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Co-occurring Disorders: Definition, Identification, and Treatment

Author: Thomas Roth

Last Updated: 05/12/2023

Co-occurring disorders, also referred to as dual diagnosis, is a term used when a person experiences a mental illness and a substance use disorder simultaneously. Either disorder—substance use or mental illness—can develop first. For instance, people experiencing a mental health condition may turn to alcohol or other drugs as a form of self-medication. Conversely, individuals who abuse substances over time may experience changes in brain chemistry that can lead to the development of mental health issues.

Common Co-occurring Disorders with Alcoholism

Alcoholism often co-occurs with a range of mental health disorders. Some of the most common include:

  • Depression: This is a mood disorder that causes persistent feelings of sadness and a loss of interest in activities. It can make it hard to function and enjoy life as one used to.
  • Anxiety Disorders: This group of mental health disorders, including generalized anxiety disorder, panic disorder, and social anxiety disorder, is characterized by significant worry, fear, or anxiety that can interfere with daily activities.
  • Bipolar Disorder: This disorder causes unusual shifts in mood, energy, activity levels, and the ability to carry out daily tasks.
  • Post-Traumatic Stress Disorder (PTSD): This is a disorder that can develop after a person has been through a traumatic event.
  • Schizophrenia: This is a serious mental disorder that affects how a person thinks, feels, and behaves.

Recognizing Co-occurring Disorders

Recognizing co-occurring disorders can be challenging, as the symptoms of mental health disorders can often overlap with those of alcoholism. Some common signs of co-occurring disorders include:

  • Withdrawal from friends and family
  • Sudden changes in behavior
  • Using substances under dangerous conditions
  • Engaging in risky behaviors
  • Loss of control over substance use
  • Having a high tolerance and withdrawal symptoms
  • Feeling like you need a drug to be able to function
  • Experiencing legal and financial troubles

Treatment of Co-occurring Disorders

Treating co-occurring disorders involves addressing both the substance use disorder and the mental health disorder concurrently. This is often referred to as integrated treatment. Key elements of integrated treatment include:

  • Detoxification: The first major hurdle that people with dual diagnosis have to pass is detoxification. Inpatient detoxification is generally more effective than outpatient for initial sobriety and safety.
  • Inpatient Rehabilitation: A person experiencing a mental illness and substance use disorder may need to be treated in an inpatient setting. This provides round-the-clock care for both mental health and substance use disorders.
  • Psychotherapy: Psychotherapy (also known as talk therapy) addresses psychological roots of mental illness and substance abuse.
  • Medications: Medications are often useful for treating mental illnesses and can be used alongside other forms of treatment like psychotherapy.
  • Supportive Housing: For people who are not ready to return to full independence but have completed a stay at a rehabilitation facility, supportive housing provides a supportive place to recover.
  • Co-occurring disorders are complex and require specialized treatment approaches. With comprehensive, integrated treatment, individuals with co-occurring disorders can achieve improved mental health and long-term recovery from alcoholism.

Prevalence of Co-occurring Disorders

Co-occurring disorders are quite common, affecting a significant proportion of individuals with alcoholism. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), about half of those who experience a mental illness during their lives will also experience a substance use disorder and vice versa. This underscores the need for comprehensive treatment that addresses both conditions.

Impact of Co-occurring Disorders

Co-occurring disorders can be particularly challenging because each disorder can exacerbate the symptoms of the other. For example, a mental health issue like depression might lead to increased alcohol consumption, and in turn, excessive alcohol use can worsen depressive symptoms. This can create a vicious cycle that can be difficult to break without professional help.

Furthermore, individuals with co-occurring disorders often face higher rates of additional physical health problems, legal issues, homelessness, and suicide compared to those with a mental or substance use disorder alone. This makes effective treatment and intervention strategies for these individuals even more critical.

What Other Treatments Are Available for Alcoholism?

Several treatment modalities are available for alcoholism. Below we list the most common alcoholism treatment options.


  • Journal of the American Medical Association (JAMA)
  • National Institute of Mental Health (NIMH)
  • Centers for Disease Control and Prevention (CDC)
  • American Journal of Psychiatry
  • Addiction Science & Clinical Practice