Co-Occuring Disorders and Dual Diagnosis Care

If you searched for “co-occuring”, you are probably trying to put words to something that feels complicated: addiction symptoms and mental health symptoms showing up at the same time. That can be scary, confusing, and exhausting for the person going through it and for anyone trying to help.

First, a quick clarity point: the most common spelling in medical and treatment settings is co-occurring (with two r’s). But many people type co-occuring and mean the same thing. In addiction care, it usually refers to co-occurring disorders, also called dual diagnosis – when a substance use disorder (SUD) and a mental health condition happen together and influence each other.

This guide explains what “co-occuring” typically means, what signs to look for, why co-occurring conditions are common, and what effective treatment usually includes.

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What does co-occuring mean in addiction and mental health?

Co-occuring means two conditions are happening at the same time in the same person. In behavioral healthcare, the phrase most often describes:

• A substance use disorder (alcohol, opioids, stimulants, benzodiazepines, cannabis, or other drugs)
• A mental health disorder (such as depression, anxiety disorders, PTSD, bipolar disorder, schizophrenia-spectrum disorders, or others)

You might also see these terms:

• Co-occurring disorders – commonly used in treatment programs and public health
• Dual diagnosis – often used to specifically mean mental illness plus substance use disorder
• Comorbidity – a broader medical term for more than one condition occurring together (mental and/or physical)

Why wording matters, but help matters more

Some people worry they have to “get the term right” before reaching out. You do not. If you are seeing mental health symptoms and substance use overlap, that is enough to ask for a screening and support.

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How common are co-occurring disorders?

Co-occurring mental health and substance use concerns are not rare. They are one of the most common realities in addiction treatment.

According to the 2023 National Survey on Drug Use and Health (released by SAMHSA), around 20.4 million adults in the U.S. experienced both a substance use disorder and a mental illness in the past year (often referred to as “co-occurring disorders” or “any mental illness with SUD”). Source: SAMHSA, NSDUH 2023 detailed tables and national release materials.

This number matters for one big reason: if you are dealing with both, you are not “too complicated” or “the only one.” Many evidence-based programs are built specifically for dual diagnosis and integrated treatment.

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Why co-occuring issues happen so often

There is no single cause. Co-occurring disorders can develop in different ways, and sometimes it is hard to tell which came first.

1) Self-medication

People may use substances to cope with:

• panic or constant anxiety
• depression, numbness, or grief
• trauma symptoms like nightmares and hypervigilance
• sleep problems
• racing thoughts or emotional overwhelm

Substances can feel like “relief” in the moment, even when they worsen symptoms later.

2) Substance-induced mental health symptoms

Alcohol and drugs can trigger or amplify mental health symptoms, especially during intoxication and withdrawal. Examples include:

• depression after heavy alcohol use (and for a deeper look at how alcohol can affect thinking and behavior, see do drunk people tell the truth?)
• panic during stimulant use or stimulant withdrawal (related: cocaine addiction symptoms and when to get help)
• paranoia or hallucinations tied to certain substances or severe sleep deprivation
• mood swings related to intoxication cycles

3) Shared risk factors

Some risk factors raise the likelihood of both SUD and mental health disorders, including:

• genetics and family history
• adverse childhood experiences and trauma
• chronic stress and discrimination
• unstable housing or unemployment
• lack of access to consistent healthcare

4) One condition can keep the other going

Untreated mental health symptoms can increase relapse risk, and active substance use can make therapy, medication adherence, and daily routines much harder. This is why treating “only one side” often leads to a cycle of partial improvement and setbacks.

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Signs of co-occuring disorders

Not everyone with a substance use disorder has a separate mental health diagnosis, and not everyone with a mental health condition has addiction. Still, some patterns strongly suggest a co-occurring situation.

