Dual Diagnosis Resource

Co-Occurring Disorders

Co-occurring Disorders and Dual Diagnosis Learn How Mental Disorders Tie into Addiction

Not only is it a tall order to face a legitimate mental health disorder, but many of these individuals struggle with substance use and put themselves at risk of addiction. Drinking or casual drug use is a common way for these individuals to try to self-medicate their mental health symptoms, and soon enough, addiction may rear its ugly head.

Substance use disorders include both abuse of and dependence on substances. A person who struggles with a substance use disorder as well as a mental health condition is said to have co-occurring disorders, also known as a dual diagnosis.

Use this resource to educate yourself about common co-occurring disorders, their close connection to addiction, and to see what the treatment process consists of for dual diagnosis patients.

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According to SAMHSA’s 2014 National Survey on Drug Use and Health (NSDUH) (PDF | 3.4 MB), approximately 7.9 million adults in the United States had co-occurring disorders in 2014.

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Understanding Addiction

Understanding Addiction Co-occurring Disorders: What Are They?

Mental illness can make routine tasks difficult, and it lowers the overall quality of life for the sufferer – and even his or her surrounding family. Mental health disorders that typically accompany substance use disorder include mood disorders, anxiety disorders and more serious thought disorders.

There are more than 200 distinct psychiatric disorders under the umbrella of “mental illness.” Only in the last few decades has the medical community started to understand and empathize with mental health issues. Society has come along even more slowly. People with legitimate mental health issues have historically suffered in silence, until recently.

Common Mental Disorders that Co-occur with Addiction

Spotting the Signs and Symptoms of Mental Illness

Co-occurring Disorders: Who Has It?

Mental health disorders affect nearly every corner of society, but you will especially find them among those currently struggling with drug or alcohol abuse. Individuals with a family history of mental illness are also at a greater risk of developing the same or a similar disorder.

Almost everybody experiences symptoms of anxiety and depression from time to time, but the difference in those who have one of these mental health disorders is that they experience severe symptoms regularly – to the point where it impacts quality of life.

Mental Health Statistics

Treating Dual Diagnosis

How Are Co-occurring Disorders Treated?

Working with dual diagnosis clients can be challenging, and some treatment centers won’t even attempt to try to accommodate such clients. Others claim to offer mental health treatment, but truly lack the resources to address all of the client’s issues and needs properly.

The difficulty in treating co-occurring disorders stems from the symptoms of drug and alcohol use often getting confused with symptoms of mental illness. In many cases, the client used drugs or alcohol to self-medicate his or her symptoms of mental illness

Drugs and alcohol interfere with the efficacy of medications prescribed for the treatment of mental health disorders, and some individuals fail to deal with their substance use because they attribute their symptoms purely to their mental health disorder.

If you struggle with substance abuse and you’ve already been diagnosed with a mental disorder or you suspect you may have one, it’s important to look for a rehabilitation center that offers dual diagnosis treatment. Long-term treatment (90 days or more) is also recommended.

How Harmony Place Treats Co-occurring Disorders

Your illness does not define you.
Your strength and courage does.
Mental Health

Signs of Substance Abuse

Signs of substance abuse include reduced function at work, at school, in social relationships and worsening medical conditions. Substance abuse advances to dependence when the negative consequences associated with substance use increase, and the individual loses the ability control their substance use. Acquisition and use of substances take precedence over other activities. Dependence is accompanied by tolerance (needing more to achieve the desired effect) and withdrawal (physical and emotional symptoms that surface when a substance is reduced or removed).

Common Mental Health Disorders

Mental health disorders that typically accompany substance use disorders include mood disorders, anxiety disorders and more serious thought disorders. Major Depression, Bipolar Disorders, and Dysthymia are some of the more common mood disorders, and severe thought disorders such as schizoaffective disorder and schizophrenia may also be present. Individuals also frequently present with anxiety-related problems including PTSD, generalized anxiety, social anxiety, or panic disorders.

Treating substance use and mental health disorders and examining how they intersect is paramount for achieving successful treatment outcomes.

Adjustment Disorders

Symptoms of adjustment disorders can look very similar to symptoms of mood disorders or anxiety-related disorders. The distinguishing features are the presence of an identifiable major life stressor, symptoms, and effects on the person’s ability to function.

The DSM-5 Criteria for Adjustment Disorders includes:

  • Emotional or behavioral symptoms within three months of an identifiable stressor
  • Experience of stress is disproportionate to the normal expected response to a stressful life event
  • Cause notable distress or impairment in function
  • Symptoms are not an escalation of existing mental health disorder
  • The response is not better accounted for by normal bereavement
  • Once stressor is removed or the person begins to cope, the symptoms abate within six months

Anxiety Disorders

Anxiety Disorders

Anxiety is an emotion everyone is familiar with, as it is inherent in many parts of life. It becomes a disorder, however, when the anxiety does not dissipate and in fact worsens over time, eventually interfering with daily functioning.

Types of anxiety are differentiated by a variety of qualifiers.

Generalized Anxiety Disorder

Panic Disorder

Social Anxiety Disorder

Bipolar Disorder

Bipolar Disorder

Bipolar disorder is a brain disorder distinguished by severe mood swings including mania or hypomania (emotional highs) and depression (emotional lows). In a depressed phase, the individual may feel sad or hopeless and lose interest of pleasure in activities that were previously interesting or pleasurable. In a hypomanic (less intense than mania) or manic phase, the individual may experience increased energy, feel euphoric, or unusually irritable.

The fluctuation between moods can have a notable impact on sleep, energy, activity, judgment, behavior and the ability to complete daily tasks.

