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What Is a Co-Occurring Treatment Program?

About 10 million people in the U.S. live with co-occurring disorders. Co-occurring disorders can be treated with integrated recovery treatment plans.

Co-Occurring Disorders

People diagnosed with a substance use disorder (an addiction or dependence on drugs or alcohol) may also be struggling with an additional psychiatric issue. This is referred to as having co-occurring disorders.

 
Having two or more mental health disorders simultaneously is sometimes referred to as “dual disorders.” The terms are often used interchangeably.


A substance use disorder (SUD) is itself a mental disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Having a SUD affects an individual’s ability to control their behavior regarding prescribed or illegal drugs and alcohol.
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Living with both substance use disorders and mental disorders is common. The National Institute of Mental Health reports that about half of those who experience a SUD also experience a co-occurring mental disorder.
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Introduction to Co-Occurring Disorders

Common Risk Factors of Both Suds and Other Mental Health Disorders

Though co-occurring conditions are common, it should not be assumed that one issue causes the other, though one may contribute to the other.

 
For example, people with anxiety and mood disorders may self-medicate their symptoms with drugs or alcohol. Using substances as a treatment for co-occurring disorders ultimately makes both conditions worse.

 
Genetics and environmental stressors such as trauma are the two major risk factors for developing a SUD or other mental health disorder. In addition, drug or alcohol use can alter brain chemistry, increasing the risk of developing a mental health disorder.

 
The two conditions are closely linked and treating one problem without treating the other makes long-term sobriety nearly impossible.


Admitting to a substance use disorder is difficult and comes with a social stigma. Being diagnosed with a mental health disorder is also challenging and can be stigmatizing.

 
Don’t let shame or a lack of understanding stop you from getting the support you need to improve your mental health and quality of life. Start by contacting a dual-diagnosis treatment center for more information.

What Are the Signs and Symptoms of Co-Occurring Disorders?

Noticing signs of a mental health disorder in someone actively abusing drugs or alcohol can be difficult because many symptoms overlap. Symptoms of a substance disorder can easily mask the symptoms of mental illness and vice versa.

 
This is one reason why some people don’t seek treatment for co-occurring disorders — they assume all their mental health issues are caused by addiction, or they don’t see the relevance in seeking help if they are not ready to address their SUD.


Seeing someone you love in the grip of a substance use disorder means you have witnessed their mood swings, erratic behavior, and retreat from family relationships. It may be almost impossible to recognize the warning signs of co-occurring conditions amidst that chaos.

Indicators of Co-Occurring Disorders

To make it even more challenging, the symptoms of a mental health problem vary according to which mental disorder a person has. However, the general signs to be aware of include:

  • Extreme emotion
  • Unusual aggression
  • Unusual thoughts or behaviors
  • Retreating from relationships
  • Loss of control over substance use
  • Higher tolerance for a drug
  • Thinking and focusing difficulties
  •  Feeling sad, depressed
  • Unusual changes in eating habits
  • Trouble relating to people and situations
  • Fatigue, problems sleeping
  • Excessive fears and worries
  • Extreme feelings of guilt
  • Changes in sex drive or risky sexual behavior

Physical Manifestations of Co-Occurring Disorders

Symptoms of a co-occurring disorder can also manifest as physical health problems. Complaints of back pain, headaches, stomach pain, or other aches and pains are common. A dual-diagnosis treatment center has experienced medical experts who care for psychiatric and physical symptoms.

 
Suicidal thoughts and behaviors are also signs of a mental health problem. If you or someone you know has suicidal thoughts or behaviors, get help immediately. Call 911, contact your mental health specialist, or call the National Suicide Prevention Lifeline.
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Dual Diagnosis vs. Co-Occurring Disorders — What Are the Differences? 

The terms “dual diagnosis” and “co-occurring disorders” are used interchangeably and mean almost the same thing. Comparing the two is somewhat like comparing red apples to green apples.


Dual diagnosis is a broad term. It can refer to having more than one mental health disorder, more than one physical health problem, or a combination of mental health and physical health issues.

Examples of Dual Diagnosis Include

Dual diagnosis can present itself in a variety of different forms. Often, people use the dangerous practice of self-medication to cope with physical or mental challenges in their lives. Examples of dual diagnosis include:

  • Opioid use disorder and anxiety disorder
  • Heart disease and cancer
  • Migraines and alcohol use disorder

Dealing With Dual Diagnosis

Examples of Co-Occurring Disorders

Co-occurring disorders are specifically two or more mental health disorders. Examples of co-occurring disorders are:

  • Substance use disorder and borderline personality disorder
  • Depression, post-traumatic stress disorder, and alcohol use disorder

Disorders may be related, such as depression and chronic pain, or unrelated, like cancer and bipolar disorder.

