Co-Occurring Disorders Treatment Guide

Someone with substance abuse disorder (drugs or alcohol) and mental illness (depression, PTSD, anxiety, OCD, etc.), the diagnosis is called a co-occurring disorder. Any combination of mental health disorders and substance abuse or addiction qualifies for this diagnosis (sometimes referred to as a dual diagnosis), such as alcoholism and depression, anorexia and cocaine dependence, post-traumatic stress disorder and heroin addiction, prescription drug dependence and anxiety, and more.

Though the symptoms of one disorder may predate the other, both disorders tend to exacerbate one another, making it impossible to extricate the symptoms caused by one disorder from the other. For example, those who attempt to escape symptoms of depression associated with a mood or personality disorder by taking prescription painkillers or shooting heroin will quickly find that though this may be effective the first few times.

In addition to the symptoms of depression, they will soon be struggling with:

  • Cravings for their drug of choice
  • A tolerance to their drug of choice, requiring higher and higher doses
  • Increased episodes of mental health symptoms
  • More intensive or longer-lasting mental health symptoms
  • Experience of withdrawal symptoms
  • Addiction

For the purposes of treatment, it is recommended that clients receive intensive medical and therapeutic intervention and care for both disorders at the same time. This allows them to manage the symptoms caused by the mental health disorder without abusing drugs and alcohol and worsening those symptoms — or allowing an untreated mental health disorder to increase the urge to drink or get high. Comprehensive care that begins during detox and continues through aftercare treatment and support is the best way to build a new life in recovery from co-occurring disorders.

What Comes First: Addiction or Mental Illness?

All people are different when it comes to their experience with addiction and mental illness. Some begin to experience mental health issues during childhood or adolescence and experiment with drugs and alcohol soon after, developing both an addiction problem and a serious mental illness at the same time.

Others may seek out drugs and alcohol in an attempt to “self-medicate” a mental health issue that develops in early adulthood or that develops out of an injury or trauma later in life. Still others may first develop an addiction problem that grows so severe that it causes mental health issues or triggers the onset of symptoms that may otherwise have remained dormant.


Addiction is defined as both a physical dependence and a psychological dependence upon a drug or multiple drugs, including alcohol. Physical dependence is characterized by a tolerance to the drug of choice (e.g., needing an increasingly larger dose in order to experience the desired effect), and psychological dependence is defined by cravings for the drug or obsessing over getting and staying high.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), substance dependence is a single disorder that is measured on a spectrum from mild to severe and classified according to the substance of choice, with the exclusion of caffeine, which cannot be the subject of a substance abuse/addiction disorder diagnosis. For example, someone struggling with an alcohol problem may be diagnosed with alcohol abuse disorder or alcoholism depending upon the severity.

The diagnostic criteria for almost all substance abuse disorders are the same, according to the DSM-5. There are 11 symptoms that can signify a substance use disorder, and in order to be diagnosed with a mild drug abuse disorder, the person must exhibit two or three of these symptoms.Addiction Articles