What Are Co-Occurring Disorders? Examples + Treatment Options

When you hear the term co-occurring disorders, it may not be immediately apparent what it means. Maybe a doctor or counselor mentioned it, or you came across it while reading about addiction or mental health. Either way, the phrase can feel a little confusing.

Mental health and substance use often overlap, and it isn’t always obvious where one ends and the other begins. A person might start drinking to manage anxiety, or find that depression deepens as drug use increases. It can feel tangled, which makes it harder to know what’s really going on or how to help.

In this post, we’ll break it down and explain what co-occurring disorders are, examine common examples, and outline treatment approaches designed to address both conditions simultaneously.

What Are Co-Occurring Disorders?

Co-occurring disorders describe a situation when an individual is dealing with both a mental health condition and a substance use disorder at the same time. The two don’t exist in separate boxes. They interact, often shaping the way symptoms show up and how recovery unfolds.

Mental health symptoms can mask the signs of addiction, or substance use might make it harder to recognize underlying depression, anxiety, or trauma. That’s why identifying co-occurring disorders requires looking at the whole person — not just one part of the struggle.

Symptoms of Co-Occurring Disorders

When a mental health condition and a substance use disorder happen together, the signs aren’t always easy to separate. Some symptoms are tied more closely to mental health, others to substance use — and many overlap. 

What often raises concern is how co-occurring disorders can combine and start to affect daily life. Common symptoms include:

• • Mood swings or emotional instability that feel difficult to manage.

• • Using alcohol or drugs to cope with anxiety, sadness, or stress.

• • Withdrawal from family, friends, or activities that once felt meaningful.

• • Ongoing problems with work, school, or keeping up with responsibilities.

• • Trouble concentrating, remembering things, or making decisions.

• • Needing a larger quantity of a substance to feel the same effect, or experiencing withdrawal without the substance.

• • Persistent feelings of hopelessness, guilt, or worry.

• • Engaging in risky or impulsive behaviors, especially during or after substance use.

• • Struggling to maintain healthy routines like sleep, meals, or self-care.

How Common Are Co-Occurring Disorders?

Living with both a mental health disorder and a substance use disorder is more common than many people realize. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), about 21.5 million adults in the US live with both a mental health condition and a substance use disorder. In fact, among people with serious mental health challenges, more than half will also face a substance use disorder at some point in their lives.

Even with numbers this high, fewer than half of those affected receive dual diagnosis treatment. Many individuals end up in programs that address only one aspect of the problem, making it more challenging to maintain recovery. Recognizing how widespread co-occurring disorders are and how often they go under-treated highlights the importance of integrated care.

Why Are They So Common?

Co-occurring disorders often feed into each other. Individuals may self-medicate with alcohol or drugs to ease symptoms of mental health conditions, while changes in the brain from substance use can make those conditions even worse. Trauma, stress, and genetics can also raise the risk for co-occurring disorders, which is why the two conditions often show up together.

Examples of Co-Occurring Disorders

Co-occurring disorders don’t follow one set pattern. The mix of mental health and substance use challenges can look very different from person to person, but certain pairings tend to appear more often. What makes them especially difficult is not only the symptoms themselves, but the way each condition complicates the other. 

These examples show how the overlap works:

• • Depression + alcohol use – Alcohol disrupts sleep and energy and erodes healthy routines, making it harder to manage mood and regain motivation.

• • Anxiety + prescription drug misuse – Misusing sedatives or painkillers chips away at focus, memory, and daily functioning, creating even more stress and worry.

• • PTSD + opioid use – Opioids dull painful memories and physical symptoms, but dependence makes it harder to process trauma or stay engaged in therapy.

• • Bipolar disorder + stimulant use – Stimulants intensify mood swings, pushing manic episodes higher and depressive crashes lower, leaving less stability to build on.

• • Schizophrenia + cannabis use – Cannabis may seem to ease anxiety or restlessness at first, but regular use can intensify confusion, paranoia, or disorganized thinking.

One condition feeds into the other until they’re tightly intertwined, which is why professional treatment is necessary — to untangle everything simultaneously.

How Are Co-Occurring Disorders Diagnosed?

Co-occurring substance use disorders can be difficult to identify. Symptoms often overlap, one condition may mask the other, and stigma or shame can make it hard for someone to share their experience in its entirety. Substance use can also cause symptoms to fluctuate, adding another layer of complexity.

Due to these challenges, an accurate diagnosis necessitates a thorough and structured evaluation. Mental health professionals take time to understand the full picture of a person’s health and history before recommending treatment. This process often includes:

• Current concerns – A conversation about symptoms and how they affect daily life.

• Medical and family history – Reviewing past diagnoses, treatments, and patterns that may contribute.

• Substance use assessment – Identifying what substances are used, how often, and with what impact.

• Mental health screening – Using validated tools and clinical interviews to explore possible conditions.

• Diagnostic criteria – Comparing findings to DSM-5 standards to confirm diagnoses.

• Treatment planning – Bringing everything together to design a comprehensive, coordinated plan tailored to the individual.

At Pasadena Villa, this diagnostic process is the foundation of our care. By looking beyond surface symptoms, our compassionate team ensures clients receive personalized, evidence-based treatment that addresses both mental health and substance use for long-term stability.

