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Co-Occurring Disorders

Co-occurring disorders are mental health conditions that exist alongside substance abuse issues. Co-occurring disorders and addiction often greatly impact one another.

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 use disorders (SUDs). Addiction and mental health have a very close relationship. Mental health disorders make it more likely that an individual will develop a substance use disorder, especially if these disorders are left untreated. On the flip side, substance abuse, especially at the level 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 of addiction or mental health issues. Therefore, each diagnosis must be made and treated simultaneously.

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. People use these substances to cope with or mask a wide variety of emotions and feelings, including pain, anxiety, guilt, and shame.

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, also known as substance-induced depression, after the initial euphoria wears off. This in turn triggers more substance abuse, as the user wishes to both experience the euphoria and avoid the negative feelings. 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.


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.

Bipolar Disorder

Bipolar disorder is caused by a chemical imbalance in the brain, resulting in intense and uncontrollable episodes of both depression and mania. People with bipolar disorder often abuse drugs to reduce the severity of these episodes, ultimately causing increasingly irregular and severe levels of activity within the brain. Few mental health conditions are as associated with dual diagnosis as bipolar disorder. Some studies have found that the majority of bipolar sufferers will develop a substance use disorder at some point in their lives.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a stress and anxiety condition that can develop due to intensely stressful and possibly life-threatening experiences, such as natural disasters, violent crimes, vehicle accidents, or long-term bullying. PTSD can further develop as a result of emotional, mental, physical or sexual abuse. Many veterans return from war with PTSD due to traumatic combat experiences. PTSD is manifested by a variety of symptoms, such as flashbacks, intrusive memories, night terrors, and hypervigilance. Drugs and alcohol can temporarily relieve the symptoms of PSTD. However, drug abuse can make PTSD last longer, cause more intense negative feelings, and disrupt sleep patterns. Because the symptoms of PTSD can be debilitating, victims may continue to abuse alcohol or other drugs as a way to avoid or cope regardless of long-term consequences.

Borderline Personality Disorder

Up to 6% of the adult population in the United States suffers from borderline personality disorder (BPD). BPD is characterized by severe mood swings, emotional instability, impulsive behavior, distorted perceptions of self, others or the world, and difficulty forming stable relationships. Individuals may abuse alcohol or drugs to cope with these symptoms and to provide a false sense of “control. This relief is temporary, however, and often increases the severity of symptoms.

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Eating Disorders

There are many similarities between eating disorders, such as anorexia and bulimia, and alcohol or drug addiction. Both involve behaviors that affect the reward pathway in the brain, resulting in repeated desire to engage in unhealthy behaviors. This desperate, reoccurring desire of the brain to reengage in these behaviors becomes an addictive, conditioned response. Eating disorders and substance abuse very often fuel each other. For example, many sufferers of anorexia begin to abuse cocaine and alcohol to suppress their appetite. As they begin to lose weight even faster as a result of substance abuse, they use increasing amounts, and a downward spiral soon starts.

Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) is a body-image disorder characterized by intrusive or persistent real or imagined defects or flaws in one’s physical appearance. 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 depression-like on life.

Attention-Deficit-Hyperactivity Disorder

Attention-deficit hyperactivity disorder (ADHD) is characterized by an inability to focus and/or hyperactivity and/or impulsiveness that interferes with an individual’s ability to function. It is common for individuals with ADHD to abuse alcohol, their prescription medicines, and other drugs to alleviate symptoms. Shortly after beginning to cope in this manner, they may develop a tolerance and begin the cycle of addiction.

Obsessive Compulsive Disorder

Obsessive compulsive disorder (OCD) is characterized by obsessive and excessive behaviors related to perfectionism, attention to detail, order, and control. Many individuals who suffer from OCD abuse alcohol or other drugs in order to alleviate the often intense symptoms.


Schizophrenia is characterized by individuals experiencing auditory and visual hallucinations, and can affect how a person thinks, feels, and behaves in a wide variety of ways. Individuals with schizophrenia often abuse substances to handle their lack of ability to distinguish between fantasy and reality and to suppress hallucinations. Tragically, substance abuse often greatly increases the severity and frequency of schizophrenic episodes.

Other Emotional Issues That Impact Addiction

Low Self-Esteem

Low self-esteem often creates feelings of anxiety and depression. These feelings often lead to substance abuse when victims fail to find a better way to cope. Entering treatment is often resisted because sufferers of low self-esteem often feel like they don’t deserve better, although these individuals are usually very good participants once they do begin.

Anger Management Issues

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

Predisposed to developing addictions, those who have an addictive personality 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 or alcohol, 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 provider today.

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