Co-Occurring Disorders

Addiction is always accompanied by a particular question: does the addict have a mental illness?

This is really a chicken-egg problem. What came first? Someone addicted to substances inevitably shows signs of mental illness. After all, they are dependent on drugs or alcohol just to feel “okay” in the world. Depression, anxiety, and symptoms of dissociation can all be the result of both substance use and withdrawal.

This does not necessarily mean that the addiction was borne of mental illness. Recreational or experimental use can lead to addiction, which can then lead to these symptoms.

On the other hand, people already suffering with mental illness are at least twice as likely as the general population to develop an addiction. Substances are often used as a means of coping when internal resources are not enough.

Addicts who only exhibited signs of mental illness once they were already dependent on a substance may not require mental illness treatment. But mental illness sufferers who consequently developed an addiction need to treat both disorders.

If they only treat the addiction, the individual will be left where they started – without the capability to cope with their problem in an effective, healthy way.

Identifying Co-Occurring Disorders

People diagnosed with both a substance abuse disorder and a mental illness are considered to have co-occurring disorders. This is also sometimes called a dual-diagnosis. They require holistic treatment in order to recover from both disorders.

The best treatment centers screen for mental health issues and have treatment options available for them. It’s not always easy to identify mental illnesses co-occurring with addiction, but there are some common, effective methods.

Patient History

On intake, a treatment center will try to get a comprehensive patient history. If the individual still needs to detox, this step may happen once they are physically stable.

A patient history will take into account the individual’s life before they began using substances. It will attempt to identify the factors in their life that led to substance use in the first place. It will also take previous mental health treatment or therapy into account.

Patient histories are a good place to start, but ultimately rely on an accurate account of the person’s life, rather than a narrative they have developed. Individuals do not always recognize that they are suffering from a mental illness, and may attribute symptoms of illness to circumstances or “weakness.”

Individual Therapy

In a treatment center, a patient is assigned a therapist. The therapist will help the individual identify the true source of the substance addiction. They will help them better understand circumstances, thoughts, feelings, and behaviors that previously didn’t seem to make sense.

This is a powerful means of identifying co-occurring mental illnesses, as well as one of the means of treatment.

Psychometric Testing

Finally, some centers will carry out psychometric testing. These are tests that are scientifically designed to identify mental illness and other problems. This is particularly useful for those for whom the line between mental illness and addiction is blurred.

Integrated Treatment For Co-Occurring Disorders

In the past, treatment centers and professionals have attempted to treat co-occurring disorders individually, in parallel. In other words, patients were treated for both substance disorder and mental illness, but these treatments did not overlap.

However, experts have since learned that co-occurring disorders cannot be treated effectively this way. Two treatment plans inevitably clash, and communication between healthcare providers can easily break down.

In order to resolve both problems, they need to be treated in tandem, with a holistic plan that targets both disorders together.


A psychiatrist working in a recovery center can prescribe the appropriate medication to the individual, aware of their history of addiction and which drugs could lead to further problems. This will inform their decisions, and they will avoid prescribing addictive medications like benzodiazepines and certain other anxiety and sleep pills.

They may also prescribe medications that help with withdrawal and minimize cravings.


Therapy is one of the primary treatments for mental illness, and mood disorders in particular. A therapist who is experienced in working with addiction will understand the complex connection between the disorders. They will use techniques that target the addictive thoughts and behaviors, as well as address the underlying issues. They will attempt to deconstruct the process that led to the addiction in the first place, and help the individual develop better coping mechanisms for future crises.

Support Groups

Individuals suffering from co-occurring disorders often benefit from support groups with others going through the same. Groups of people suffering from both addiction and a mood disorder, for example, help them share stories, both of successes and setbacks, and help each other understand their circumstances.

Family Support

Dual-diagnosis treatment takes into account the individual’s history and environment. Very often, family issues have contributed both to the mental illness and addiction. It is often necessary to implement family-centric interventions, so that the person does not go back to the same unhealthy environment. Those who are meant to be of most support can often be the biggest stumbling blocks. Without taking them into account, the person undergoing treatment is more at risk of relapse.


Anyone who has been in a treatment center needs aftercare to help ensure they don’t relapse. They should continue therapy and support groups, in order to get assistance in implementing what they have learned. Aftercare is particularly important for those suffering from co-occurring disorders. Mental illness is often a chronic issue. Antidepressants or other medication prescribed by a psychiatrist needs to be continued, as does any therapeutic interventions.

Holistic Treatment

More and more, addiction centers are recognizing the need for holistic treatment. They understand that treating the individual is more effective than treating the problem.

Mental illness inevitably accompanies addiction. When the mental illness is not just a consequence of the addiction, treating only one of the problems is not going to be sufficient.