Co-occurring disorders, formerly known as dual diagnosis, is the technical term for mental health disorders that coexist with substance abuse disorders. Approximately 8 million individuals in the United States of America suffer from co-occurring disorders, particularly as people with mental health disorders are statistically more likely than those without to have a substance abuse disorder. Furthermore, co-occurring disorders are often difficult to identify, due to the wide array of symptoms, and as a result, only one disorder is identified for treatment. This often means that the symptoms are generally unalleviated until mental health professionals and substance abuse counselors are able to properly diagnose each disorder. Dual diagnosis is often a misnomer for co-occurring disorders, along with comorbidity – neither of them truly encompass co-occurring disorders, which is a specific term for the co-occurrence of substance use disorders alongside mental health disorders.

Addiction is generally defined as the psychological and physical dependence upon substance(s), whereupon physical dependence is the tolerance of any given drug and the subsequent manifestation of symptoms indicating physical withdrawal when that drug is absent and psychological dependence the craving and mental obsession for the drug and its effects. Commonly abused substances include alcohol, marijuana, cocaine, heroin, prescription opioids, benzodiazepines, and methamphetamines. Mental illness, as defined by the Diagnosis and Statistics Manual of Mental Disorders, 5th edition (DSM-5) defines diagnostic criteria, classification information, and explanations for each specifical mental health disorder, along with signs and symptoms and their duration – mental disorders are not equivalent to developmental disabilities. Common mental health disorders are depression, generalized anxiety disorder, bipolar disorder, obsessive-compulsive disorder (OCD), schizophrenia, and personality disorder. Any of these can manifest as co-occurring disorders, and it is not always clear whether the disorder motivates the substance abuse or the substance abuse triggers the mental health disorder.

The nature of the symptoms of co-occurring disorders varies greatly depending on the combination of disorders and substances. Common co-occurrences include alcohol addiction and panic disorder, major depression and alcohol abuse disorder, marijuana addiction and schizophrenia, cocaine addiction and anxiety disorders, trauma and substance abuse, obsessive-compulsive disorder and anorexia nervosa, self-harm behavior and opioid abuse, and binge eating disorder and alcohol abuse disorder. These are not the only combinations, though, as any personality disorder can co-occur with a substance abuse disorder. Causes for these co-occurring disorders depend greatly on both internal and external factors, but common causes are genetics, loss of a job or loved one, past history of abuse/trauma, abnormalities in brain chemistry and disruptions in prenatal brain development, poor nutrition or exposure to environmental toxins, low self-esteem or neglect, and dysfunctional family relations and intimate relationships. Generally, individuals living with co-occurring disorders struggle to function on a daily basis, grappling with an inability to maintain employment and functional relationships, financial and legal issues, extreme mood swings and violent behavior, suicidal ideation, prostitution or unsafe sexual behavior, and hygiene and health problems. All of this makes relapse complicated, and leads to complications such as hospitalizations, financial problems, social isolation, family problems, homelessness, sexual and physical victimization, and incarceration.

As a result, treatment for co-occurring disorders must aim to treat both the mental health disorder and the substance abuse disorder, including treatments such as medical detoxification, psychotherapy, family therapy, social support groups, medication to treat mental health disorders, and aftercare treatment. Some psychotherapy approaches that may also be used as treatment are cognitive behavioral therapy, dialectical behavioral therapy, and interpersonal therapy. Treatment levels depend on duration and severity of the individual’s condition, with detoxification, as well as residential treatment, partial hospitalization treatment, intensive outpatient treatment, or outpatient treatment depending on the severity within the individual. We at Divine House utilize a myriad of expert professionals in order to create a treatment team that is uniquely qualified to treat the various different aspects of co-occurring disorders. We focus on lifestyle changes such as improving sleep habits, addressing any chronic medical conditions, improving communication skills and nutritional behaviors, working on family and intimate relationships, addressing and managing legal issues as well as job skills and work-related issues. Furthermore, we recognize that recovery is a lifelong process – simply because a patient has completed therapy and is well on their way to rehabilitation does not mean that they do not require aftercare, which is why we provide recommendations to programs such as 12-step meetings, recovery support groups, online support groups, and outpatient therapy sessions.