What a Co-Occurring Disorder Is and What It Is Not

The human brain is one of the most complex parts of the human body. There are often multiple systems operating at once and in relationship with one another. 

Because of this, it may not be surprising that substance abuse and alcohol can instigate, perpetuate, and sometimes mask symptoms of other mental and emotional disorders. And since substances like drugs and alcohol have a significant influence on the brain and its chemical balances, it can be tricky to identify where from or why something originated.

A “co-occurring disorder” means that someone has been diagnosed with a substance abuse disorder or addiction, as well as another psychological disorder at the same time. Co-occurring disorders (CODs) are also known as dual disorders or dual diagnoses, and should be addressed by professional treatment models that focus on both disorders and how they relate to one another. 

How Prevalent are CODs?

A number of studies have shown significant overlap between substance abuse disorders and mental-emotional disorders. One study found that in the last half decade between 50-70% of clients in treatment for substance abuse disorder had histories of at least one mental disorder. The same went for those in treatment for psychological conditions—between 20-50% had current or past histories with substance abuse disorders. 

It’s also common to have more than one psychological health disorder, which can make addiction patterns even more likely. Sometimes a mental illness precedes the substance abuse, while in other situations, mental or emotional disorders come about because of the abuse or addiction. In both cases, one disorder almost always exacerbates the expressions of the other disorder(s). 

What Types of CODs Are There?

While many CODs are quite severe—such as personality disorders, behavioral disorders and psychotic disorders—others are more mild and express as underlying anxiety or depression. 

There are also developmental disabilities that occur from a young age, like learning disabilities, which can affect social, linguistic, and even physical developments. But in conversations surrounding substance abuse and addiction, CODs more often refer to psychological disorders rather than developmental disabilities.

The broad categories of CODs include but are not limited to the following:

  • Mood Disorders (depression, bipolar)
  • Anxiety Disorders (social, PTSD, OCD, panic anxieties)
  • Psychotic Disorders (schizophrenia, schizoaffective)
  • Eating Disorders (anorexia, bulimia)
  • Personality Disorders (narcissistic, paranoia, histrionic) 
  • Behavioral Disorders (defiance, hyperactivity)

What are the Signs of CODs?

The signs and symptoms of CODs depend on a person’s life and socioeconomic circumstances, the types of substances they may be abusing, and the underlying mental-emotional disorders.

Some of the symptoms of CODs that can be seen in social and lifestyle behavior may include:

  • Seclusion
  • Thoughts or attempts of suicide
  • Overall aggressiveness
  • Extreme and unexplainable mood changes
  • Trouble with authority figures
  • Employment instability
  • Housing instability
  • Financial instability
  • Prostitution or sexual deviance
  • Resistance to hygiene and cleanliness
  • Difficulty focusing

One may take notice that many of the symptoms of CODs closely resemble those of addiction and substance abuse. Because of this, it can be hard to identify the source of the symptom—that is, whether the mental disorder triggers the substance abuse or vice versa. 

Professional treatment centers are acquainted with these complexities and are able to work with every type of person and their current condition. 

What Causes the Onset of CODs in Addiction and Substance Abuse? 

Environmental Factors: 

  • Stressful and traumatic situations (whether early in life or later) can often trigger an underlying psychological health disorder that was previously unexpressive. In the midst of this stress, it can make substance use and abuse more attractive.

Similar Brain Stimulation: 

  • The parts of the brain that regulate mood, stress, and reward systems may be unintentionally triggered by both or either substance abuse and mental-emotional disorders.

Exposure during Early Years:

  • In addition to hereditary or genetic predisposition, a person has a higher risk or substance abuse if they are exposed to drugs or alcohol at a young age. This exposure has the potential to effect the development of their brain and bodily response systems, as well as the development of psychological disorders.

Social Stigma: 

  • One of the greatest difficulties for those with mental disorders is the social associated with their conditions. They can be perceived as dangerous, innately broken, or sometimes even contagious. These harmful misunderstandings can cause fear and shame for those with CODs, which may lead them to isolate themselves and not seek help.

Incarceration Injustices:

  • Of the number of individuals convicted of possession and use of illegal substances and are incarcerated as a result, those with CODs have a much higher likelihood of being detained again within a six-year period. The failure of the criminal justice system to identify such cases results in an unending cycle without the individuals receiving the treatment they desperately need. 


  • People experiencing homelessness often have multiple CODs due to a number of factors. Moreover, they often have difficulty accessing healthcare because of distrust, financial limitation, and sometimes even the mental disorders themselves.


  • Veterans are at extremely high-risk for CODs including a combination of PTSD and anxiety disorders that often result in substance abuse or addiction. The difficulty of navigating the VA system can be a barrier to receiving help, as well as a distrust of institutions. 

How Does Someone Recover from CODs?

Professional treatment centers are the best place to start if you or someone you know is struggling with one or multiple CODs. A treatment center will first provide a dual-diagnosis, which involves treating any underlying causes of addiction (such as mental and emotional disorders) alongside the person’s substance abuse patterns. 

While detoxification is often emphasized as one of the main treatments at a recovery center, it is not adequate on its own to address addiction. The psychological background and traumatic events in a person’s life that drove them to that point are just as important in the process of healing. In-patient and out-patient care, as well as making a clear aftercare program, are key parts of walking the path of recovery from addiction and CODs.

To learn more about how to start your healing journey at Impact Recovery, get in touch with a member of our team here