Co-Occurring Addiction & Mental Health Signs & Symptoms

Understanding Dual Diagnosis

Learn about co-occurring disorders

Co-occurring disorders refers to individuals who are dealing with a combination of substance abuse and mental illness simultaneously. Some patients may be struggling with three or more disorders. For example, a person may be battling an alcohol use disorder, depression, and anxiety.

While many patients are aware of their multiple issues and seek co-occurring disorders treatment designed to address them all, some enter treatment for one problem without realizing the existence of the co-occurring conditions. For example, many people who enter treatment for alcohol use disorder or another form of addiction discover during the therapy process that they are also suffering from depression, posttraumatic stress disorder (PTSD), or a similar mental health concern. The substance abuse may have originated in an attempt to self-medicate the symptoms of depression or PTSD, without the patient even realizing that he or she had this underlying disorder.

Because simultaneous conditions can impact each other, it is important to get professional care from a provider who is able to treat all of the disorders from which an individual is suffering. If a patient who is struggling with both depression and opiate addiction only gets help with the addiction, the continued depression (which may have led to the addiction in the first place) will significantly undermine the patient’s efforts to remain in recovery.


Co-occurring disorder statistics

Experts estimate that about 17.5 million Americans are currently struggling with a mental health disorder, and that about one in four of these individuals has also been engaging in substance abuse or developed an addiction. Unfortunately, only about 50% of individuals with co-occurring disorders actually receive treatment. Of those who do get care, many only receive treatment for one of their disorders. One study suggested that about 34% of dual diagnosis patients who got help received mental health assistance only, while 2% only received care for an addiction. Only 12% of people who are dealing with multiple conditions actually received treatment that was designed to address all of their issues and disorders.

Causes & Risks

Causes and risk factors for co-occurring disorders

As is true for chemical dependency and psychiatric conditions in general, co-occurring disorders can be fueled by a combination of internal (genetic) and external (environmental) influences. The following factors can significantly increase the likelihood that a person will struggle with the presence of co-occurring disorders:

Genetic: Decades of research strongly suggest a genetic component to the development of addiction and mental health problems. Having a history of depression or addiction in one’s family increases the odds that a person will also suffer from these problems. Recent scientific inquiries into the genetics of addiction have identified both individual genes and gene networks that appear to function differently in individuals who are struggling with addictions than they do in people who have not struggled with this disease. Also, being exposed to alcohol or another drug – or to certain viruses and toxins – while in the womb can increase a person’s odds of facing mental health concerns later in life.

Environmental: Family history of substance abuse and addiction can also be an environmental influence, as children who grow up in houses where alcohol or other drugs are freely used may believe that this behavior is acceptable. Mental illness can also have several environmental influences, including exposure to certain drugs or chemicals, accidents that involve damage to the brain, traumatic experiences (including combat, severe traffic accidents, and physical or sexual abuse), and stressful events (including financial pressure, death of a loved one, divorce, or similar experiences).

Risk Factors:

  • Family history of substance abuse or addiction
  • Family history of mental illness
  • Prenatal exposure to certain drugs, toxins, and viruses
  • Gender (men are said to be more likely to require treatment for dual diagnosis)
  • Low self-esteem or poor self-image

Signs & Symptoms

Signs and symptoms of co-occurring disorders

The nature of co-occurring disorders means that a person may be exhibiting a variety of symptoms related to their addiction and mental health concern(s). The following signs and symptoms may suggest that a person is suffering from more than one mental health condition:

Behavioral symptoms:

  • Turning to alcohol or other drugs to deal with anger or sadness
  • Stark changes in personality
  • Withdrawal from family or friends
  • No longer participating in activities that were previously of great importance
  • Erratic behavior
  • Intense bursts of energy
  • Associating with individuals who use drugs
  • Aggressive behaviors

Physical symptoms:

  • Insomnia or hypersomnia
  • Malnutrition
  • Significant weight loss or weight gain
  • Extreme fatigue
  • Poor hygiene

Cognitive symptoms:

  • Paranoia
  • Panic
  • Episodes of confusion
  • Disorientation
  • Inability to focus
  • Blackouts / loss of consciousness

Psychosocial symptoms:

  • Unwarranted anger or aggression
  • Dramatic mood swings
  • Extreme agitation and impatience
  • Hostility toward others
  • Extended periods of profound sadness
  • Feeling invincible or all-powerful
  • Periods of emotional detachment
  • Self-hatred
  • Suicidal ideation


Effects of co-occurring disorders

When individuals are struggling with the presence of co-occurring disorders and do not or are unable to receive treatment, there can be any number of adverse effects that are imposed upon them. While the actual short- and long-term effects will inevitably vary from person to person, some examples may include the following:

  • Overall decline in one’s psychological health
  • Overall decline in one’s physical health
  • Disturbances within one’s relationships with friends and family
  • Decline in work performance and attendance, potentially resulting in job loss and ongoing unemployment
  • Financial distress
  • Homelessness
  • Interaction with law enforcement as the result of abusing illegal substances
  • Social withdrawal and isolation
  • Onset of self-harming behaviors
  • Suicidal ideation

Galax helped me work through my depression and alcoholism.

– Gary
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