die.
  • Social anxiety disorder (SAD): Excessive and irrational fear of attention, humiliation, and embarrassment in social situations.
  • Agoraphobia: Fear and avoidance of places or situations that could trigger a panic attack or lead to feeling panic-like symptoms.

Anxiety disorders and substance use disorders commonly co-occur and can affect the severity and outcomes of each other. Having a drug use disorder may be associated with a 1.2 to 1.3 increased odds of also having any type of anxiety disorder.5

Depression and Addiction

Depressive disorders are also highly prevalent amongst people with SUDs. Two types of depressive disorders that commonly co-occur include major depressive disorder (MDD) and persistent depressive disorder (PDD).5 Both are characterized by:

  • Excessive sadness.
  • Noticeably diminished interest in all or almost all activities.
  • Changes in weight and sleep patterns.
  • Low energy and low self-esteem.
  • Feelings of worthlessness or hopelessness.

When depression co-occurs with substance use disorders, people often experience relatively more severe mood symptoms and related functional impairment than those with depression alone.5

Bipolar I Disorder and Alcohol and Drug Use

Bipolar I disorder is a mental disorder in which an individual’s mood fluctuates between manic episodes (extreme energy, feelings of euphoria, impulsiveness, and little to no need for sleep) and depressive episodes (loss of interest in pleasurable activities, excessive sadness, and low energy).5

Of individuals with bipolar I disorder, 65% may struggle with substance use disorder at some point in their lives. The most commonly misused substance in individuals with a bipolar I disorder diagnosis is alcohol, although cannabis and other drugs are also prevalently misused. Co-occurring substance use disorders and bipolar I disorder have been found to increase symptom severity and are associated with less favorable treatment outcomes.5

Attention Deficit Disorders and Addiction

Attention-deficit/hyperactivity disorder (ADHD) is characterized by hyperactivity, an inability to control/sustain attention, or both. Individuals with ADHD may exhibit:5

  • Disorganization.
  • Restlessness.
  • Difficulty concentrating for long or short amounts of time.

Of individuals who misuse substances, roughly 23% may also have ADHD. A study conducted on more than 500 children with and without ADHD found that through adolescence and early adulthood, children with ADHD used substances earlier and their substance use escalated more quickly than children without ADHD.5

Substances commonly misused by individuals with ADHD include:5

  • Alcohol.
  • Nicotine.
  • Cannabis.
  • Cocaine.

PTSD: How It Can Affect Addiction

Post-traumatic Stress Disorder (PTSD) is a mental health condition that can develop after exposure to one or more traumatic events. Its characteristic symptoms fall into one of four categories, including:5

  • Intrusive re-experiencing of the trauma (through flashbacks, distressing memories, and nightmares).
  • Persistent avoidance of things and places that remind the individual of the trauma.
  • Negative mood and cognition.
  • Heightened arousal and reactivity.

It is estimated that 36% to 52% of individuals with PTSD also experience a substance use disorder in their lifetime. People who struggle with both PTSD and addiction often experience more cognitive difficulties, poorer social functioning, diminished treatment response and relatively worse treatment outcomes.5

Eating Disorders and Substance Use

Eating disorders that may co-occur with substance use disorders include:5

  • Anorexia nervosa: Characterized by an intense fear of weight gain and any extreme restriction or purge behaviors in connection with this fear, potentially reinforced by a distortion of body image.
  • Bulimia nervosa: A condition with two primary features—one of bingeing, or of eating larger than normal amounts of food in a discrete amount of time, and a second feature of purging, which may entail several methods to “compensate” for the periods of overeating, including laxative misuse, self-induced vomiting, extreme exercise, fasting, etc.
  • Binge eating disorder: Similar to bulimia in that individuals eat excessive amounts of food in a short amount of time, but without the purging element of bulimia.

