An In-Depth Overview of Drug Use and Co-Occurring Disorders

Last Updated on August 16, 2023

understanding co occurring disorders

About 7.9 million adults in the United States suffered from co-occurring disorders in 2014, according to the 2014 National Survey on Drug Use and Health publDrug Use and Co-Occurring Disorders: Most Common Co-Occurring Disorders with Addictionished by the Substance Abuse and Mental Health Services Administration.1 Unfortunately, since co-occurring disorders are often very complex, many individuals only receive partial treatment that is inadequate. This can lead to higher instances of related issues, such as medical problems, homelessness, incarceration, suicidal behaviors or death.2

What Is a Co-Occurring Disorder?

A co-occurring disorder (previously referred to as dual diagnosis) is a clinical term that is used to describe the existence of a mental health and substance use disorder that exists simultaneously.2  For example, a person may be suffering from both alcohol addiction and depression. Or an individual may be addicted to methamphetamine and also have an eating disorder.

It’s not always clear which disorder developed first or which disorder caused the other. This is because substance abuse is often a form of self-medication. Conversely, the severity of an already-existing mood disorder may increase as a result of substance abuse. Regardless of which developed first, it’s important to understand that there is no single cause of addiction, but a person with a mental illness is certainly more likely to develop an addiction.3

Drug Use and Co-Occurring Disorders: Most Common Co-Occurring Disorders with Addiction

There are several psychiatric disorders that may coexist alongside addiction, including:4

  • Clinical depression
  • Social anxiety disorder
  • Mania
  • Borderline personality disorder
  • Schizophrenia
  • Panic disorder
  • Bipolar disorder

Substance abuse and psychiatric disorders may also occur simultaneously because addictive substances change the way the brain works, impacting a person’s mood, thoughts, and behaviors.4,5

Co-Occurring Eating Disorders and Addiction

Eating disorders such as bulimia or anorexia are also common among people with substance use disorders. According to the National Eating Disorders Association, up to 50 percent of people with eating disorders also abused alcohol or illicit drugs, a rate that’s five times higher than the general population. Additionally, up to 35 percent of people who abused drugs or alcohol or were dependent on them have also had eating disorders, which is a rate 11 times greater than the general population.10

A 2010 SAMHSA review of clinical and community studies found that:

  • Women with either a substance use disorder or an eating disorder were more than four times as likely to develop the other disorder as women who had neither disorder.11
  • 14 percent of women with a substance use disorder had anorexia nervosa11
  • 14 percent of women with a substance use disorder had bulimia nervosa11

The relationship between substance use disorders and eating disorders is dynamic. People with eating disorders frequently misuse the same types of drugs or substances to achieve their goals regarding their appearance and weight or to help them cope. For example, a person in recovery from an eating disorder may abuse drugs or alcohol to cope with the triggers and stressors of recovery. Conversely, a person who is recovering from addiction, may severely restrict their diet or overeat to cope with the challenges of sobriety.

People who suffer from both substance use disorders and eating disorders frequently misuse the following substances:

Although more women experience eating disorders than men, both genders can suffer from them. The two types of disorders frequently occur simultaneously because they share many of the same risk factors. Risk factors for both substance abuse and eating disorders include:

  • Genetics
  • Brain chemistry
  • Family history
  • Depression
  • Anxiety
  • Social anxiety/peer pressure
  • Low self-esteem
  • Compulsive behavior
  • Social isolation
  • Risk for suicide

According to the Substance Abuse and Mental Health Services Administration, both eating disorders and substance use disorders share the same primary characteristics: compulsive behaviors, a loss of control, and continuing the behavior despite the negative consequences that occur as a result.11

Causes of Co-Occurring Disorders

Mental health and substance use disorders are highly complex and many of the same factors that cause mental illness also lead to substance abuse. These factors can be environmental or biological and often include:6

