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Co-Occurring Disorder and Addiction


A Comprehensive Guide


Did you know that approximately 50% of individuals who have a substance abuse disorder will develop a mental health illness? This statistic remains the same for those suffering from mental health illnesses who go on and develop an addiction to a substance.

Even more shockingly, 60% of adolescents have a co-occurring disorder and addiction. Co-occurring disorders have risen from 2015 to 2018 and are putting more adults and adolescents at serious health risks.

There are treatment options that address mental health illnesses and substance abuse disorders. If you want to learn more about treatment options and common co-occurring disorders, then keep reading on.

 What Is a Co-Occurring Disorder?


A co-occurring disorder entails someone who has a substance use disorder as well as a mental illness. Substance disorders are commonly seen with anxiety, depression, PTSD, and other mood or personality disorders.

It is also extremely common to see co-occurring disorders in youth. The nature of co-occurring disorders requires specialized training and treatment plans that are often found in drug and rehab centers.

These trained individuals develop individual treatment plans that factor in mental health illnesses in recovery, detoxing, and long-term success.

In order to explain why co-occurring disorders are so common, researchers have found three possible mechanisms.

The first is overlapping risk factors. This may include an individual’s genetics, the environment they grew up in, or a traumatic event they experienced.

Another factor would be self-medicating. Self-medicating can be seen in individuals that have a mental illness and use substances to cope with symptoms.

Lastly, drug-induced brain changes hindered by mental health disorders can cause an increase in the likelihood of mental health illnesses. Mental disorders that affect the brain can be made worse by these substances.

A co-occurring disorder involving substance abuse is more common than initially thought. Because both addiction and mental health illnesses affect the brain, it puts someone more at risk for suicidal tendencies and overdoses.

Approximately one in four people with significant mental illnesses will also have an addiction to a substance.

Alcohol and Depression

A common co-occurring disorder and addiction are found with alcohol and depression. This disorder is tricky for determining the root cause. For example, someone might drink to mask the symptoms of depression, or excessive drinking can lead to depression.

Many other studies have also shown a correlation between veterans, PTSD, and alcohol consumption.  There are three main categories that predispose someone to this co-occurring illness which are:

  • Family history
  • Personality types
  • Individual history

Genetics was previously mentioned as a risk factor for several addictions. Research is pointing towards genetics as one of the factors that lead to alcohol abuse and depression.

This does not mean that someone will develop these disorders if a parent had them, but it should bring awareness of the added risk. Lower self-esteem has also been associated with an added risk to someone abusing alcohol and higher rates of depression.

Finally, personal history plays another key role in this development. For example, abuse and trauma are associated with a greater likelihood of these illnesses.

Abuse and Addiction

Several researchers have looked into the correlation between abuse and addiction. Domestic abuse affects one in four women and one in nine men. Oftentimes, domestic violence is associated with alcohol abuse.

Domestic abuse can take on many forms including physical, sexual, emotional, psychological, and financial. Alcohol affects inhibitions and judgments. This is largely why it is correlated with higher reports of violence.

Many times, the complexity of co-occurring illnesses, such as depression, lead to increased drinking and violent behavior.

This twisted web occurs with other substances outside of alcohol. Drug addictions can also lead to domestic abuse. In fact – up to 60% of domestic violence cases involved the abuse of substances.

Domestic abuse is one of the causes of increased PTSD, anxiety, or depression for victims. In return, this leads to increased use of substances to mask the symptoms of mental illnesses by victims.

For this reason, both partners should receive proper medical treatment. If there are children in the household, this also places the child more at risk of developing a mental health disorder or addiction later on in life.

Sexual abuse is one of the leading factors for women developing a co-occurring disorder and substance abuse. Rape victims are ten times more likely to use hard drugs and over five times more likely to abuse prescription medications.

Substance Abuse Disorder

Substance abuse disorder is also known as a drug disorder. Sometimes, this term also gets used for alcohol abuse. Alcohol use disorder is typically used by practitioners for those suffering from alcohol abuse.

Contrary to popular belief, substance abuse disorders can include abuse of prescribed medication. The best example of one of the most significant drug abuses is oxycodone.

This is otherwise known as the opioid crisis and initially stemmed from prescribed opioids in the 1990s. In 2010, heroin started becoming more popular and led to many deaths. Most recently, the news has highlighted the concern that fentanyl has had in increased deaths from overdoses.

Substances include more than just illegal and legal drugs. It can include things such as marijuana and nicotine. Essentially, an addiction is when you are unable to control your behavior towards a specific substance.

Although any drug or substance causes harm with excessive use, addiction means that the person is unable to stop using. This causes more harm to themselves and their loved ones.

Addiction is a tricky topic. Not everyone responds to drugs the same way. Some people are more at risk of developing an addiction to one substance compared to others.

