Almost 9 million Americans suffer from co-occurring substance use and mental health disorders. Sadly, only about 7.4% receive the appropriate care that is needed to handle co-occurring disorders. The remainder often bounces in and out of various rehab or mental health facilities that are either ill-equipped to handle the situation or are using varying and inconsistent treatment methods. Finding the right type of facility that has trained staff and proper protocols, is imperative in achieving the best outcome for recovery.

What is a Co-Occurring Disorder?

The term Co-occurring Disorder refers to the coexistence of both a mental health disorder and a substance use disorder. You may have also heard the term Dual Diagnosis, which has a similar definition. The most common mental health disorders seen in drug and alcohol rehab facilities are mood disorders, anxiety disorders, post-traumatic stress disorders, severe mental illnesses, antisocial personality disorder, and borderline personality disorder.

Dual Diagnosis, or Dual Disorder, was coined in the 1980s in reference to having both a mental health and substance use disorder. However, it could also be used to describe having two mental health disorders. And because of the specific use of the word “dual” the term implies only two disorders are occurring. In reality, a person could be suffering from multiple disorders concurrently. Thus, over the years, the term evolved and became known as “Co-occurring Disorder” or COD. So what is a co-occurring disorder specifically? The Substance Abuse and Mental Health Services Administration (SAMHSA) states that ”a diagnosis of co-occurring disorders occurs when at least one disorder of each type can be established independent of the other and is not simply a cluster of symptoms resulting from the one disorder.”

Evolution of Co-occurring Disorders

Many years ago facilities would treat mental health disorders and substance use disorders in different facilities with different methodologies. This resulted in inadequate treatment as those suffering from mental health disorders were not properly treated for their substance use, and vice versa. The disconnect in care was a considerable issue because unfortunately, individuals who suffer from co-occurring disorders are at particular risk for poverty, homelessness, incarceration, suicide, illness and hospitalization.

In the 1970s, as low success rates became evident, practitioners began to see the connection between mental health and substance use and the implication for treatment outcomes. The earliest studies were focused on the relationship between depression and substance use. In the 80s and 90s, the two fields started to see that depression was not the only issue. There was actually a wider range of mental health issues that were associated with substance abuse. At that time, substance use treatment programs reported an average of 50-75% of clients had co-occurring disorders while mental health practitioners averaged 20-50% of patients had co-occurring substance use disorders.

Nowadays, medical professionals and addiction specialists understand that substance use and mental health disorders are intertwined and study the two in a combined field. What’s more, recent studies show that using integrated treatment is the most effective approach for co-occurring disorders. There is a significant drop in relapse, reduction in suicide rate, and an increase in long-term abstinence. Take this study as a primary example:

In a study by the National Treatment Improvement Evaluation Study (NTIES) of

4,411 persons (adults, young adults, and adolescents) there was a four-fifths reduction in suicide attempts one year after substance abuse treatment where an integrated approach was used.

Importance of Integrated Treatment Programs

Integrated substance use rehabilitation programs are specifically designed with both disorders in mind so that the client’s specific needs can be addressed appropriately. In fact, facilities that offer treatment for co-occurring disorders should have staff that has specialized training in this area. Some of the positive attributes of integrated treatment are:

  • Takes into account the particular side effects of mental health disorders such as reduced attention span, low motivation, and social anxiety.
  • Effective medication therapy that considers the client’s full diagnosis.
  • Group therapy with individuals in similar circumstances results in a stronger and more understanding support system.
  • Addresses the distinct relapse triggers that those with mental health disorders are prone to such as depression, mood swings, and panic attacks.

Treatment of Co-occurring Disorders

With continued research and studies in the area of dual diagnosis and co-occurring disorders, clinicians and medical professionals have been able to determine best practices, guiding principles, and fundamental elements for treatments of co-occurring disorders. According to a publication by SAMHSA, “successful strategies include interventions based on addiction work in contingency management, cognitive-behavioral therapy, relapse prevention, and motivational interviewing.”

The following are key approaches to treatment for co-occurring disorders:

Residential (inpatient) Rehabilitation – Residential rehab is ideal for its structured and supervised environment. Receiving round-the-clock care can be extremely beneficial to those suffering from co-occurring disorders.

Outpatient Rehabilitation – In some milder cases and when inpatient rehab is impractical due to other obligations such as work, outpatient rehab is a viable option, allowing the individual to benefit from a variety of therapies while continuing to reside in their home.

Medication Therapy – Pharmacological advances have produced antipsychotic, antidepressant, anticonvulsant, and other medications that are more suitable to this population. This allows for an easier recovery process and transition into sobriety while allowing the client to maintain a level of control.

Individual Therapy – Individual therapy is paramount as the focus is working through deep-rooted issues and limiting beliefs while building up confidence, self-worth, and motivation.

Support Groups – As evidenced by popular 12-step programs, support groups can be a vital source of community and strength. Being surrounded by individuals who understand your situation on a personal level can be more reassuring.

Holistic Therapies – Holistic therapies approach rehab from a whole-body perspective – the mind, body, and soul. Thus, they are ideal for integration into treatment for co-occurring disorders as they work to heal all aspects of a person, not just the addiction.

Family Counseling – An important aspect of rehabilitation so that family and loved ones can gain a deeper understanding and can be better equipped to handle situations that may arise. 

Aftercare Support – As many people know, recovery is a life-long journey. With a co-occurring disorder, this truth is amplified. Aftercare support provides essential services such as counseling, group therapy, and other resources that can help you integrate back into society and stay on a path of sobriety.

Co-occurring disorders shouldn’t be a barrier to receiving treatment. At St. John’s Recovery Place, we have the right team of medical professionals in place that will develop the most promising treatment program for your unique and specific needs. Contact us today to find out more information about our program and how you can start your recovery journey.


  • Center for Substance Abuse Treatment. Substance Abuse Treatment for Persons With Co-Occurring Disorders. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 42.) 1 Introduction. Retrieved March 31, 2021 from
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  • Volume 28, 2013 – Issue 3-4: The Role of Social Work in the Prevention and Treatment of Substance Use Disorders. Pages 424-439. Published online: 03 Jun 2013. Retrieved April 1, 2021 from
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