Verified by 
Key points
- Co-occurring disorder is when a person has both a substance use disorder and a mental illness.
- It is proving to be more effective to treat these disorders concurrently and in a completely integrated way.
- Increased awareness in the addiction treatment field is helping patients with co-occurring disorder get better.
The great news right off the bat: We’re discovering better ways to treat people with co-occurring disorder, which is when a person has both a substance use disorder (SUD) and a mental illness.
That’s an especially welcome development as nearly 10 million adults in the U.S. have a co-occurring disorder or dual diagnosis. That includes 30% to 60% of people living with SUD.
The evolving treatment for co-occurring disorder
Co-occurring disorder has been around for a long time, but we just didn’t recognize it. Now we do, and the treatment for it is improving. Up until a few decades ago, SUD and mental illness were usually treated separately. When I worked with veterans in the VA hospital system years ago, for example, we would first help them quit their substance use, then turn to address their PTSD or other mental illness.
Now we treat these disorders concurrently right from the get-go, in a completely integrated way. This is proving to be more effective. Thus, when people go into rehab for SUD treatment, they normally start treatment for their mental illness (if needed) as soon as they get through detox.
What took us so long?
This is one of those times in medicine and addiction treatment when you think: why didn’t we figure this out sooner? Of course it makes sense to tackle these two health conditions concurrently.
What it took was seeing certain patients relapse quickly after leaving treatment. It didn’t make clinical sense, and it made all of us in the addiction treatment field look harder at the treatment protocols we were using. Eventually we realized we were getting people sober for the short-term, but we weren’t solving for the co-existing mental illness that was in many cases causing or exacerbating the SUD—and causing people to relapse.
That’s when we realized we had to start looking at this challenge more holistically during treatment. The results continue to validate this new thinking, as long-term prognoses are improving.
What comes first, the substance abuse or the mental illness?
The classic chicken versus egg question! The answer is similarly complicated. Many times, and this may be the most common scenario with co-occurring disorders, someone with a mental illness will self-medicate with drugs and/or alcohol as a way to deal with their depression, trauma, or anxiety disorder. At which point they’re off and running with their dual diagnosis/co-occurring disorder.
Other times, a person’s chronic substance use can lead to things like depression, mood or eating disorders, and even psychosis or schizophrenia. Which, again, simply means that he or she needs to be treated in an integrated manner. Regardless of the path a person takes to the co-occurring disorder, there’s always hope, and there’s always a path forward to long-term sobriety and mental health.
Screening has become SOP now
The addiction treatment field is now at the point where we screen incoming patients for mental illness right away. That’s standard operating procedure at most centers—certainly the good ones. (Note: If you, a loved one, or a friend seeks addiction treatment, always ask about a facility’s ability to screen for and treat co-occurring disorders.) To screen people for depression, for example, we use the PHQ-9 test protocol. For anxiety disorder, it’s the GAD-7 test. And so on.
Tailored treatment for co-occurring disorders
As for the treatment that then needs to happen, many addiction treatment centers now have specialists on staff whose training is in various mental illnesses. At the very least, existing staff therapists and M.D.s receive supplemental training in mental illness so they can recognize symptoms, tailor their treatment programs, and handle the integrated treatment requirements. For SUD patients with PTSD, for instance, they get what’s called “trauma-informed care.”
At the addiction treatment center where I work, all staff—from therapists to nurses to cooks to the maintenance team—receive awareness training that helps them recognize and deal with various types of mental illness.
All of this looks like progress to me. The heightened awareness throughout the addiction treatment field is a key part of helping patients with co-occurring disorder get better.
