What are Co-Occurring Disorders?

What are Co-Occurring Disorders?

Co-occurring disorders, also called dual diagnosis or comorbidity, refer to the simultaneous presence of a mental health disorder and a substance use disorder within the same individual. 

For example, someone may have both a mental health condition, such as depression, anxiety, or bipolar disorder, and a problem with drug or alcohol use.

It can be almost impossible to know which condition presents first – the substance use disorder or mental illness. 

However, much research shows that many people with mental health conditions like depression or anxiety disorder use substances such as alcohol or drugs to help them cope with the unpleasant symptoms associated with these conditions.

Co-occurring disorder symptoms can vary in intensity, and the severity of each condition may change over time.

Compared to individuals who have single disorders, those with a combination of mental health challenges often experience more physical and mental health issues. 

Moreover, those with co-occurring disorders may require more extended treatment periods than those with only one condition.

For instance, some individuals may need to try a combination of different treatments and therapeutic approaches to manage the symptoms associated with comorbid conditions.

This article explores co-occurring disorders, their symptoms, and effective treatments that can help.

In the meantime, if you (or a loved one) are struggling with a mental health condition and/or substance addiction, our friendly team in Bali is here to help.

How we can help

The Lighthouse Bali offers a comprehensive, personalized alcohol and substance abuse recovery program, a customized trauma program, and specialized counseling to help treat and address the complex symptoms and presentations associated with co-occurring disorders.

Treatment at The Lighthouse Bali typically involves a holistic, blended approach to mental health and substance use disorder recovery, which includes a combination of the following:

  • EMDR – eye movement desensitization reprocessing therapy. 
  • Cognitive behavioral therapy (CBT).
  • Dialectical behavior therapy (DBT).
  • Schema therapy.
  • Mindfulness-based therapy.
  • Psychoeducation.
  • 12-step program philosophies.

Our trauma-informed staff blends various evidence-based treatments and experiential approaches to address all the different parts that need to be unpacked and worked through for a successful, long-lasting recovery from co-occurring addiction and mental health issues.

Moreover, our customized treatment programs are flexible and can be adapted to suit your needs and preferences. 

Thus, we work with you to create a program that feels the most authentic to you, your history, and your recovery goals.

Contact our friendly team today to learn more about our addiction and mental health treatment programs and begin your transformative journey to lasting sobriety and wellness.

What are co-occurring disorders? 

As mentioned, co-occurring disorders, or dual diagnosis, refer to having a co-existing mental illness and a substance use disorder at the same time.

Below are some examples of co-occurring disorders and how these conditions may present:

Depression and alcohol use disorder

It is common for people with depression to use alcohol to alleviate or numb feelings of sadness or despair.

However, any relief the person experiences is usually temporary, and, as is often the case, the individual may continue using alcohol to get those same pleasurable rewards in the future.  

This can lead to alcohol dependency and may also worsen a person’s depressive symptoms over time.

Anxiety and opioid addiction

Studies show that anxiety disorders can lead to the misuse of prescription opioids or illicit drugs, as individuals may misuse opioids or other prescription pills to alleviate or take the edge off their anxiety symptoms.

If the above pattern persists, this can lead to opioid or prescription drug addiction, where the individual may require some form of inpatient treatment to overcome their drug dependency issues.


Bipolar disorder and cocaine use

The highs and lows of bipolar disorder can be exacerbated by the stimulant effects of cocaine, leading to more severe manic and depressive episodes. 

Additionally, when a person continues to use cocaine to manage the symptoms of bipolar disorder, they significantly increase their risk of developing a cocaine addiction.

ADHD and alcohol use disorder

The connection between ADHD and alcohol addiction is marked by a complex interplay of symptoms and behaviors. 

Individuals with ADHD often struggle with impulsivity, inattention, and hyperactivity, which can lead them to use alcohol as a form of self-medication to manage these symptoms. 

The calming effects of alcohol may provide temporary relief, but over time, this reliance can lead to the development of alcohol dependency. 

Additionally, the impulsive nature of ADHD can exacerbate risky drinking behaviors, further entrenching the cycle of addiction. 

This dual diagnosis requires comprehensive treatment strategies that address both ADHD symptoms and alcohol use disorder to achieve effective and lasting recovery.

Anxiety and benzodiazepine addiction

Co-occurring anxiety and benzodiazepine addiction often form a vicious cycle where each condition exacerbates the other. 

Individuals with anxiety disorders may turn to benzodiazepines, such as Xanax or Valium, for their calming effects, leading to dependency due to the drug’s high potential for addiction. 

Over time, tolerance builds, requiring higher doses to achieve the same anxiety-relieving effects, which can deepen the addiction. 

When benzodiazepines are not available to the individual, withdrawal symptoms can intensify anxiety, creating a compelling need to continue using the drug. 

This cycle of relief and dependence makes it challenging to treat either condition in isolation, highlighting the necessity for integrated treatment approaches that address both anxiety and benzodiazepine addiction simultaneously.

What are the characteristics of co-occurring disorders?

The complex nature of co-occurring disorders has meant that healthcare professionals treating clients for these conditions must be aware of how these disorders interact with each other and the challenges that may arise with each case.

Here’s what the researchers have found so far:

Complex interactions

The presence of one disorder can exacerbate or worsen the symptoms of the other, creating a vicious cycle that can complicate diagnosis and treatment. 