Certain people have a potential genetic component or predisposition towards addiction and substance abuse. In general, opioids tend to be more addictive than others.

Drug Addictions

There are a variety of legal and illegal drugs that put someone at risk of becoming addicted. Additionally, some of them have different withdrawals and symptoms compared to others. Rehab and detox centers specialize in treatment plans for specific addictions.

Some common drugs that lead to addictive behaviors include:

  • Heroin
  • Benzodiazepines
  • Opioids
  • Heroin
  • Methadone
  • Anti-Depressants

There are general signs that someone has become addicted to drugs, such as requiring more of a substance to feel its effects. This is known as developing a tolerance to drugs which can be an indicator that you or a loved one needs help from a health care professional or rehab center.

Other symptoms of drug addiction include withdrawal effects when the drug wears off, loss of interest in hobbies or spending time with family, obsessively thinking about the substance, and increased risky behavior.

If you suspect a loved one is addicted to a drug, then you might notice physical signs or behavioral changes such as:

  • Bloodshot eyes
  • Increased tremors
  • Declining personal hygiene
  • Increased agitation


Excessive use of drugs such as fentanyl which are more potent than other opioids can lead to an overdose. Fentanyl places a person at an increased risk for an overdose, especially when combined with other drugs.

Some people are more susceptible to the effects of drugs at a lower dosage than others. This is an important fact to keep in mind because the therapeutic dosage of certain drugs differs.

An overdose occurs when the body is unable to fully metabolize the drug that was ingested. There are a few key signs to look for when suspecting someone has overdosed from drugs. These signs include changes in vitals, coma, cool and sweaty skin, shortness of breath, and excessive vomiting.

A suspected overdose is an event that requires immediate medical attention. These clinicians are better equipped for managing the serious effects of an overdose. They can also reduce the possibility of death or lasting complications.


Withdrawals are also common with addiction. Opioid withdrawals are one of the reasons why people are afraid to fully detox. Treatment centers are equipped to handle the symptoms and side effects of withdrawal from drug addictions.

Some common symptoms that one might see with opioid withdrawals include:

  • Nausea
  • Decreased appetite
  • Anxiety
  • Depression
  • Body aches
  • Other flu-like symptoms

Detoxification programs assess individual patients and can provide medication-assisted treatment plans for detoxing. This is one of the benefits of choosing a rehab center for opioid or other drug addictions.

Alcohol Use Disorder

Alcohol use disorder has the same characteristics of addictive behavior as with drug addictions. In this scenario, rather than using legal or illegal drugs, a person has a compulsive drinking disorder that harms their health.

Alcohol use disorder is a complex disorder that has close ties to genetic predispositions and the environment. A person is more at risk of abusing alcohol if they binge drink or start drinking at a young age. Also, having a family history of alcohol abuse and other mental health disorders puts someone at a higher risk.

Alcohol acts as a depressant which puts someone at risk of operating machinery or vehicles. When alcohol is combined with medications that also depress your system, it can lead to overdoses.

Prescription medications that act as a depressant include benzodiazepines, barbiturates, and other sleep medications. It is fairly common to see contraindications and warnings on prescriptions for avoiding consuming alcohol with the prescribed medication.

Excessive alcohol use can lead to other health issues involving the liver, digestive tract, heart, eyes, and brain. Many of the same signs of addiction to drugs are used for recognizing someone who has an alcohol abuse problem.

Alcohol is especially detrimental to adolescents and teens. Alcohol use before the age of 21 puts adolescents at a higher risk for mental health disorders, sleep disorders, self-harm, and risky behavior. Additionally, almost 40% of fatal motor vehicle accidents for teens and young adults between the ages of 16 and 24 involved alcohol use.

Alcohol Withdrawal

The timeline for detoxing from alcohol vary but typically runs between 7 to 10 days. During this time, it is common to see various withdrawal symptoms. Similar to opioid withdrawals, this process is best monitored in a rehab and detox center where skilled professionals can help you or a loved one through the process.

Withdrawal symptoms can start within eight hours of someone’s last drink. The symptoms typically present with visible shaking. For the next few days, the symptoms will start to progress to delirium, hallucinations, and mood swings.

Symptoms should start to subside after almost a week. The first few days are when someone is most likely to turn to alcohol for relief – this makes a rehab center even more critical to a person’s overall success.

Mental Health Disorder

Mental illnesses are usually classified under two different categories – any mental illness and serious mental illness. Most people with a mental health disorder fall under the first category.

A mental illness is classified as a disorder that affects someone’s behavior or mental and emotional status. There are three different levels of mental illness ranging from mild to severe.

A severe mental illness has the same definition as stated above with the qualifier that it greatly affects day-to-day activities. Some examples of serious mental illnesses include bipolar disorder and schizophrenia.

