Co-Occurring Disorders FAQ's

The term co-occurring disorders refer to mental disorders that are independent of substance use but that occur at the same time with a substance use disorder.

A person with co-occurring disorders has at least one mental health problem and one substance use problem. Many of those with co-occurring disorders have more than one mental illness and more than one substance use issue resulting in multiple life problems.

Mental health problems can range from mild depression or anxiety to severe and persistent mental illnesses, such as schizophrenia or bipolar disorder. Substance use problems may range from abuse of alcohol or marijuana to dependence on intravenous drugs such as heroin or methamphetamine.

More than 10 million people in the United States may have co-occurring mental health and substance use disorders.

3 million people with co-occurring disorders may have at least 3 disorders, and 1 million people with co-occurring disorders may have 4 or more disorders.

Only a mental health professional (such as a psychiatrist, psychologist, licensed mental health counselor, or a licensed social worker) and/or substance use counselor can diagnose co-occurring disorders.

A professional will ask questions about your substance use and mental health history and may want to monitor you over a period of time in order to make a correct diagnosis.

There are many resources on the internet that can help you to determine whether you may have substance use or mental health problems.

There are many ways in which co-occurring disorders develop. Most people with co-occurring disorders report that the symptoms of mental illness began first and that they used alcohol or other drugs to cope with the symptoms (often known as self-medication).

For example, if you feel depressed, you may find that a couple of drinks or a little cocaine makes the depression lift, at least for a while.

When the buzz or the high wears off, you will probably feel worse. The solution may be to drink or use more. The more you drink or use, the worse you feel, and the cycle of co-occurring disorders begins.

The cycle gets worse when the other consequences of substance use – family difficulties, employment problems, legal issues, or financial troubles – come into play.

The cycle doesn’t have to start with symptoms of mental illness though. For some people with co-occurring disorders, the cycle begins with substance use.

Alcohol or drugs may trigger a genetic predisposition to a mental illness, or the consequences of substance use may generate depression or anxiety.

Finally, it is possible that the mental health and substance use problems develop independently of each other.

No matter how the co-occurring disorders developed, the symptoms of the disorders interact, typically resulting in increased symptoms of both or all disorders.

Any mental illness can co-occur with any substance use disorder. Studies have shown, however, that people with certain mental health disorders are more likely to also have a substance use problem.

85-90% of those with Post-Traumatic Stress Disorder also have a substance use disorder.

About 82% of those with Antisocial Personality Disorder misuse substances.

Around 71% of persons with Bipolar Disorder use substances.

About 50% of those with Schizophrenia also use substances.

Adolescents who have Conduct Disorder, Oppositional Defiant Disorder, or Attention Deficit Disorder are up to 7 times more likely to have a substance use disorder than those without these disorders.

Adolescents with depression are 4 times as likely to use substances

Adolescents with anxiety are twice as likely to use substances compared to adolescents without anxiety.

Neither….or both, depending on how you think about it.

For people with co-occurring disorders, treatment for mental health and substance use issues should happen at the same time. This simultaneous treatment is referred to as integrated treatment.

Truly integrated treatment involves treating both (or all) disorders as if they were different parts of one disorder, just as they are components of one person.

Integrated treatment focuses on the interaction between or among the disorders.

Co-occurring disorders are sometimes treated in either a sequential or parallel manner.

Sequential treatment means that you receive either mental health or substance use treatment first, followed by treatment for the other issue. Parallel treatment means that mental health and substance use disorders are treated at the same time, but separately.

There are many problems with sequential and parallel treatment including mixed messages from different treatment providers. This often leaves you to figure out for yourself what to do.

CenterPointe specializes in truly integrated treatment. We treat both issues together in real-time.

The idea that addicted people can’t take psychiatric medications because they won't really be clean and sober is false and dangerous.

There is a big difference between alcohol, street drugs, and medications prescribed by a psychiatrist. It is typically not recommended that persons with co-occurring disorders take potentially addictive medications such as benzodiazepines or opiates (although that decision needs to be made on an individual basis).

Most psychiatric medication is not addictive. Taking it will not jeopardize your sobriety. In fact, taking the medication may help you remain free from alcohol and other drugs.

Think of it this way – if you are addicted to meth, and have schizophrenia, which makes you hear voices, are you better off continuing to hear those voices or better off taking medication so you don’t hear the voices?

Which option would more likely lead to relapse?

If you find yourself being pressured to stop taking your psychiatric medication because someone thinks you're not clean and sober, provide that person with some education about the medication (you can get pamphlets and other information from your doctor).

If they continue to pressure you, consider whether he or she is really a supportive person in your overall recovery.

No. You need treatment for both (or all) of the disorders, and at the same time.

For example: let's say you’re depressed and you use cocaine as a way to cope with the depression. It's likely that you have become addicted to cocaine.

If you stop using cocaine, the depression won't go away because it was there in the beginning.

If you tried to get treatment for the depression but continued to use it, you'd likely not learn any new skills for coping. Why would you? Your old coping skill is probably still working, and working much more quickly than any new skills or medication would work.

In the end, you'd still be depressed and addicted.

Another example: say you've been drinking for years now, and the drinking has caused chemical changes in your brain, created legal and financial trouble, and led to a divorce.

These events have caused you a great amount of anxiety, and you find you're having panic attacks quite often.

If you quit drinking but still have panic attacks, how long do you think you'll stay sober? Probably not for long; you'll likely go back to drinking because of the discomfort of the panic disorder.

The bottom line is that if you have co-occurring disorders, you need treatment that addresses ALL of your issues simultaneously, or your chances of recovery are greatly reduced.

There are many ways to find help. Good places to start may be at the SAMSHA treatment locator or the CARF International websites.

These sites allow you to search for a provider in your area and there are descriptions of their programs. The description will indicate whether the program provides treatment for people with co-occurring disorders.

You can also call your state's Health and Human Services Department for a referral.

CenterPointe offers walk-in outpatient services in the Lincoln community and residential treatment in both Lincoln and Omaha.

Just don't give up! Help is out there and recovery from co-occurring disorders is possible.