For instance, someone with depression may use alcohol to self-medicate, which can then worsen their depressive symptoms in the long run.

High prevalence rates

Co-occurring disorders are profoundly common: many people with substance use disorders also have underlying mental health issues.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), around 9.5 million US citizens had both a mental illness and a substance use disorder in 2019.

In addition, those with co-occurring disorders are at a higher risk for additional complications such as financial difficulties, social isolation, family issues, symptomatic relapses, homelessness, incarceration, and severe physical illnesses.

What are the symptoms of co-occurring disorders?

The symptoms of co-occurring disorders can vary between people and may depend on the type of addiction and mental health disorder you have, symptom severity, and other factors.

However, typically, the combined symptoms of a co-occurring disorder often include the following: 

  • Increased severity: Mental health symptoms may become more severe or increase with substance use, such as worsening depression or anxiety when intoxicated or withdrawing from either alcohol or drugs.
  • Mood changes: Rapid, significant mood changes that may be influenced by both the mental health disorder and the effects of the substance(s) you are taking.
  • Social and occupational impairment: Individuals with co-occurring disorders may experience difficulties in maintaining relationships, employment, or daily responsibilities due to the combined impact of both conditions.
  • High-risk behaviors: Many people with co-occurring disorders engage in risky behaviors, such as unprotected sex or driving while under the influence, which can be more common in those with dual diagnosis issues.
  • Poor treatment outcomes: Challenges in complying with treatment plans and maintaining recovery due to the dual demands in managing both disorders, which can produce poor treatment outcomes for those with co-occurring disorders.

It’s also essential for you to recognize the symptoms of substance use disorder so that you can get prompt treatment and support for your condition.

These symptoms are outlined below:

  • A loss of control over how much you drink or the quantity of drugs you take.
  • Exhibiting intense (often painful) withdrawal symptoms.
  • Craving the substance and believing that you need the substance to feel normal or to function.
  • Needing more of a substance to get the desired effect (tolerance).
  • Using substances in unsafe conditions or environments.
  • Secretive behaviors and lying to your loved ones about the severity of your substance use or believing that you don’t have a problem with addiction at all.

Co-occurring disorder treatment

Understanding and treating co-occurring disorders requires an individualized approach that addresses both mental health and substance use issues simultaneously. 

Integrated treatment models and tailored therapeutic interventions are vital and can effectively support individuals on their journey to lasting recovery and well-being.

Co-occurring disorder treatment typically requires:

  • Combined mental health care and addiction treatment within a comprehensive, customized treatment program.
  • A multidisciplinary team experienced in diagnosing and treating dual or co-occurring disorder issues. A good clinical team includes a combination of trauma-informed therapists, psychiatrists, and addiction specialists.

Treatment interventions

Co-occurring disorders are complex conditions and, therefore, require a more nuanced, multifaceted treatment approach to help guide people on the path to sustainable sobriety and wellness.

Treating these conditions includes a combination of the following therapies and approaches:

Cognitive behavioral therapy (CBT)

CBT helps individuals understand the association between their thoughts, behaviors, and substance use, allowing them to change maladaptive thought and behavior patterns that may cause or worsen their mental health and substance use.

Dialectical behavior therapy (DBT)

DBT is an effective therapy for treating emotion regulation issues (and other symptoms) experienced in co-occurring disorders.

Eye movement desensitization reprocessing (EMDR)

EMDR is a pioneering trauma treatment utilized in co-occurring disorder programs to help address unresolved trauma and other adverse experiences that may cause or exacerbate substance use and mental health issues. 

Using bilateral stimulation (side-to-side eye movements) and other techniques, EMDR helps clients reprocess traumatic memories so they can be effectively stored in the brain and the nervous system. 

Once these memories are successfully reprocessed, they no longer cause such unpleasant symptoms, and eventually, the person can view their traumatic history in a new, more empowering way.

EMDR offers countless benefits for individuals grappling with substance use disorder and other mental health issues. 

For instance, EMDR helps to:

  • Reduce the risk of relapse.
  • Reduce anxiety symptoms.
  • Minimize and alleviate depression symptoms.
  • Relieve the symptoms of post-traumatic stress disorder (PTSD).
  • Reduce alcohol cravings.

Support groups

Support groups, including Dual Recovery Anonymous (DRA), provide peer support and help for people with co-occurring disorders. 

Such groups offer those in recovery a community of individuals facing similar challenges, cultivating shared coping strategies and mutual support.


Within programs designed to address co-occurring disorders, psychoeducational sessions play a crucial role in raising awareness about the symptoms of various disorders and the connection between mental health issues and substance abuse. 

Additionally, relapse-prevention education helps clients recognize any triggers that may lead to substance abuse. 

These programs also teach individuals alternative coping strategies to help them manage intense emotions and daily stressors without needing to resort to substance use.

Other treatments often used as part of a co-occurring disorder treatment program may include:

  • Family support.
  • 12-step program philosophies.
  • Mindfulness therapy.
  • Art therapy.
  • Equine therapy.
  • Meditation.
  • Somatic therapies. 
  • Relapse prevention.
  • Aftercare and support programs.

Contact The Lighthouse Bali team today to learn more about our customized mental health and substance abuse recovery programs.

We are here and ready to guide you to lasting recovery and lifelong sobriety.

Speak to a specialist today!

Additional resources

  1. Co-Occurring Disorders, Psychology Today  


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