Mental health signs that may show up alongside substance use

• persistent sadness, emptiness, or loss of interest
• intense anxiety, panic attacks, or constant fear
• PTSD symptoms: nightmares, flashbacks, avoidance, feeling “on edge”
• extreme mood swings (very high energy or irritability, then a crash)
• paranoia, hallucinations, or feeling disconnected from reality
• irritability, rage, or emotional numbness
• sleep problems that do not improve even when trying to cut back

Substance use disorder signs

• using more than intended or for longer than intended
• cravings or urges that feel hard to resist
• withdrawal symptoms when stopping or reducing use
• tolerance (needing more to feel the same effect)
• continuing to use despite consequences (health, work, legal, relationships)
• repeated attempts to quit that do not last
• spending significant time using, recovering, or obtaining substances

A common clue: symptoms spike when you try to stop

If cutting back leads to a sharp increase in anxiety, depression, agitation, or insomnia, a few things may be happening at once:

• withdrawal effects
• a mental health condition that was being masked
• both withdrawal and underlying mental health symptoms

This is exactly where professional assessment and integrated treatment can make a difference.

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Common co-occurring mental health conditions

Co-occurring disorders can include many diagnoses, but these are frequently seen in dual diagnosis care:

• Depression
• Anxiety disorders (GAD, panic disorder, social anxiety)
• PTSD
• Bipolar disorder
• ADHD
• Schizophrenia-spectrum disorders
• Personality disorders (in some cases)

Physical health issues can co-occur too, like chronic pain, sleep disorders, hepatitis C, liver disease, or cardiovascular complications. These can affect which medications are safest and what level of monitoring someone needs.

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How co-occurring disorders are diagnosed

Diagnosis can be challenging, because substance use can mimic or hide mental health symptoms. A strong dual diagnosis program typically includes:

1) Screening and a full assessment

This often covers substance use history, mental health symptoms, trauma exposure, medical conditions, current medications, and safety risks.

2) Looking at timing

Clinicians may ask:

• Did symptoms exist before heavy substance use began?
• Do symptoms occur during periods of sobriety?
• Is there a family history of mood disorders, psychosis, or addiction?

3) Distinguishing substance-induced symptoms

Some symptoms improve significantly after stabilization and abstinence. Others persist and require direct mental health treatment. It is not always immediate or obvious, which is why ongoing evaluation matters.

4) Safety assessment

Good care includes screening for overdose risk, suicidal thoughts, self-harm, domestic violence, and severe psychiatric symptoms such as psychosis.

If you are seeking help, it is appropriate to ask directly: “Do you evaluate and treat co-occurring mental health conditions along with addiction?”

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Best treatment for co-occuring disorders

The most widely recommended approach for co-occurring disorders is integrated treatment – meaning the mental health condition and the substance use disorder are treated together in a coordinated plan.

What integrated treatment usually includes

• Addiction care: relapse prevention, recovery planning, and withdrawal management when needed
• Mental health care: therapy and, when appropriate, medication management
• Care coordination: providers communicate so treatment is not fragmented
• Trauma-informed practices: avoiding approaches that intensify shame or trigger trauma responses

Why treating both matters

Treating only one condition can leave the other acting like a constant “push” back toward crisis. For example:

• Untreated PTSD symptoms can create intense triggers that increase relapse risk.
• Ongoing heavy alcohol use can worsen depression and reduce the effectiveness of mental health treatment.
• Severe anxiety can make early recovery feel unbearable without coping skills and support.

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Therapies used in dual diagnosis and co-occurring treatment

Not every therapy fits every person, but many evidence-based programs draw from a combination of approaches.

CBT for addiction and mental health

Cognitive Behavioral Therapy (CBT) helps people identify patterns in thoughts and behaviors that drive substance use, depression, or anxiety. It is often used for relapse prevention and coping skills.

DBT for emotion regulation and safety

Dialectical Behavior Therapy (DBT) can be especially helpful for intense emotions, impulsivity, self-harm behaviors, and relationship instability. DBT skills like distress tolerance and emotion regulation can support recovery.

Trauma-informed therapy

For trauma-related disorders, treatment may include evidence-based trauma approaches once stabilization is in place. Many programs focus first on safety, coping skills, and substance stabilization before moving into deeper trauma processing.