Almost 52 million adults in America had a mental illness based on reports in 2019. Additionally, females, young adults, and those who reported two or more races were the highest groups with mental illnesses.

Thirteen million Americans fell under the classification of having a serious mental illness.
Outside of bipolar and schizophrenia, there are many other types of mental health disorders.

Common mental health disorders include:

  • Anxiety
  • Depression
  • Eating disorders
  • Personality disorders
  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)

Anxiety and Depression

Anxiety and depression are two of the more common mental illnesses that people deal with. While not everyone receives treatment for these disorders, it is helpful to better understand them and how it affects the brain.

It is common to see both anxiety and depression in diagnosis. This is likely why depression is the number one most common mental illness and anxiety disorders are a close second.

Almost 50% of individuals who have one condition will have the other. Studies are showing how depression and anxiety alter the brain, much in the same way that addiction alters neural pathways. However, with anxiety and depression, the effect is slightly different.

By using MRIs, researchers found that people with both anxiety and depression had greater volumes in their amygdala. Those with only depression as a diagnosis had an almost 7% smaller-sized hippocampus compared to those without depression.

A smaller hippocampus puts someone at a greater risk of developing Alzheimer’s or dementia. Researchers made the suggestion that an earlier diagnosis of anxiety was helpful in the overall treatment courses for these patients.

Schizophrenia and Addiction

Some studies are looking at the links between serious mental illnesses, such as schizophrenia, and the link to addiction. There is no single or definitive cause for schizophrenia. Researchers believe it is a combination of genetics and the environment.

If you have a parent that has schizophrenia, it increases your likelihood compared to the general public. However, there are a variety of other factors that go into the development of this mental illness.

Dopamine and glutamate play a significant role in schizophrenia. In fact, areas of the brain respond to dopamine in a hyperactive manner, which leads to the typical signs of schizophrenia such as hallucinations and delusions.

In addition to genetic predispositions, some studies are showing that substance abuse can predispose someone to a more serious mental illness. The drugs that were more likely associated with triggering schizophrenia were methamphetamine, LSD, and marijuana.

This risk increases with the younger population.

Co-Occurring Disorder and Treatments

If you or a loved one has a co-occurring disorder and are looking for treatment, what can you expect? Cognitive-behavioral therapy (CBT) is one of the leading treatment methods for combating both addiction and mental illnesses.

CBT is ideal for patients who have addictions and one of the following mental illnesses:

  • Anxiety
  • Attention Deficit Disorder (ADD)
  • Bipolar Disorder
  • PTSD
  • Eating Disorder

CBT utilizes strategies that alter thinking patterns. It is based on the assumption that someone’s thought patterns lead to certain behaviors. If someone’s attitudes or beliefs impact how they behave, then CBT is a useful strategy in therapy.

For instance – if someone has negative thought patterns, this can result in psychological problems. These thought patterns can also result in behaviors consistent with addictive patterns or abuse.

By teaching new ways of thinking, practitioners find positive results in psychological mindsets and behaviors. A skilled clinician is critical during this process since they teach the patient skill sets they can use once discharged.

CBT Strategies

Some strategies that a practitioner might use for a CBT session include:

  • Identifying problems
  • Addressing wrongful assumptions
  • Identifying facts versus irrational thoughts
  • Recognizing past traumas
  • Offering different perspectives
  • Bringing awareness to one’s mood
  • Avoiding generalizations
  • Teaching positive thinking

There are many other tools and ways of thinking that skilled providers use with patients. Ultimately, changing someone’s thought processes takes time and open communication between the counselor and patient.

Some people work better in individual sessions, although CBT is offered in group therapies as well. In a rehab setting, the counselor might suggest that the person keep a CBT journal or participate in role-playing scenarios.

Medication-Assisted Treatment

Opioid withdrawal symptoms are challenging to deal with and can also lead to the exacerbation of mental illnesses. For that reason, it is sometimes important for the management of withdrawal symptoms in a controlled setting.

There are benefits of medication-assisted treatment plans for patients with opioid addictions. Some common medications include Naltrexone or Vivitrol. However, medication-assisted treatment plans are sometimes difficult for patients.

This is due to the long period of time that it takes for detoxing from opioids. In addition to the length of time, many of the withdrawal symptoms are extremely painful or uncomfortable to deal with.

Restore Detox Centers Is Here For You

A co-occurring disorder and addiction involve abuse of substances and mental illnesses. The combination of these two can make it seem impossible for you or a loved one to move on with your life.

Luckily, there are safe and effective treatments found in San Diego inpatient rehab centers that lead to positive long-term results. You shouldn’t have to wait any longer to find relief from the negative effects of addiction and mental illness.

Contact us today and find out more about how our treatment center can help you or a loved one get back up on their feet.


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