Treatment Options for Co-Occurring Disorders

When someone is dealing with both a mental health disorder and a substance use disorder, treating them separately is rarely effective. If therapy focuses only on depression but ignores drinking, or if detox happens without addressing anxiety, progress is more difficult to maintain. 

The good news is that when both conditions are addressed together, also known as dual diagnosis, individuals have a much stronger chance of building stability.

Integrated treatment combines multiple approaches, but not every person requires all of them simultaneously. Think of it as a set of core components that can be combined in different ways depending on the situation.

Core Therapies Used

Therapy helps individuals understand the connection between their mental health symptoms and substance use. Instead of treating one without the other, therapy explores how the two interact and teaches healthier ways to cope.

Therapy may involve:

• • Cognitive behavioral therapy (CBT) – Identifies negative thought patterns (e.g., “I can’t cope without drinking”) and replaces them with healthier coping strategies.

• • Dialectical behavior therapy (DBT) – Builds skills like emotion regulation and distress tolerance to manage intense feelings without turning to substances.
    
    

• • Seeking Safety (trauma-informed therapy) – Focuses on building safety in thoughts, behaviors, and relationships while addressing both trauma and substance use. It teaches coping skills and grounding strategies without requiring a detailed exploration of trauma.

• • Family therapy – Strengthens connections that may have been strained by symptoms or substance use.

• • Relapse prevention planning – Helps individuals identify early warning signs of a setback and implement protective strategies.

Levels of Care

Not everyone starts recovery in the same place. The right level of care depends on how severe the symptoms are, how often relapses happen, and what kind of support is available at home. Treatment often works as a step-down journey:

• • Residential treatment – 24/7 support in a structured setting, often the first step when symptoms or relapses are severe.

• • Partial hospitalization program (PHP) – Full-day treatment in a clinical setting, with the ability to return home at night.

• • Intensive outpatient program (IOP) – Several sessions a week that provide structure and flexibility, allowing time for work, school, or family.

• • Outpatient care – Ongoing therapy and medication management to maintain recovery in daily life.

Many people move through more than one of these levels, starting with the highest level of support they need and gradually stepping down as stability grows.

Medication Management

Medication can make recovery more manageable by reducing symptoms that might otherwise block progress. It isn’t a standalone solution, but it can create stability that allows someone to engage in therapy and daily life with greater ease.

Examples of medication support include:

• • Antidepressants – Relieve depressive symptoms that often drive alcohol or drug use.

• • Mood stabilizers – Help regulate the highs and lows of bipolar disorder that can make sobriety difficult.

• • Anti-craving medications – Reduce urges for alcohol or opioids, lowering relapse risk.

• • Close medical supervision – Ensure the correct dose, track side effects, and adjust treatment as needed.

Safe + Supportive Environment

Lasting recovery doesn’t happen in a vacuum. People tend to do better when they’re surrounded by support, accountability, and connection. These things make the process feel less overwhelming and more sustainable. A supportive environment can take many forms, including:

• • Group therapy – Fosters connection and helps people learn from shared experiences.

• • Peer support – Encourages those who’ve faced similar challenges.

• • Structured treatment programs – Add routine and accountability, which reduces the chaos of unmanaged symptoms.

• • Family involvement – Equips loved ones to understand the disorders better and provide consistent support.

Lifestyle + Coping Skills

Professional treatment provides individuals with structure and tools, but recovery must extend into everyday life to be sustained and maintained. That’s why many treatment programs place a strong emphasis on developing habits that support stability outside the clinic. 

These skills make therapy and medication more effective by giving people ways to manage symptoms and avoid emotional triggers day to day:

• • Sleep hygiene – Consistent sleep patterns, steady mood, and lower relapse risk.

• • Balanced nutrition – Regular meals provide the brain and body with the fuel needed for focus and energy.

• • Exercise – Movement, even light activity, reduces stress and supports emotional regulation.

• • Mindfulness + relaxation techniques – Tools such as deep breathing or meditation can create healthier responses to cravings and stress.

• • Daily structure – Routines make life more predictable and provide a stronger foundation for recovery.

How Long Does it Take to Treat a Co-Occurring Disorder?

There isn’t a set timeline for treating co-occurring disorders. Recovery depends on the type of mental health disorder, the severity of substance use, and how much support is in place. Some individuals experience progress within a few months, while others require longer-term care that may continue for years.

Treatment typically occurs in stages, first focusing on stabilization and safety, then building coping skills, and finally, learning how to sustain recovery in daily life. Even after professional treatment ends, ongoing therapy, medication management, and peer support may be needed to keep symptoms and cravings under control.

Take the Next Step Toward Recovery

When mental health challenges and substance use happen together, it can feel like there’s no way out. The proper care makes recovery possible. At Pasadena Villa, we offer integrated treatment that addresses both conditions simultaneously, helping you or your loved one achieve stability and lasting relief.

Our programs combine therapy, medication management, and a supportive environment to make change sustainable. Whatever your pathway to recovery requires, our team will work with you to create a personalized plan that meets your specific needs.

Contact us today to learn more about how our co-occurring disorder treatment programs can support you or your loved one.