The Unique Challenges of Co-Occurring Disorders

Woman in hat struggling with co-occurring addictions

When someone with an addiction walks through the doors of a treatment facility, there is likely more to their story than the substance abuse that has led them there. There is a person that needs to be healed mentally and physically.

Statistics show that they’ve most likely experienced some type of trauma or they are struggling with a mental health disorder such as depression, bipolar disorder or post-traumatic stress disorder. The substance abuse is just one more layer of the battle they are facing.

The 2016 Surgeon General’s Report on Alcohol, Drugs and Health revealed alcohol was the most prevalent substance abused, followed by marijuana, misuse of prescription pain relievers, cocaine and methamphetamines.

More than 8 million people, around 40 percent of those with a substance use disorder, also have a Dual Diagnosis or co-occurring mental health disorder – yet only 6.8 percent of these individuals receive treatment for both conditions. More startling is 52 percent receive no treatment at all. [1]

Whether the excessive drug or alcohol use led to the mental illness or that the mental issue has lead the person to self-medicate, the treatment of co-occurring disorders is extremely complex and has continued to evolve over the last 30 years.

Dual Diagnosis is common especially in homeless populations and those that are in the criminal justice or military fields. Clinicians continue to refine programs across the country to ensure long-term recovery. Undiagnosed or untreated Dual Diagnosis can lead to homelessness, incarceration, suicide or early death. {2}

The Progression of Dual Diagnosis Treatment

Traditionally, those with co-occurring disorders either treated one condition and not the other or they received parallel treatment, meaning the mental health and substance abuse issues were treated separately by different medical professionals at different facilities and with completely different approaches.

Woman by beachOnly one condition was assigned primary. Over time, this proved to be ineffective, not to mention costly for patients.

By the mid-1980s a new approach involving integrated treatment of primary and behavioral care.

Patients with co-occurring disorders started to receive treatment from a multidisciplinary team, working in a more collaborative, non-confrontational way – and most importantly, both the mental health and substance abuse issues were categorized as primary and treated simultaneously. [3]

Why Integrated Treatment?

Integrated recovery plans address the unique and difficult challenges the mental health disorders bring, such as a reduced attention span, lack of motivation or severe depression.

Integrated treatment helps patients address their unique relapse triggers and group therapy sessions can be structured for those with mental challenges. Also, medication therapy is more effective when the plan addresses both disorders. [3]

Successful Integrated Treatment referenced an article by Dr. Kenneth Minkoff, a pioneer in the field of Dual Diagnosis treatment, who identified the best standards in integrated treatment. These include conducting assessments for mental health disorders early in the rehab process so treatment can begin promptly.

Minkoff also emphasized that the co-occurring conditions are treated with the same level of attention and care as the substance abuse and that both the mental illness and substance use disorders are treated as chronic, relapsing conditions that require long-term care. [4]

Access to Care

Woman in fieldThe Substance Abuse and Mental Health Administration states people with co-occurring disorders are best served with integrated treatment.

Luckily insurance companies have recognized the need with recent changes under the Affordable Care Act.

It extends the impact of the Mental Health Parity and Addiction Equity Act (MHPAEA) so that many health plans’ coverage of mental health and substance use disorders are equal to physical health coverage. [5]

About the Author:

Todd BarnesTodd joined JourneyPure’s digital marketing team as a content writer in June 2017. His responsibilities include writing in-depth articles on addiction news, treatments and personal stories from those struggling and succeeding in their recovery process. He is a Hands On Nashville and Under the Bridge volunteer and takes pride in helping those needing a voice in a world where stigmas overshadow humility.


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The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Addiction Hope understand that addictions result from a combination of environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.

Published on August 9, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on August 9, 2017.
Published on

About Jacquelyn Ekern, MS, LPC

Jacquelyn Ekern founded Addiction Hope in January, 2013, after experiencing years of inquiries for addiction help by visitors to our well regarded sister site, Eating Disorder Hope. Many of the eating disorder sufferers that contact Eating Disorder Hope also had a co-occurring issue of addiction to alcohol, drugs, and process addictions.