There are four types of bipolar disorder, and each produces abnormal changes in mood.

Bipolar I Disorder

Bipolar II Disorder

Cyclothymic Disorder

Bipolar Disorder, Other Specified or Unspecified Bipolar



Codependency is a term that was first attributed to spouses of alcoholics, but it was learned that the identifiable characteristics are prevalent in the broader population as well. Codependency is a dysfunctional pattern of emotional and behavioral features that impact one’s ability to enjoy healthy relationships with others. It can be considered a one-sided, dysfunctional relationship where one person subordinates their own needs to the attention and care of another. It may also be a trait acquired through mirroring the dysfunctional patterns in the family.

Codependency patterns can be found in caretakers of ill or elderly, as well as individuals in relationships suffering from mental or chronic illnesses. When applied to addictions, it is a behavior that enables the addict to continue to fly under the radar of responsibility and continue irresponsible addictive behaviors. Further, addicts/alcoholics in committed relationships with other substance users may find themselves struggling in their primary relationships.

Codependent traits include:

Low self-esteem


Poor boundaries






Problems with intimacy

Depressive Disorders

Depressive Disorders

Depressive disorders should not be confused with “the blues,” nor are they sad moods that one can easily dismiss or “get over.” The hallmark of a depressive disorder is the persistent feelings of sadness or worthlessness, with a loss of interest in things that used to bring the person pleasure.

A depressive disorder is a mental illness that affects the individual physically, emotionally and cognitively. Left untreated, the symptoms can last for long periods and cause varying degrees of impairment in daily tasks. The good news is that research shows that most people with depressive disorders respond well to medication, therapy or a combination of both.

Signs & Symptoms of Depressive Disorders:
  • Persistent depressed mood – as evidenced by feelings of sadness, hopelessness or purposelessness
  • Misplaced guilt or feelings of excessive worthlessness nearly every day
  • Loss of pleasure or interest in activities or hobbies that used to be enjoyable
  • Disproportionate reactions to minor concerns with irritability, frustration or angry outbursts
  • Feelings of fatigue or low energy almost every day
  • Significant changes in weight
  • Notable changes in appetite
  • Psychomotor retardation (such as moving or talking slowly) as observed by others
  • Psychomotor agitation (such as feeling restless or difficulty sitting still)
  • Diminished ability to think, focus, recall or make decisions
  • Difficulty sleeping, awakening early or oversleeping
  • Thoughts of death or suicide, or suicide attempts

Depressive Disorder Classifications:

Major Depressive Disorder

Persistent Depressive Disorder

Perinatal Depression

Psychotic Depression

Seasonal Affective Disorder

Process Addictions

Process Addictions

Addiction can manifest itself in other ways besides drug or alcohol abuse. During treatment, absent the primary substance of abuse, it is not unusual for other addictive behaviors to surface. At Harmony Place, we work with clients to identify such behaviors. We endeavor to guide our clients towards recovery from all addictive behaviors.

Process Addictions are repetitive behaviors sometimes referred to as “behavior addictions.” In the short-term, some behaviors provide a “reward”, and survival is dependent upon certain rewards. For example, eating and sex are biological processes that are pleasurable, so the reward is the impetus for reproduction and survival of the species.

Current evidence reveals that behavior addictions possess features that resemble those of substance addictions. These behavior addictions serve to provide the same type of immediate gratification that is derived from substance use. They both provide rewards that will incentivize individuals to repeat the behavior or activity despite any negative consequences that follow or that interfere with day-to-day living.

Behavior addictions may initiate with feelings of tension or excitement before performing the behavior and a feeling of pleasure or relief when the behavior is completed. Over time, the behavior addiction, like substance dependence, becomes more compulsive and less pleasurable. Afterward, individuals typically experience guilt or regret for their actions. At this point, the behavior is acted out to avoid any negative effects (i.e. reduce anxiety or quiet obsessions).

Disordered Eating

Gambling Addiction

Sex Addiction


PTSD and Trauma

PTSD and Trauma

Trauma is a distress response or emotional state that results from exposure to serious emotional stressors or physical injury. Combat, natural disasters, car accidents, or sexual assault are examples of life-threatening or life-ending events considered to be traumatic. Not everyone is exposed to potential fatal or injurious events, however. Experiencing devastating, dangerous, or terrifying events can also trigger a trauma response. The sudden unforeseen death of loved one can also prompt an acute stress response.

Most people who experience a traumatic incident have short-term difficulty adapting and coping with the effects of the trauma. They do not escape unscathed, though. After exposure to a traumatic event, shock or disbelief are expected to follow. However, most individuals recover from the experience of the traumatic stressor naturally with time, support, and self-care.

When the trauma response symptoms last more than one month and cause clinically significant impairment in social or occupational functioning, the criteria for Post-Traumatic Stress Disorder (PTSD) have been met. PTSD is a psychological disorder that can surface following a traumatic event.

Symptoms of PTSD present within three months of the traumatic experience. The distinguishing features of a PTSD diagnosis include:

Exposure to threat or actual event, directly or indirectly

Intrusion or Re-experiencing


Negative thoughts or feelings that begin or worsen following trauma

Increased arousal and reactivity

Other features

Frequently Asked Questions

Co-occurring Disorders FrequentlyAsked Questions

Do you have any additional questions about this complex subject? See if we have your answer in the frequently asked questions below, or reach out to us directly if you have a more specific question.

Does the substance use disorder or the mental health disorder come first?

What are the common signs of anxiety?

How does Harmony help with mental disorders after residential treatment?

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