Co-Occurring Disorders
Patients entering addiction treatment often struggle with symptoms of anxiety, depression, trauma, or bipolar disorder without recognizing how these conditions fuel substance use (and vice versa). Clinicians say addressing both simultaneously is essential for long-term recovery, a model widely known as integrated or co-occurring care.
Experts point to mounting evidence that integrated treatment improves outcomes. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that people with co-occurring disorders experience higher rates of relapse when only one condition is treated. “Treating the substance use without addressing the underlying mental health condition leaves patients vulnerable,” said a spokesperson for SAMHSA. “Integrated care improves engagement, reduces hospitalizations, and supports sustained recovery” (SAMHSA).
The National Institute on Drug Abuse (NIDA) notes that mental health disorders and substance use disorders frequently overlap due to shared risk factors such as genetics, stress, and trauma. “Co-occurrence does not mean causation, but the disorders interact in ways that can intensify both,” NIDA guidance states, underscoring the need for coordinated care plans (NIDA).
Early in treatment, many patients do not see the connection. Withdrawal, shame, and crisis stabilization can mask psychiatric symptoms, clinicians say. “It’s common for people to attribute panic attacks or insomnia solely to quitting substances,” said Jamie P., a licensed addiction psychiatrist. “With careful assessment over time, we often uncover a persistent anxiety disorder or PTSD that predated the substance use.”
Integrated strategies typically begin with comprehensive, staged assessment. SAMHSA recommends screening for depression, anxiety, PTSD, and psychosis during intake, then reassessing after acute withdrawal to differentiate substance-induced symptoms from primary mental illnesses (SAMHSA). Standardized tools such as the PHQ-9 for depression and GAD-7 for anxiety help guide diagnosis and monitor progress.
Coordinated treatment plans combine evidence-based therapies for both conditions. Cognitive behavioral therapy (CBT), trauma-informed approaches such as Seeking Safety, and medication-assisted treatment (MAT) can be used together. The American Psychiatric Association (APA) supports the use of antidepressants, mood stabilizers, and antipsychotics when clinically indicated, emphasizing close monitoring for interactions with addiction medications like buprenorphine or naltrexone (APA).
Supportive services also make a difference. NIDA highlights that recovery-oriented case management, like housing support, employment services, and family education, reduces stressors that can trigger relapse (NIDA). “Stability in daily life is treatment,” said Alison, who leads a co-occurring outpatient program. “When people sleep safely, eat regularly, and feel connected, their symptoms become more manageable.”
Patients and families benefit from clear, practical strategies:
Seek integrated care settings. Programs that offer addiction and mental health services under one roof—or use shared treatment plans across providers—reduce gaps in care. SAMHSA’s Behavioral Health Treatment Services Locator helps identify co-occurring diagnosis resources (SAMHSA).
Use measurement-based care. Regular symptom check-ins, urine toxicology when appropriate, and medication reviews help refine treatment. “Patients feel seen when progress is tracked and discussed,” said [Clinician Name]. “It turns recovery into a series of achievable steps.”
Build a relapse-prevention plan that includes mental health triggers. Plans should address sleep, stress, conflict, and trauma reminders, not just substance cues. The APA recommends skills-based therapies to manage distress without substances (APA).
Coordinate peer and family support. Peer-led groups, including Dual Recovery Anonymous and SMART Recovery, can complement therapy. Family education reduces stigma and improves communication, which SAMHSA links to better adherence and outcomes (SAMHSA).
Prioritize lifestyle interventions. Exercise, structured routines, and mindfulness practices show promise in reducing cravings and improving mood. NIDA cites evidence that physical activity and sleep hygiene support neurobiological recovery (NIDA).
For many, recognition unfolds gradually. “I thought drinking caused my panic, so I figured it would disappear when I stopped,” said John, 31, who entered treatment after an ER visit. “When the anxiety stayed, my therapist explained how both problems fed each other. Treating them together finally made the panic manageable.”
Clinicians emphasize that progress may be nonlinear. Medication adjustments, therapy shifts, and life stress can produce setbacks. “The goal is not perfection,” said Alison. “It’s steady stabilization, fewer crises, better coping, and a life that feels worth protecting.”
As health systems expand integrated services, experts urge primary care and emergency departments to routinely screen for both disorders and refer to co-occurring care. The evidence is clear: treating addiction and mental health together offers the best chance at durable recovery.
Edited by: Rohun Sendhey, MSW
