Co-occurring Disorders and Substance Abuse

There is a high level of substance abuse issues among individuals with mental health disorders; at the same time, the percentage of people with a substance use disorders who also suffer from a mental health disorder is far lower. Huh? What does that mean? It means if you have a mental health issue you have a higher risk of developing issues with addiction, but individuals with co-occurring disorders (formally referred to as dual diagnosis) make up a relatively small, although still significant, portion of individuals with addiction issues.

According to the latest servery by SAMSA (The Substance Abuse and Mental Health Services Administration), 11.3% of individuals with a substance use disorder also suffered from a Serious Mental Illness*, around 2.3 million Americans in 2014. What kind of things are we talking about when we talk about serious mental illness? The list includes, but is not limited to, such things as Anxiety Disorders, Post-Traumatic Stress Disorder (both common among people with substance abuse issues), Personality Disorders, such as Borderline Personality Disorder, Depression, and Bi-Polar Disorder.

One of the difficulties in dealing with co-occurring disorders is that they can be difficult to diagnose during active addiction and early recovery. The symptoms of addiction often mimic the symptoms of mental illness and I am often skeptical of diagnoses made during these periods. Some, such as PTSD, are fairly straight forward, but many, such as Bi-Polar Disorder. Anxiety, or Depression, are far harder to make definitively early on.

What does this mean? First of all, I don’t believe you should ignore any diagnosis. An untreated mental health issue can make it extremely difficult, if not sometimes impossible, to recover from addiction. At the same time, a diagnosis of a mental health issue does not have to be a catastrophic event. Sometimes an apparent mental health issue may clear up in sobriety and most are very manageable, many without long term medication.

I think the key is staying engaged with a mental health professional. Untreated mental health issues can be a barrier to recovery and not taking action can be a path to relapse. If you have been diagnosed or you feel that you may have issues, seek professional help and above all be honest with the person you choose. It may take months of sobriety to get a really good picture of what is going on.

Jeff Harrolle

Thrive Counseling & Trauma Therapy


*Serious mental illness is defined as having any mental, behavioral, or emotional disorder in the past year (excluding developmental disorders and Substance Use Disorder) that substantially interfered with or limited one or more major life activities.


Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health