Motivational interviewing

This approach helps people explore ambivalence and strengthen commitment to change without shame or confrontation.

Family support

Addiction and mental health conditions affect the entire household. Family therapy or education can improve communication, boundaries, and support planning. If a relationship is a major part of someone’s recovery story, you may also find it helpful to read about rehab for couples and how programs may support partners together.

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Medication options in co-occurring care

Medication can be part of treatment for both SUD and mental health conditions. The right plan depends on diagnosis, history, and safety considerations.

Medications for substance use disorder

• Opioid use disorder: medications such as buprenorphine, methadone, or naltrexone may be considered
• Alcohol use disorder: medications such as naltrexone, acamprosate, or disulfiram may be considered

These treatments can reduce cravings and overdose risk, and help stabilize recovery enough to engage in therapy.

Medications for mental health symptoms

Depending on the condition, treatment may include antidepressants, mood stabilizers, anti-anxiety options that are appropriate for people with SUD, or antipsychotic medications.

Important: Some medications carry misuse risk or may not be appropriate with certain substances. A provider experienced in dual diagnosis can help choose safer options and monitor side effects and interactions.

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What level of care do you need?

Co-occurring disorders can range from mild to severe. The safest and most effective level of care depends on a few key factors: withdrawal risk, suicidal thoughts, psychosis, medical stability, housing stability, and prior relapse history.

Common levels of care

• Medically supervised detox – if withdrawal from alcohol, benzodiazepines, or heavy opioid use could be unsafe
• Inpatient or residential treatment – structured environment with 24/7 support
• PHP (partial hospitalization program) – intensive daytime treatment with return home at night
• IOP (intensive outpatient program) – several sessions per week with more flexibility
• Standard outpatient therapy – ongoing counseling and medication management
• Peer support – recovery groups and community support alongside clinical care

If you are unsure where to start, a professional assessment can recommend a level of care that matches risk and needs. If you’re exploring how programs are structured, DAN also has an overview on what rehab facilities do and how they support recovery.

If you’re in California and trying to understand coverage quickly, you may also want to review how to use IEHP-covered rehab benefits or see what detox programs in Chino accept IEHP (cross-checking benefits and level of care can reduce delays).

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Questions to ask a program about co-occuring care

If you are calling a rehab, clinic, or mental health provider, these questions can help you quickly understand whether they truly offer integrated dual diagnosis services:

• Do you provide treatment for co-occurring disorders or dual diagnosis?
• How do you screen for trauma, depression, anxiety, bipolar disorder, or psychosis?
• Is there psychiatric care and medication management on-site or coordinated?
• Do addiction counselors and mental health clinicians share a treatment plan?
• How do you handle relapse, crisis situations, or suicidal thoughts?
• What does aftercare include (therapy, MAT, peer support, recovery coaching)?

If you want a practical checklist for comparing options, ADR has a helpful guide on how to choose a drug rehab center (questions to ask, red flags, and what “good fit” looks like).

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When to seek urgent help

Please seek immediate help if you or someone you love is in danger. Call 988 in the U.S. for the Suicide and Crisis Lifeline, or call local emergency services if there is immediate risk.

Urgent warning signs include:

• suicidal thoughts, a plan, or intent
• signs of overdose (slow or stopped breathing, blue lips, unresponsiveness)
• severe withdrawal symptoms (confusion, seizures, hallucinations)
• hallucinations, extreme paranoia, or inability to care for basic needs

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Key takeaway

Co-occuring usually refers to co-occurring disorders – a substance use disorder plus a mental health condition happening together. The most effective care is typically integrated treatment that addresses both conditions at the same time, with the right level of support and a realistic aftercare plan.

If you are reading this while overwhelmed or scared, try to hold onto this: needing support for both addiction and mental health is not a failure. It is a common, treatable medical situation, and the right care can make life feel manageable again.

If you’d like a gentle, skills-based way to support stress and cravings between therapy sessions, ALT offers a practical guide to meditation for addiction recovery (best used alongside clinical treatment, not as a replacement).