  • Genetics
  • Trauma
  • Stress
  • Early exposure to addictive substances

Symptoms and Signs of Co-Occurring Disorders

Because there are so many different combinations of co-occurring disorders, the symptoms and signs are vastly varied. This may make it difficult to diagnose all disorders that are affecting an individual. In addition, many of the signs and symptoms are overlapping.7

If a person is struggling with coexisting substance abuse and psychiatric disorders, they may exhibit the following signs and symptoms:

  • Deliberate isolation
  • Severe mood swings
  • Trouble at school or work
  • Strained relationships
  • Hallucinations
  • Extreme sadness or hopelessness for weeks at a time
  • Lying about whereabouts or activities
  • Sudden changes in appearance or hygiene
  • Withdrawal symptoms during attempts to quit drugs or alcohol
  • Loss of control over drug/alcohol usage

Assessment of Addiction and Co-Occurring Disorders

Screening for the presence of both substance use disorders and eating disorders is complex, as signs and symptoms of both can overlap. However, it is very important that drug rehab centers and programs repeat the screening process several times over the course of a client’s treatment, as the nature of the client’s overall health and well-being will fluctuate.

According to SAMHSA, assessment of addiction and co-occurring disorders should always be facilitated by a qualified healthcare professional and generally includes the review and collection of the following information:12

  • Family history and background: This should include any history of trauma, domestic violence, housing status, education and employment, health, financial status, marital status, and any legal problems.
  • Substance use history: This usually includes the age the client first started using drugs or alcohol, primary drugs of use, and family history of substance use, abuse, or addiction.
  • Mental health problems: It’s also important to collect details about the client’s mental health history, his or her family’s mental health history, and the client’s current mental health status (including medications and medication adherence).

It’s important that treatment professionals collect the information above, so they can adequately address both women and men’s co-occurring disorders.

Co-Occurring Disorders in Recovery from Addiction

In the past, many people struggling with substance abuse disorders and psychiatric disorders simultaneously were denied treatment until they were sober. Today, the standard for high-quality treatment regarding co-occurring disorders has changed.

Research has shown that treatment is much more effective when mental and substance use disorders are addressed at the same time.  This is called integrated treatment. Not only is this approach more affordable, but it is also more effective in treating all co-occurring disorders.2,8

Effective integrated treatment and care for co-occurring disorders should include the following characteristics:9

  1. Balanced use of psychotherapeutic medications and evidence-based therapies
  2. Parallel treatment of psychiatric disorders and substance abuse disorders
  3. Individual, group and family counseling

Although every person’s treatment plan should be individualized based on their circumstances and needs, the above characteristics of integrated treatment for co-occurring disorders can be met with a continuum of care plan that incorporates the following:

Increasing your own awareness of dual diagnosis and co-occurring disorders may help you understand your own struggle with addiction or be more compassionate towards the struggle of a loved one. In addition, education on the topic may also aid in finding the best type of treatment.

If you are searching for integrated treatment for yourself or a loved one, please contact Nova Recovery Center today to learn more about our long-term drug and alcohol rehab programs.


  1. https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf
  2. https://www.samhsa.gov/disorders/co-occurring
  3. https://www.drugabuse.gov/publications/research-reports/comorbidity-addiction-other-mental-illnesses/why-do-drug-use-disorders-often-co-occur-other-men
  4. https://www.drugabuse.gov/publications/research-reports/comorbidity-addiction-other-mental-illnesses/why-do-drug-use-disorders-often-co-occur-other-men
  5. https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Dual-Diagnosis
  6. http://www.dbsalliance.org/site/PageServer?pagename=education_brochures_dual_diagnosis
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753025/
  8. https://www.nationaleatingdisorders.org/substance-abuse-and-eating-disorders
  9. https://store.samhsa.gov/shin/content/SMA10-4617/SMA10-4617.pdf
  10. https://www.ncbi.nlm.nih.gov/books/NBK64196/
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