Co-Occurring Disorders and Addiction

Also known as dual diagnosis or co-morbid disorders, co-occurring disorders are underlying mental health issues that appear alongside substance abuse disorders. Addiction and mental health have a very close relationship. Mental health disorders make it easier to develop a substance abuse disorder, especially if these disorders are left untreated. On the flip side, substance abuse, especially at the addiction level, greatly worsens the severity and frequency of most mental health issues.

Because addiction and many mental health conditions have similar symptoms, proper diagnosis of either condition is often very difficult. Due to the difficulty in diagnosis, one disorder might be treated while the other is left undiagnosed, leaving the patient vulnerable to relapse or worsening mental health.

Co-occurring disorders are tragically common. Approximately 7.9 million adults in the United States had co-occurring disorders in 2014.

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Common Co-Occurring Disorders

Many underlying mental health issues lead to the abuse of drugs and alcohol. Some use these substances to cope with pain or anxiety, though guilt and shame are often a significant underlying cause as well.

Examples of common co-occurring disorders include:


Depression is one of the most common mental disorders across the globe, affecting millions of people worldwide. Many abuse substances to numb or forget their emotional pain or to feel joy or pleasure, even if artificially. However, alcohol and many other drugs cause somber and bleak feelings after the initial euphoria wears off, which inspires more substance abuse. A vicious cycle of depression intensifying addiction and vice versa then ensues.


Anxiety comes in many forms and is one of the most common of all mental health disorders. Many sufferers turn to substance abuse to find relief or get through their daily lives. For example, alcohol abuse can suppress feelings of anxiety in social settings, and prescription drugs can relieve the shaky feelings anxiety brings. As sufferers use substances to cope, they begin to rely heavily on their effects, putting them at risk for addiction and making their anxiety far worse.

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The abuse of substances can make one feel hopeless, unworthy, and suicidal. Depressing suicidal thoughts from drug abuse can trigger the user to take other drugs such as stimulants to bring back good feelings. Unfortunately, once the drug wears off, their thoughts are far worse than before, leading to a cycle of abusing more drugs and developing more frequent and intense suicidal thoughts.

Bi-Polar Disorder

Bi-polar disorder is caused by a chemical imbalance in the brain, resulting in intense and uncontrollable episodes of both depression and mania. People with bi-polar disorder often abuse drugs to reduce the severity of these episodes, ultimately causing increasingly irregular and severe levels of activity within the brain. Perhaps no mental health condition is as associated with dual diagnosis as bi-polar disorder, and the majority of bi-polar sufferers will develop a substance abuse disorder at some point in their lives.

Post-Traumatic Stress Disorder (PTSD)

Caused by physical and/or emotional trauma such as combat or abuse, PTSD can manifest in a number of crippling symptoms such as flashbacks. Drugs and alcohol can temporarily relieve the effects of PSTD. However, drug abuse can make PTSD last longer, cause more intense negative feelings, and disrupt sleep patterns. The effects of PTSD, however, are so severe, victims continue to abuse drugs in order to endure the symptoms, regardless of the known negative results.

Borderline Personality Disorder

Those who suffer from Borderline Personality Disorder have extreme emotional pain and often turn to substance abuse for relief. This relief is temporary, however, and often increases the severity of symptoms.

It is critical to treat co-occurring disorders alongside addiction to maximize the chances of recovery.

Eating Disorders

Many characteristics of eating disorders (such as bulimia and anorexia) and addiction overlap. For example, many anorexics become alcoholics or cocaine abusers in order to suppress their appetite. These disorders often feed off of one another, intensifying both problems.

Body Dysmorphia Disorder

Obsessing over an overly-critical view of one’s body can lead to anxiety and many other health problems. Victims of BDD self-medicate to deal with stress and their depressing outlook on life.

Attention-Deficit-Hyperactivity Disorder (ADHD)

ADHD causes an inability to focus and a strong drive for constant activity. It is common for individuals with ADHD to abuse alcohol and their prescription medicines to cope. Shortly after beginning to cope in this manner, they develop a tolerance and begin the cycle of addiction.

Obsessive Compulsive Disorder (OCD)

Individuals with OCD exhibit high levels of discomfort over every day experiences. To endure constant triggers, OCD sufferers turn into substance abusers.


Schizophrenics often abuse substances to handle their lack of ability to distinguish between fantasy and reality and to suppress auditory and visual hallucinations. Tragically, substance abuse often greatly increases the severity and frequency of schizophrenic episodes.

Low Self-Esteem

Low self-esteem often creates feelings of anxiety and depression. These hopeless feelings lead to substance abuse when victims fail to find a better way to cope. Treatment is often resisted because sufferers of low self-esteem often feel like they don’t deserve better.

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Anger Management

Anger issues are typically made substantially worse by substance abuse, especially alcohol and stimulant abuse. Not only are anger issues more frequent and severe due to substance abuse, but episodes are more likely to result in violence due to reduced self-control.

Addictive Personality Disorder

Predisposed to developing addictions, those who suffer from addictive personality disorder can develop any type of addiction mainly for the rewards they bring. The more they give into their addiction, the more they feed their disorder, and vice versa.


Guilt can cause emotional chaos. It can keep you up at night worrying, and it can certainly put you at risk for drug abuse. People take drugs to forget about the experience they feel guilty about, which only delays and prolongs the experience, leading to more substance abuse and potentially addiction.


Shame brings anxiety and potentially intense depression depending on how severe the situation is. Drugs may ease the physical and emotional pain of shame temporarily but take users down a spiraling path to addiction.

Finding Treatment for Co-occurring Disorders

Having a mental health issue can be an intense experience by itself. Mental disorders coinciding with a substance abuse disorder can be extremely hard to beat on your own. If you or someone you love has a mental health issue and is abusing drugs, it is extremely important to get help as soon as you can. Substance abuse can make disorders much worse for the individual both physically and emotionally. Contact a treatment expert today, and start the path to healing.

Last Edited: April 2, 2018

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