Understanding Co-Occurring Disorders: When Mental Health and Substance Use Intersect
In the world of mental health and substance use disorder treatment, few challenges are as complex—and as critical to address—as co-occurring disorders. Also known as dual diagnosis, co-occurring disorders refer to the presence of both a mental health disorder and a substance use disorder in the same individual. For people navigating these overlapping conditions, life can feel overwhelming and unmanageable, often leading to cycles of relapse, emotional distress, and difficulty maintaining stability in everyday life.
At Silver Lining, we understand the intricacies of co-occurring disorders and the importance of compassionate, integrated care. In this post, we’ll explore what co-occurring disorders are, why they develop, common combinations, signs to watch for, and how specialized treatment can support long-term recovery and healing.
What Are Co-Occurring Disorders?
Co-occurring disorders occur when a person experiences both a mental health disorder—such as depression, anxiety, PTSD, or bipolar disorder—and a substance use disorder, like an alcohol or opioid substance use disorder. These conditions interact in complex ways, often exacerbating one another.
For example, someone struggling with untreated PTSD might turn to alcohol to numb their symptoms, eventually developing an alcohol use disorder. On the flip side, chronic substance use can alter brain chemistry and behavior, potentially triggering or worsening mental health conditions.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly 1 in 4 adults with a mental illness also has a substance use disorder. Despite this high prevalence, co-occurring disorders often go undiagnosed or undertreated, particularly when providers focus on just one part of the equation.
Common Co-Occurring Disorders
Co-occurring disorders can take many forms. Some of the most frequently seen combinations include:
Depression and Alcohol Use Disorder: Individuals may use alcohol as a way to manage persistent sadness or numb emotional pain.
Anxiety Disorders and Benzodiazepine Use Disorder: People living with generalized anxiety, panic disorder, or social anxiety may misuse anti-anxiety medications like Xanax or Valium.
PTSD and Substance Use Disorders: Trauma survivors may turn to substances to avoid intrusive memories, flashbacks, or hypervigilance.
Bipolar Disorder and Substance Use: During manic or depressive episodes, people with bipolar disorder may use drugs or alcohol to regulate their mood or energy levels.
ADHD and a Stimulant use disorder: Some individuals with undiagnosed or untreated ADHD may misuse stimulants to improve focus or energy.
These combinations are not exhaustive, but they illustrate how mental health and substance use can feed into one another, creating a cycle that can be difficult to break without comprehensive support.
Why Do Co-Occurring Disorders Develop?
There is no single cause for co-occurring disorders. Instead, they typically result from a mix of biological, psychological, and environmental factors:
Genetics: Family history of mental illness or addiction can increase vulnerability.
Brain Chemistry: Mental health and substance use both involve neurotransmitter imbalances that can reinforce one another.
Trauma and Stress: Childhood adversity, trauma, or ongoing stress can set the stage for both mental health issues and substance use.
Early Exposure to Substances: Using drugs or alcohol at a young age may increase the risk of developing both a substance use disorder and mental health problems.
Lack of Access to Mental Health Care: Untreated mental illness can lead individuals to self-medicate with substances, increasing the likelihood of substance use disorders.
It’s also important to note that stigma around both mental illness and substance use disorders can prevent people from seeking help, which allows symptoms to worsen over time.
Signs and Symptoms of Co-Occurring Disorders
Co-occurring disorders can look different depending on the individual, the disorders involved, and the severity of symptoms. However, common red flags include:
Using drugs or alcohol to cope with distressing emotions, trauma, or mental health symptoms
Difficulty maintaining responsibilities at work, school, or home
Frequent mood swings, irritability, or feelings of hopelessness
Isolating from family and friends
Increased tolerance to substances and withdrawal symptoms when not using
Trouble sleeping, concentrating, or regulating emotions
Engaging in risky behaviors while under the influence
Previous treatment for either addiction or mental health issues without lasting improvement
If these signs sound familiar, it’s important to know you’re not alone—and effective treatment is available.
The Importance of Integrated Treatment
Historically, mental health and substance use were treated separately. Someone might go to rehab for a substance use disorder without any attention to their underlying anxiety, or they might receive therapy for depression while continuing to use substances. This fragmented approach often led to incomplete recovery, higher relapse rates, and continued suffering.
Today, best practices emphasize integrated, holistic care that addresses both disorders at the same time. At our practice, we believe in the power of collaborative, person-centered treatment that meets clients where they are.
An integrated treatment plan for co-occurring disorders may include:
Comprehensive assessment to diagnose both mental health and substance use disorders
Individual therapy using evidence-based approaches like CBT, DBT, or EMDR
Medication management when appropriate, in coordination with prescribing professionals
Group therapy for peer support and skill-building
Psychoeducation to increase understanding of how the disorders interact
Family involvement to strengthen support systems and address relational dynamics
Relapse prevention planning that includes mental health triggers and substance use risks
Support for underlying trauma, which is often at the root of both conditions
Recovery Is Possible
While co-occurring disorders present unique challenges, they are also highly treatable with the right support. Recovery does not mean the absence of all symptoms—it means building a life with tools, awareness, and resilience to manage those symptoms in healthy ways.
People with co-occurring disorders can go on to thrive in their relationships, careers, and communities. Many find renewed purpose in their lives as they begin healing not just from addiction or mental illness, but from the shame, disconnection, and isolation that so often accompany them.
The journey may not be linear, and setbacks can happen—but with a strong therapeutic alliance, evidence-based care, and a personalized approach, healing is possible.
How We Can Help
At our private mental health practice, we specialize in working with individuals facing the complexities of co-occurring disorders. We understand how frustrating it can be to feel stuck in a cycle of emotional pain and substance use, and we’re here to help you make sense of your experiences in a nonjudgmental, supportive environment.
Whether you’re newly seeking help or have been in treatment before, we’re committed to walking alongside you with care, compassion, and clinical expertise. Our goal is to help you build insight, strengthen your coping skills, and move toward meaningful recovery—on your terms.
Final Thoughts
Co-occurring disorders can be confusing, overwhelming, and difficult to navigate alone. But you don’t have to figure it out by yourself. If you or someone you love is struggling with both a mental health issue and substance use, reach out. The path to healing begins with a single, courageous step.
Let us support you in moving forward—one step at a time.
Interested in learning more or scheduling an appointment? Contact us today to find out how our practice can support your recovery journey. Click on the "Start Today" button below, complete the google form, and we will be in touch shortly. We look forward to talking with you!