When someone has both a mental health disorder and a substance use disorder (SUD) at the same time, it’s referred to as a co-occurring disorder (sometimes called “dual diagnosis”). Understanding how these two conditions interact, and how best to treat them together, is vital. At MATClinics, we recognise the complexity of these dual challenges and are committed to delivering integrated care that addresses both sides of the coin.
What Are Co-occurring Disorders?
A co-occurring disorder means a person has both a diagnosed mental health disorder (such as depression, anxiety, bipolar disorder, PTSD) and a substance use disorder (for example alcohol, opioids, stimulants).
These conditions often overlap: mental health problems can lead to substance use (sometimes via self-medication), and substance use can trigger or worsen mental health disorders.
Understanding this pairing is the first step in addressing it effectively.
Why They Matter: Prevalence & Risk
Here are some key data points that show how common and serious co-occurring disorders are:
- Studies show that among people who develop a substance use disorder, many also meet criteria for a mental disorder. For example, one review noted that roughly half of individuals who experience a mental illness in their lifetime will also experience a substance use disorder, and vice versa.
- According to Substance Abuse and Mental Health Services Administration (SAMHSA) data: approximately 21.5 million adults in the U.S. have a co-occurring disorder (mental health + SUD) as per the 2022 National Survey on Drug Use and Health.
- From Centers for Disease Control and Prevention (CDC) data: in 2022, among U.S. overdose deaths, 21.9% of decedents had a reported non-substance-related mental health disorder. This underscores how mental health and substance use disorders often go hand in hand in serious adverse outcomes.
The takeaway: co-occurring disorders are common, and when left untreated or improperly treated, the outcomes can be worse than when a single disorder is present.
Why these disorders often go together
Here are some of the reasons mental health disorders and substance use disorders often co-occur:
- Shared risk factors: Genetics, brain chemistry, childhood trauma, chronic stress, and social environment can all contribute to both mental illness and substance use disorders.
- Self-medication: Someone with a mood disorder or anxiety may use alcohol or drugs to try to relieve symptoms temporarily. A substance use disorder could develop if these substances are misused consistently.
- Substance impact on the brain: Substance misuse can change the brain in ways that increase the risk of developing a mental health disorder.
- Complex interplay: Determining which came first (the mental health disorder or the SUD) is often difficult, the conditions influence each other, making diagnosis and treatment more complex.
Understanding these mechanisms helps shape an effective treatment strategy.
Treatment approaches: what works
Treating co-occurring disorders requires more than simply treating each disorder separately. Integrated, coordinated care is the gold standard. Here are key principles and approaches:
Integrated treatment
- According to the National Institute on Drug Abuse (NIDA), the best outcomes come when people with both a SUD and a mental disorder receive care that addresses both conditions together in a coordinated manner.
- The American Society of Addiction Medicine (ASAM) describes three levels of program capability:
- Co-occurring capable: primarily SUD-focused but can treat stable mental disorders.
- Co-occurring enhanced: higher integration of mental health & SUD services.
- Complexity-capable: designed for people with multiple complex conditions (e.g., trauma, medical illness, legal issues) in addition to co-occurring mental health + SUD.
Core treatment components
- Screening and assessment: It’s important to identify both conditions early. According to research, accurate diagnosis of both disorders, including severity, timing, and functional impact, is key.
- Medication management: Medications exist for many substance use disorders (e.g., opioid use disorder) and for many psychiatric disorders.
- Behavioral therapies: These include cognitive behavioural therapy (CBT), motivational interviewing, contingency management, family‐based therapies, etc. For example, NIDA notes that behavioral therapies help individuals build coping skills to manage both mental illness and SUD.
- Stage-wise and individualized care: Because people with co-occurring disorders present with varying levels of severity and types of disorders, treatment should match the individual’s needs and may shift over time.
- Addressing broader life issues: Often co-occurring disorders are accompanied by challenges like trauma, homelessness, unemployment, legal issues, and medical illness. Effective programs often include wrap-around supports.
Why integrated treatment matters
When mental health and substance use disorders are treated separately or one is ignored, outcomes are worse: higher relapse rates, more hospitalisations, poorer functioning. Research shows integrated care (treating both together) leads to better engagement, retention, and outcomes.
How this looks in practice at MATClinics
At MATClinics, our approach to co-occurring disorders is centred on holistic, personalised care:
- Comprehensive intake: We screen for both mental health disorders and SUDs, asking about history, substance use patterns, psychiatric symptoms, trauma, and social factors.
- Integrated treatment plan: Instead of treating addiction and mental health as separate silos, we craft a unified plan that coordinates medication, therapy, and support services.
- Specialised therapies: We offer evidence-based therapies, CBT, and motivational interviewing, tailored to a person’s specific mix of disorders.
- Medication management: For those with opioid use disorder or alcohol use disorder, we provide medication-assisted treatment (MAT), alongside psychiatric medication when needed.
- Addressing life context: Recognising that recovery doesn’t happen in a vacuum, we help with referrals to social supports, housing, legal services, employment counselling, as needed.
- Ongoing monitoring and adjustment: Since co-occurring disorders often shift over time, we monitor progress, symptoms, substance use, and adjust the plan accordingly.
Why choosing the right care environment matters
Because of the complexity of co-occurring disorders, not every treatment setting is equally effective. Things to look for:
- Staff trained in both addiction and mental health treatment.
- Ability to address non-clinical needs (housing, trauma, employment) that often impact recovery.
- Monitoring and continuity of care over time, relapse prevention, transition support.
- Evidence-based therapies and medication options with coordination between disciplines.
Final Thoughts
- Co-occurring disorders (mental health + substance use) are common and serious, treating both together is critical.
- Integrated care that addresses both conditions simultaneously, with therapy, medication, and support, leads to better outcomes.
- At MATClinics, we embrace this integrated approach because we know recovery is more than stopping substance use, it’s restoring mental health, quality of life, and purpose.
- If you or a loved one is facing both a mental health condition and a substance use challenge, the first step is screening and finding a provider who treats both. You’re not alone, help exists and recovery is possible.
Common Questions About Co-occurring Disorders
1. Can you treat both substance use and a mental health disorder at the same time?
Yes, in fact, treating them together is the most effective approach.
2. Does one disorder have to come first?
Not necessarily. It’s often unclear which came first or whether they developed together because they share risk factors.
3. How long does treatment take?
It varies widely. Because co-occurring disorders involve two complex conditions, recovery may require longer or more intense care, especially if other life challenges are present.
4. What if my treatment center only treats one disorder?
That can be a barrier. Ideally, one center treats both or closely coordinated care is provided. According to research, many SUD programs lack the ability to treat mental illness and vice versa.