Methods for Diagnosis

Knowing it can be difficult to separate related disorders and distinguish the primary issue, healthcare professionals approach diagnosis with patience and knowledge. Factors that are considered during diagnosis include:

  • Family history — genetics play a major role in developing mental health disorders
  • Examining symptoms when a person has completed substance withdrawal and is sober
  • Examining the relationship between mental health and substance/alcohol use
  • Review treatment history — addiction treatment may be unsuccessful if mental health issues are not addressed, and vice versa

In some ways, it’s easier to diagnose physical disease or injury. X-rays, MRIs, and other diagnostic testing give doctors a clear picture of what’s going on inside the body.

Technologies and Tactics for Diagnosis

Brain scans, genetic testing, and other technologies are becoming more common for diagnosing mental illness. However, in many cases, mental health professionals must still refer to the criteria provided in diagnostic manuals.


Unfortunately, an accurate diagnosis is only possible for many people once symptoms have become severe enough to affect a person's life negatively.

What Are Some of the Most Common Co-Occurring Disorders?

Almost everyone struggles with feelings of depression, anxiety, or extreme emotions at some time in their lives. Sometimes speaking with a professional is helpful when mental health concerns arise. However, temporary life issues are not the same as mental illness.


The Mayo Clinic defines mental illness as experiencing ongoing symptoms that affect a person’s ability to function.
4 Some of the most common co-occurring disorders are discussed below.

Anxiety Disorder

Anxiety disorders may include social anxiety disorder, generalized anxiety disorder, separation anxiety disorder, panic disorder, specific phobias, etc. It's not uncommon to have more than one type of anxiety disorder at a time.


Symptoms of an anxiety disorder include:

  • Feeling nervous and restless
  • Sweating
  • Difficulty controlling worry or negative thoughts
  • Avoiding people or situations that may trigger anxiety
  • Increased heart rate

Anxiety disorders sometimes have a medical cause. Issues such as heart disease, chronic pain, or irritable bowel syndrome may be the root of anxiety that becomes chronic.

Substance Use Disorder

According to the National Center for Drug Use Statistics, approximately 15 million Americans have an alcohol use disorder, and 8.1 million have a drug use disorder.5


Symptoms of a SUD include:

  • Intense urges or cravings for the substance
  • Needing more frequent doses to get the desired effects
  • Continuing to use the substance even when it causes problems in your life or physical/psychological harm
  • Taking risks or illegal actions, such as stealing, to get drugs

Not being able to stop drug or alcohol use even though a person wants to is a common sign that their body is becoming dependent on a substance. Frequent drug or alcohol use alters brain chemistry, causing the brain to become dependent on the substance to function.

Bipolar Disorder

Bipolar disorder is characterized by episodes of mood swings that occur several times a year or once every few years. Sufferers experience highs — known as mania or hypomania — and depressive lows. There are several types of bipolar disorder, including bipolar I, bipolar II, and cyclothymic disorder.


Bipolar disorder can develop at any age, but it's commonly diagnosed during teens or early 20s. Bipolar disorder is a lifelong condition, but it can be managed with medication.

Schizophrenia

Schizophrenia may cause delusions, hallucinations, disordered thinking, and difficulty interpreting reality. It's a severe mental health disorder, but early treatment may help manage symptoms and prevent complications.

 
People with schizophrenia frequently lack full awareness of their condition. It often falls on friends and family members to seek medical attention on their behalf.

Schizophrenia Fundamentals

Schizoaffective Disorder

Schizoaffective disorder combines schizophrenia symptoms and mood disorder symptoms, such as mania or depression. There are two types of schizoaffective disorder.

 
Bipolar type includes episodes of mania and may also include bouts of major depression. People with the depressive type of schizoaffective disorder experience major depressive episodes but not episodes of mania.

Post-Traumatic Stress Disorder

The National Center for PTSD estimates that seven or eight out of every 100 people will experience symptoms of post-traumatic stress disorder at some point.5 Women are at higher risk for developing PTSD.


PTSD is a condition triggered by witnessing or experiencing a terrifying event. Victims of violence and sexual assault, combat survivors, and civilians who have lived in a war zone are at risk of developing PTSD. This mental health disorder can also affect people whose loved one has gone through a traumatic event.

Symptoms of PTSD 

Symptoms of PTSD include:

  • Intrusive memories
  • Avoiding the places or people who remind you of the triggering event
  • Trying to avoid thinking or speaking about the event
  • Feeling emotionally numb, removed
  • Feeling hopeless
  • Having negative thoughts about yourself or others
  • A lack of interest in activities and hobbies you used to enjoy
  • Irritability, anger
  • Guilt or shame
  • Trouble sleeping
  • Being easily startled/frightened
  • Suicidal thoughts

PTSD symptoms don’t go away on their own. They tend to intensify over time.

