Co-Occurring Disorders

The term co-occurring disorder replaces the terms dual disorder and dual diagnosis when referring to an individual who has a co-existing mental illness and a 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 and intellectual disability).

When a substance use disorder and a psychiatric disorder co-occur, the two disorders may differ in severity, and the severity of each disorder 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.

Symptoms

The symptoms of co-occurring disorders include those associated with the particular substance-abuse and/or mental health conditions a person has.

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.

Causes

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

People with mental health disorders are more likely to have a substance use disorder than those without them. 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.

DSM-5 notes that increased risk of alcohol use disorder, for instance, 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.

Treatment

To provide appropriate treatment for co-occuring 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 and 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 part of programs that treat co-occuring 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.

Find a Co-Occurring Disorder Treatment Center here.

 

References

  • Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
  • Office for Treatment Improvement, Alcohol, Drug Abuse, and Mental Health Administration
  • Substance Abuse and Mental Health Services Administration
  • Center for Substance Abuse Treatment
  • National Institute on Drug Abuse

Last reviewed 02/22/2019