Mental health and substance use conditions often occur at the same time. If a person has two or more diagnoses at the same time, that person may be described as having a “dual diagnosis” or “co-occurring disorders.” It is surprisingly common for a person to suffer with both mental illness and a substance use disorder at the same time.

  • Approximately 8.9 million adults have co-occurring disorders.
  • Only 7.4 percent of patients receive treatment for both conditions, and 55.8 percent of hospital patients receive no treatment at all for these conditions.1

Co-occurring disorders may occur simultaneously (independently), or sequentially (one causing the other). When these two conditions occur at the same time, the two illnesses often interact, which affects the course and prognosis of each condition individually.2

Some mental health conditions that often co-occur with addiction diagnoses include, but are not limited to:

  • Depression
  • Anxiety disorders
  • Bipolar disorder
  • Schizophrenia
  • Post-traumatic stress disorder
  • Personality disorders

Sometimes the mental health problem occurs first. This can lead people to use alcohol or drugs that make them feel better temporarily. Sometimes the substance abuse occurs first. Over time, that can lead to emotional and mental problems.

Diagnosing Co-occurring Disorders

In order to effectively treat co-occurring disorders, we need to first recognize that drug addiction is a type of treatable physical and mental illness.2 Addiction is a complex brain disease characterized by compulsive – at times uncontrollable drug craving, seeking, and use.

Similar areas of the brain are impacted by both addiction and mental illness. So, it is not surprising that studies show a high rate of co-occurrence between drug addiction and other mental illnesses. It is often difficult to disentangle the overlapping symptoms of drug addiction and other mental illnesses, which sometimes make diagnosis and treatment more challenging.

Correct diagnosis is critical to ensure appropriate and effective recovery. Ignorance of or failure to treat a dual diagnosis can jeopardize a patient’s chance of recovery. Enhanced understanding of the common genetic, environmental, and neural bases of these disorders will lead to improved treatments for dual diagnoses and will help diminish the social stigma that makes patients reluctant to seek the treatment they need.2

Integrated Treatment Works

Integrated treatment is a comprehensive approach to wellness and recovery that addresses an individual’s co-occurring conditions in one location. A growing body of research suggests that integrated approaches to treatment will improve patient outcomes.

Although integrated care is still the exception in most treatment settings, interest in this approach is mounting, and many programs are attempting to incorporate integrated models of care.Many programs now recognize the downside of separate systems for dual diagnosis patients and have added some integrative elements into their curricula.

Integrated treatment is associated with lower costs and better outcomes, such as:

  • Reduced substance use
  • Improved psychiatric symptoms and functioning
  • Decreased hospitalization
  • Increased housing stability
  • Fewer arrests
  • Improved quality of life

The Substance Abuse and Mental Health Services Administration – a leading national authority on both addiction and mental health – advocates an integrated treatment approach for co-occurring disorders.1

Why Do Addictions Frequently Coincide with Mental Conditions?

Distraught female patient with counselorThe high prevalence of co-occurrence between substance use disorders and mental health conditions does not mean that one caused the other, even if one appeared first. In fact, establishing causality or directionality is difficult for several reasons. Diagnosis of a mental disorder may not occur until symptoms have progressed to a significant level; however, sub-clinical symptoms may also prompt drug use, and imperfect recollections of when drug use or abuse started can create confusion as to which came first.

Still, three scenarios deserve consideration when contemplating the common co-occurrence of substance use disorders and mental health conditions:

  1. Drugs of abuse can cause individuals to experience one or more symptoms of another mental health condition. The increased risk of psychosis in some marijuana abusers has been offered as evidence for this possibility.
  2. Mental conditions can lead to drug abuse. Individuals with overt, mild, or even subclinical mental disorders may abuse drugs as a form of self-medication. For example, the use of tobacco products by patients with schizophrenia is believed to lessen the symptoms of the disease and improve cognition.
  3. Both drug use disorders and mental health conditions are caused by overlapping factors, such as variations in brain structure, genetic vulnerabilities and an early exposure to stress or trauma.2

What Does Research Tell Us About Effective Dual-Diagnosis Treatment?

One study of rehab treatment patients with a co-occurring disorders found that patients in programs with specialized, integrated services were more likely to seek psychological and social support in the future, and ultimately had better mental health and substance use outcomes after six months of treatment.4

Another study found that patients who saw mental health professionals who had completed specialty training in integrated care had better health outcomes at 18 months than did those who received the usual mental health services.4

Indeed, a growing body of research suggests that an integrated, dual-diagnosis approach to treatment will likely improve the outcome for patients with coinciding conditions.With the number of co-occurring disorders on the rise, evidence – and, likewise, pressure on care providers – is mounting to more thoughtfully consider how to develop treatment solutions that are more patient-centered.2

Here at Skywood Recovery, we believe strongly in providing an integrated, dual-diagnosis approach to treatment, as may be needed by our clients. We have been recognized by more than ten federally funded studies for our highly effective strategies and results in comparison to other programs nationwide. We encourage you to carefully consider all the pertinent facts before deciding which treatment provider is worthy of your trust. Skywood Recovery not only takes the approach being shown to be most effective today, but we also have the expertise and environment that we believe will be most conducive to successful results.


1Co-occurring Disorder.” Substance Abuse and Mental Health Services Administration. 8 March 2016. Web. Accessed 28 June 2017.

2 “Comorbidity: Addiction and Other Mental Illnesses”, Research Report Series, National Institute on Drug Abuse. September 2010. Web. Accessed 28 June 2017.

3Dual Diagnosis.” MedLinePlus, U.S. National Library of Medicine. 25 March 2016. Web. Accessed 28 June 2017.

4 Sterling, Stacy, M.P.H., M.S.W., et. al., “Integrating Care for People with Co-occurring Alcohol and other Drug, Medical, and Mental Health Conditions.” National Institute on Alcohol Abuse and Alcoholism. 2011. Web. Accessed 28 June 2017.