Eating Disorders

Eating disorders are mental health issues that revolve around food, eating, body image, and weight. It’s estimated that in the U.S. alone, 20 million women and 10 million men will develop an eating disorder at some point in their life.6

Most Common Eating Disorders

The most known eating disorders are:

  • Anorexia nervosa: characterized by very restricted eating and a relentless desire to be thin, even when being underweight is causing health problems
  • Bulimia nervosa: characterized by cycles of restricted eating and binge eating followed by purging
  • Binge eating disorder: characterized by eating large amounts of food in a short time

Eating disorders can lead to dangerous and even deadly health problems if left untreated.

Personality Disorders

People with personality disorders exhibit inflexible and unhealthy patterns of behaving and thinking. They may have trouble relating to others or functioning normally in social situations, work, or school.

Types of Personality Disorders

There are several types of personality disorders organized into three clusters.


Cluster A disorders include:

  • Paranoid personality disorder
  • Schizoid personality disorder
  • Schizotypal personality disorder

Cluster B disorders include:

  • Antisocial personality disorder
  • Borderline personality disorder
  • Histrionic personality disorder
  • Narcissistic personality disorder

Cluster C disorders include:

  • Avoidant personality disorder
  • Dependent personality disorder
  • Obsessive-compulsive personality disorders

It may be difficult for a person to realize they have a personality disorder because it’s natural to believe your way of thinking and seeing the world is “right.” People with personality disorders often blame others or “the world” when things don’t go their way.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a long-lasting mental health issue in which an individual cannot control reoccurring thoughts or behaviors. The urge to repeat gestures, habits, or words over and over can interfere with personal relationships, school, work, and social activities.

Different Signs of OCD

Signs of OCD include:

  • Excessive cleaning or hand washing
  • Compulsive counting
  • Unwanted thoughts involving harm
  • Fear of contamination
  • Tic disorder

Everyone occasionally worries or focuses on troubling thoughts from time to time. People with OCD typically cannot control their thoughts and spend one hour or more a day dwelling on intrusive thoughts or acting out their habitual rituals.

Treatment for Co-Occurring Disorders

Integrated therapy is a therapeutic method for treating individuals with co-occurring disorders. Unlike early forms of addiction treatment focused on detox and sobriety, integrated treatment for co-occurring disorders should consider the whole person.

 
Integrated treatment simultaneously addresses both mental health and substance use disorders. This lowers the cost and gives individuals the best chance of a positive outcome.


The Substance Abuse and Mental Health Services Association recommends integrated treatment for co-occurring disorders. The organization has even provided a treatment toolkit for healthcare providers.
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Co-occurring conditions are not separate experiences happening to one person. They are connected experiences — each triggering and potentially worsening the other. Both disorders (or as many disorders as are present) are addressed simultaneously using an integrated approach.

Types of Therapy to Treat Co-Occurring Disorders

The types of therapy recommended in an integrative treatment plan might include:

  • Cognitive-behavioral therapy
  • Dialectical behavior therapy
  • Life skills training
  • Medication
  • Residential care
  • Hypnotherapy
  • Music therapy
  • Group therapy

Additional Therapy Options

Other therapies may also be available according to the individual's needs and personal interests.


Integrative therapy is an effective, evidence-based treatment for co-occurring disorders. It has been shown to improve self-esteem, reduce the stress of living with a mental health disorder, improve personal relationships, and empower individuals to manage their behaviors more effectively.

Learn More with Boardwalk Recovery Center

The caring team at Boardwalk Recovery Center in Pacific Beach, CA, understands that recovery can be difficult, especially for people coping with co-occurring conditions. We provide assertive community treatment, including several innovative therapies that help our clients learn how to focus on solutions.


Our clinical team offers a variety of psychotherapies and interventions that are effective in an integrated recovery plan. Those therapy options include Acceptance and Commitment Therapy, Solution-Focused Brief Therapy, Mindfulness and Grounding Practices, and Cognitive-Behavioral Therapy.


The Boardwalk Recovery Center staff is committed to your recovery success. In addition to treatment programs for opiate addiction, alcohol addiction, meth addiction, and suboxone abuse, we also offer treatment for co-occurring disorders.

 
We stand by our clients through every step of their recovery process. We offer the support and guidance you need to change your life and meet your personal wellness goals from detox to aftercare.


If you or someone you know is living with co-occurring disorders, call Boardwalk Recovery Center. We understand the courage it takes to make that first step, and we'll work hard to help you achieve lasting recovery.

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