Eating disorders may co-occur more prevalently in people with SUD than in the general population, where they are relatively rare. It is estimated that 25% of individuals with eating disorders also have a substance use disorder, with alcohol use disorders and substance use disorders involving illicit drug use being the most prevalent examples.5

Borderline or Other Personality Disorders and Drug Misuse

As a group, the personality disorders comprise several chronic mental health conditions. Though they have many distinctions between them, they all are marked by a similarly debilitating lifetime inability to develop an adaptive sense of self and to form functional relationships with others. These issues may be exemplified by problematic perceptions of themselves and others, as well as negative behaviors toward other people around them.5 Personality disorders are highly prevalent in people with SUDs. Two of the most common co-occurrences include:5

  • Borderline personality disorder (BPD): A condition characterized by pervasively unstable interpersonal relationships and may include symptoms of marked impulsivity, fear of abandonment, feelings of emptiness, and difficulty controlling intense anger.
  • Antisocial personality disorder (ASPD): A condition marked by a pervasive disregard for the needs, feelings, and rights of others and an inability to create long-term healthy relationships with others. Symptoms of ASPD may include aggression, recklessness, remorselessness, and a disregard for laws and other rules.

Estimates vary, however the prevalence of personality disorders among individuals with substance use disorders is high—varying from 35% to 65% based on different studies.5 People with co-occurring personality disorders and substance use disorders may experience:5

  • More severe symptoms for both disorders.
  • Increased rates of SUD treatment dropout.
  • An increased likelihood of developing other co-occurring disorders.
  • Higher mortality.

Schizophrenia and Other Psychotic Disorders and Addiction

Psychotic disorders affect a person’s emotional control, thinking, and perception.5 Common symptoms of psychotic disorders include:5

  • Disorganized thinking: Jumbled speech or talking about something unrelated to the topic being discussed
  • Hallucinations: Feeling, hearing, seeing, or tasting things that don’t exist
  • Delusions: Beliefs that are not grounded in reality or are impossible
  • Abnormal motor behavior: Smiling or laughing inappropriately, holding rigid body positions, talking to oneself
  • Negative symptoms: A cluster of symptoms including diminished emotional expression (e.g., flattened affect), a decline in self-motivated, purposeful activities (i.e., avolition), inability to experience pleasure (i.e., anhedonia), diminished speech, a lack of interest in social activities, etc.

Schizophrenia is the most well-known type of psychotic disorder and involves many of the above symptoms. It is estimated that individuals with severe psychotic disorders have 4 times the risk of heavy alcohol use compared to the general population. In one study, over half of the people with schizophrenia also had a substance use disorder in their lifetime.5

Treatment Options

What Are My Treatment Options for Co-Occurring Disorders?

Various treatment options are available for co-occurring disorders, however, integrated treatment that addresses both the mental health issues and the substance use disorders is widely thought to be superior to treating each diagnosis separately and, increasingly so, is becoming the standard of care in situations of SUD and other mental health disorders.7 The overall goal is to provide a comprehensive treatment approach that addresses all the needs of the individual.

Certain medications may be used as part of an integrated treatment program. Medications used are determined on a case-by-case basis and may be prescribed to assist with treatment of the substance use disorder, the mental health disorder, or in some cases, both.5

Recovery First offers various levels of addiction treatment in Florida. Our clinical team will perform an evaluation before you start the rehab admissions process  to determine which level of addiction treatment is appropriate for your needs. We offer a complete continuum of care that includes:

Patients stay in treatment for as much time as is right for them, whether that is a weekend in rehab, a month-long rehab program, or long-term addiction treatment.

Therapies used in addiction treatment at Recovery First include:

  • Cognitive-behavioral therapy (CBT).
  • Dialectical behavior therapy.
  • Process group therapy.
  • Motivational interviewing.
  • Anger management therapy.
  • Recreational therapy.
  • Art and music therapy.
  • Meditation/mindfulness therapy.

How Will I Pay for Dual Diagnosis Treatment?

Treatment for co-occurring disorders can be paid for in several ways. Many people find their health insurance covers all or part of treatment. Our inpatient rehab facility in Hollywood, FL, allows many patients to use health insurance to pay for rehab. At Recovery First, we partner with many major health insurance providers in Florida and the surrounding regions, including:

Check your insurance coverage instantly by using our safe and secure .

If you or your loved one don’t have insurance, please do not let that discourage you from seeking help. Recovery First offers alternate ways of paying for addiction treatment including financing and other flexible payment solutions.

Finding Help

How to Find Help for Co-Occurring Disorders

Help is available for people with co-occurring disorders. Recovery First, one of American Addiction Centers’ addiction treatment centers in Florida, is ready to help you overcome the disease of addiction and find long-term recovery. Admissions navigators are available 24/7 to walk you through the admissions process and help you find the right treatment center for your needs. Call us today at  to learn more about addiction treatment offerings near you.

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