Co-occurring Disorders: When Two is Definitely Not Better Than One

First a note…My blog posts are mostly based on my experiences. But this time, I am explaining a specific combination of disorders, called co-occurring disorders (also known as COD, dual diagnosis or dual disorder). Because I don’t want you t have any confusion or misconceptions, I am also citing subject matter experts. While the style of this post is a bit more erudite, I feel that it’s necessary to explain this complicated (often misdiagnosed) subject…and I urge you and your loved ones to learn as much as possible about COD.

Co-occurring disorders describes having two or more addiction and mental disorders at the same time. For example, someone may suffer with substance abuse as well as a psychiatric or mental disorder, like bipolar disorder, schizophrenia, depression, or anxiety.

According to Psychology Today, “People with dual disorders are at high risk for many additional problems, such as symptomatic relapses, hospitalizations, financial problems, social isolation, family problems, homelessness, suicide, violence, sexual and physical victimization, incarceration, serious medical illnesses, such as HIV and hepatitis B and C, and early death. Any one of these problems complicates the treatment of co-occurring disorders.”

When “dual” might mean “more than two”

Certainly in the case of co-occurring disorders, two disorders are NOT better than one! And although the term implies that a person suffers from only two disorders, in fact, there may be even more.

It’s also important to note that COD is not at all uncommon, with more than half of all adults with severe mental illness being impaired by substance use disorders (abuse or dependence related to alcohol or other drugs).

Compared to patients who have a single mental health disorder or a drug or alcohol abuse use problem alone, patients with dual disorders often experience more severe and chronic medical, social, and emotional problems. Thus, relapse prevention must be specially designed for patients with COD, often requiring longer treatment and progress more gradually in treatment.

SAMSA, the government’s Substance Abuse and Mental Health Services Administration, says that approximately 8.9 million adults have co-occurring disorders. So you can see why COD is a critical consideration when planning an integrated rehab treatment program that is associated with lower costs and better outcomes such as:

  • Reduced substance use
  • Improved psychiatric symptoms and functioning
  • Decreased hospitalization
  • Increased housing stability
  • Fewer arrests
  • Improved quality of life

What comes first isn’t what’s important

In the case of COD, the chicken/egg metaphor comes to mind. But, don’t be misled.

While there is a strong link between substance abuse and mental issues, I don’t believe one directly causes the other. Unfortunately through, drug and alcohol abuse are closely linked to mental health issues with one worsening the symptoms of the other. states that, “Dealing with substance abuse, alcoholism, or drug addiction is never easy, and it’s even more difficult when you’re also struggling with mental health problems, but there are treatments that can help. With proper treatment, support, and self-help strategies, you can overcome a dual diagnosis and reclaim your life.”

It takes time to figure out what’s a mental health disorder and what’s a drug or alcohol problem. With my own clients I’ve noticed that denial and/or shame substantially complicates the issues. But neither will improve if ignored.

First, acknowledge the problems

The issues will NOT get better on their own, and in fact, could get much WORSE. So, to conquer those demons, you have to admit you have problems. Healthguide recommends that you:

  • Consider family history. 
  • Consider your sensitivity to alcohol or drugs.
  • Look at symptoms when you’re sober. 
  • Review your treatment history. (Have you been treated before for either your addiction or your mental health problem? Did the substance abuse treatment fail because of complications from your mental health issue or vice versa?)

Treat both disorders simultaneously

Whether your mental health or substance abuse problem came first doesn’t matter. I’ve found that recovery depends on treating both disorders at the same time with an integrated treatment program.

But, how do you find the right licensed and accredited treatment for you?

In my previous post on Managing Vs. Curing I said that ” … true recovery requires that we address the psychological, physical, emotional, and spiritual conditions that arise with addiction… Looking at, treating and supporting the whole person rather than just segmented parts are the foundation of a strong recovery and successfully managing addiction long term.”

That’s why I encourage you to look for a treatment program that:

  • Addresses both the substance abuse problem and your mental health problem.
  • Helps you share in the decision-making process and are actively involved in setting goals and developing strategies for change.
  • Includes basic education about your disorders and related problems.
  • Teaches healthy coping skills and strategies to minimize substance abuse, cope with upset, and strengthen your relationships.

And, please drop me an email at or phone 310-415-2299 if you need help and guidance in recognizing COD and getting treatment that fits your needs and situation like a glove.

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