Regardless of whether the addiction or the mental health condition occurs first, co-occurring disorders treatment should address both diagnoses.

It is not unusual for someone to need mental health and substance abuse counseling, as addiction and mental health conditions can occur side-by-side. When a person has both conditions, they benefit from co-occurring disorders treatment. Here, learn the facts about co-occurring disorders, including how common they are, how they develop, and how they are treated.

What Are Co-Occurring Disorders?

Co-occurring disorders exist when a person has both a mental health condition and a substance use disorder. According to the National Institute on Drug Abuse (NIDA), co-occurring disorders can interact with each other and make a person’s condition more severe. For example, addiction may be more severe and more difficult to treat among people who have a co-occurring mental health condition.  

When people have co-occurring mental illness and addiction, they may also be said to have “comorbid conditions.” In some cases, one condition may develop after the other; in other instances, they may occur right at the same time. 

Signs and Symptoms of Co-Occurring Disorders

When someone has co-occurring disorders, they will show symptoms of both mental illness and addiction. Sometimes, symptoms of the two can look similar, but keep in mind that each condition is a separate diagnosis.

While there are various mental health conditions, each of which has its own symptoms, the following general signs can point to a mental health condition:

  • Significant anxiety or fear
  • Extremely depressed or low mood
  • Ongoing anger or irritability
  • Withdrawing from friends
  • Intense mood swings
  • Having trouble interacting with other people
  • Changed sleeping habits, including sleeping more or less than usual
  • Eating more or less than usual
  • Thoughts of suicide
  • Difficulty functioning in daily life 
  • Having hallucinations (hearing or seeing things that aren’t really there) or delusions (beliefs with no basis in reality)

On the other hand, someone who has a substance use disorder, which is the clinical term for an addiction, will show the following signs and symptoms: 

  • Using larger amounts of drugs or alcohol than intended
  • Being unable to reduce consumption of drugs or alcohol
  • Using substances when it is physically dangerous, such as driving while under the influence 
  • Spending a significant amount of time using or obtaining drugs
  • Giving up other activities in favor of drug use
  • Continuing to use drugs/alcohol, even when it causes problems in relationships or inability to function at work 
  • Using drugs despite worsened physical or mental health 
  • Showing signs of tolerance, meaning larger amounts of drugs/alcohol are needed to obtain the same effects
  • Experiencing unpleasant withdrawal symptoms when not using substances 
  • Strong cravings for drugs/alcohol

When a person shows signs and symptoms of addiction, alongside common signs of mental illness, this can indicate the presence of co-occurring disorders. 

Examples of Mental Health Conditions That Co-Occur With Addiction

There are some general signs and symptoms of mental illness, but as noted above, the various mental health conditions that co-occur with addiction each have their own diagnostic criteria. Below are some conditions that may co-occur with addiction. 


Individuals with attention deficit hyperactivity disorder (ADHD) have difficulty remaining on task and staying organized, and they may show impulsive behaviors, such as fidgeting, speaking out of turn, or having trouble remaining seated. Genetic factors have been found to increase the risk of substance abuse in individuals with ADHD.

Anxiety Disorders

People with anxiety disorders don’t just have a normal level of anxiety about stressful events. Their worry and fear is excessive and begins to interfere with daily life. Among the anxiety disorders are generalized anxiety disorder, which involves exaggerated worries about daily life, and social anxiety disorder, in which people have intense fear surrounding social situations, such as interacting with other people or participating in group discussions at work or school. A person who has anxiety may use substances in order to cope with their worries and fears.

Mood Disorders

Mood disorders include depression, which is associated with symptoms like persistent feelings of sadness, difficulty concentrating, changes in sleeping and eating habits, and loss of interest in usual activities. Bipolar disorder, in which a person swings between periods of depression and periods of mania (extremely elevated mood) is also considered a mood disorder. People may self-medicate low moods with drugs or alcohol. 

Personality Disorders

Individuals who live with personality disorders have patterns of thinking and behaving that vary from what is expected, and these patterns cause significant difficulties with functioning in everyday life. For instance, people with borderline personality disorder experience intense emotions and unstable relationships, whereas those with histrionic personality disorder require constant attention and feel distressed when they are not the center of attention. Substance abuse can become a method of coping with the distress that comes with personality disorders.

Eating Disorders

People who live with eating disorders are hyper fixated on food and weight, to the extent that they have difficulty functioning in other areas of life. They may have anorexia nervosa, which involves an intense fear of gaining weight and results in extreme food restriction, or bulimia nervosa, which is characterized by cycles of binging and purging or another eating disorder. For individuals with eating disorders, substance abuse can be a way to control weight or avoid taking in calories.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) occurs when someone has witnessed a traumatic event, and then experiences troubling symptoms, like difficulty sleeping, flashbacks of the trauma, and attempts to avoid anything associated with the traumatic memory. Drugs and alcohol may allow people to “numb” their emotions and avoid the flashbacks that occur with PTSD. 

Psychotic Disorders

Psychotic disorders, including schizophrenia, result in unusual patterns of thinking and behaving, and a person is likely to experience hallucinations and delusions with this mental health condition. Studies have suggested that genetic risk factors can also make individuals with schizophrenia more vulnerable to developing addictions. 

Risk Factors and Causes of Co-Occurring Disorders

There is no single factor that leads to the development of a co-occurring disorder, but several factors can increase the risk of having both a mental health condition and an addiction. They include the following:

  • Genetics
  • Stress and trauma 
  • Lack of parental supervision
  • Child abuse and neglect
  • Bullying 
  • Family history

Which Comes First: Mental Health Disorders or Substance Abuse?

It is often difficult to determine whether a mental health condition or a substance use disorder came first. In some cases, shared genetic risk factors may lead a person to develop both conditions at about the same time. On the other hand, some people may develop symptoms of a mental health condition, and then begin using substances to self-medicate. Finally, it is also possible for brain changes from substance abuse to lead to the development of a mental health condition.

How Common Are Co-Occurring Disorders?

Co-occurring disorders are extremely common. According to NIDA, about half of people with mental health disorders will develop substance use disorders at some point during their lives, and vice versa. 

Recent research has also revealed the following statistics:

  • Mood and anxiety disorders are the most common co-occurring diagnoses among people with opioid addictions.
  • 7.7 million adults in the United States have co-occurring addiction and mental illness. 
  • About one-fourth of people with a serious mental illness like bipolar disorder or schizophrenia also have a substance use disorder. 

Co-Occurring Disorders Treatment

When a person has co-occurring disorders, it is important that they receive treatment for both conditions. If the mental illness is treated but the substance use disorder is not, a person may continue to use drugs, causing a worsening of mental health symptoms. Similarly, if a person receives treatment for the addiction but not the mental health condition, they may return to using drugs to self-medicate the mental illness.

Mental Health Counseling

Mental health counseling can be utilized to treat co-occurring disorders. Several forms of therapy, including cognitive behavioral therapy and dialectical behavioral therapy, are effective for treating both mental illnesses and addictions. In counseling sessions, you can learn to uncover negative patterns of thinking that are contributing to both mental illness and addiction, and learn healthy coping skills. 

Substance Abuse Treatment

In addition to mental health counseling, substance abuse treatment may involve taking medications, as needed, to help reduce cravings and withdrawal symptoms. Treatment for substance use may also include participation in support groups or group counseling sessions. The specific length of time spent in substance abuse treatment will vary for each person, but experts recommend that treatment last at least three months to ensure the best outcomes. 

Dual Diagnosis Treatment Center in Denver, CO

If you’re seeking dual diagnosis treatment in the Denver area, Denver Mental Health Counseling is here to help. In addition to offering individual therapy and group therapy, we provide both outpatient and intensive outpatient services as well as medication-assisted treatment (MAT) when appropriate. Contact us today to start your treatment. 

Editor – Nicole LaNeve
Nicole leads a team of passionate, experienced writers, editors and other contributors to create and share accurate, trustworthy information about drug and alcohol addiction, treatment and recovery for The Recovery Village and all Advanced Recovery Systems sites. Read more
Medically Reviewed By – Jenni Jacobsen, LSW
Jenni Jacobsen is a licensed social worker through the Ohio Counselor, Social Worker and Marriage and Family Therapist Board. She has seven years of experience working in the social work field, working with clients with addiction-related and mental health diagnoses. Read more

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Medical Disclaimer

Denver Mental Health Counseling by The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.